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Robbins N, Harvey K, Moller MD. Emotional Freedom Techniques for Postpartum Depression, Perceived Stress, and Anxiety. Nurs Womens Health 2024; 28:41-49. [PMID: 38103574 DOI: 10.1016/j.nwh.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/10/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To examine the effect of an Emotional Freedom Techniques (EFT) group intervention on perceived stress, depression, and anxiety symptoms in women in the postpartum period. DESIGN A one-group pre- and posttest quasi-experimental design. SETTING/LOCAL PROBLEM Postpartum depression (PPD) and anxiety affect nearly one in five women in the first 12 months after childbirth. The COVID-19 pandemic was associated with a significant worsening of symptoms of PPD, stress, and anxiety in this population. Mental health screening is the standard of care in perinatal settings. This practice has led to an increased rate of PPD and anxiety diagnoses and the need for evidence-based nonpharmacologic interventions to support mothers with PPD and anxiety. PARTICIPANTS Eleven mothers seeking care for lactation concerns who screened positive for PPD and anxiety symptoms. INTERVENTION/MEASUREMENTS A total of eight 1-hour group EFT sessions were offered to participants over a period of 4 weeks. During the group sessions, participants were taught how to perform the steps of EFT and apply it in a supportive group format. Measurement tools included the Subjective Unit of Distress Scale, Edinburgh Postnatal Depression Scale, and Generalized Anxiety Disorder-7. The preintervention and postintervention scores of these tools were compared using a paired-samples t test. RESULTS After implementing EFT as a group intervention, we observed a reduction in mental health burden experienced by women in the postpartum period. There was a statistically significant decrease in depression (p = .003), anxiety (p <.001), and perceived stress (p <.001) scores 1 month after the EFT intervention. CONCLUSION These findings suggest that EFT may be a viable adjunctive intervention for managing depression, anxiety, and stress in the postpartum period. Further research with larger and more diverse samples is needed to confirm these findings.
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Hall SV, Zivin K, Piatt GA, Weaver A, Tilea A, Zhang X, Moyer CA. Factors associated with mental health treatment among Michigan medicaid enrollees with perinatal mood and anxiety disorders, 2012-2015. Gen Hosp Psychiatry 2023; 83:164-171. [PMID: 37210824 DOI: 10.1016/j.genhosppsych.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Perinatal mood and anxiety disorders (PMADs) represent the most prevalent pregnancy-related comorbidity and a leading cause of maternal mortality. Effective treatments exist, but remain underutilized. We sought to identify factors associated with receipt of prenatal and postpartum mental health treatment. METHODS This observational, cross-sectional analysis used self-reported survey data from the Michigan Pregnancy Risk Assessment Monitoring System linked to Michigan Medicaid administrative claims for births from 2012 to 2015. We used survey-weighted multinomial logistic regression to predict prescription medication and psychotherapy utilization among respondents with PMADs. RESULTS Only 28.0% of respondents with prenatal PMAD and 17.9% of respondents with postpartum PMAD received both prescription medication and psychotherapy. During pregnancy, Black respondents were 0.33 (95%CI: 0.13-0.85, p = 0.022) times less likely to receive both treatments while more comorbidities were associated with receipt of both treatments (adjRR = 1.31, 95%CI: 1.02-1.70, p = 0.036). In the first three months postpartum, respondents with four or more stressors were 6.52 times more likely to receive both treatments (95%CI: 1.62-26.24, p = 0.008) and those satisfied with prenatal care were 16.25 times more likely to receive both treatments (95%CI: 3.35-78.85, p = 0.001). DISCUSSION Race, comorbidities, and stress are critical factors in PMAD treatment. Satisfaction with perinatal healthcare may facilitate access to care.
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Affiliation(s)
- Stephanie V Hall
- University of Michigan, Department of Psychiatry, Ann Arbor, MI, USA; University of Michigan, Department of Learning Health Sciences, Ann Arbor, MI, USA.
| | - Kara Zivin
- University of Michigan, Department of Psychiatry, Ann Arbor, MI, USA; University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
| | - Gretchen A Piatt
- University of Michigan, Department of Learning Health Sciences, Ann Arbor, MI, USA
| | - Addie Weaver
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Anca Tilea
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
| | - Xiaosong Zhang
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
| | - Cheryl A Moyer
- University of Michigan, Department of Learning Health Sciences, Ann Arbor, MI, USA; University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA
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Liu S, Ding X, Belouali A, Bai H, Raja K, Kharrazi H. Assessing the Racial and Socioeconomic Disparities in Postpartum Depression Using Population-Level Hospital Discharge Data: Longitudinal Retrospective Study. JMIR Pediatr Parent 2022; 5:e38879. [PMID: 36103575 PMCID: PMC9623466 DOI: 10.2196/38879] [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: 04/19/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In the United States, >3.6 million deliveries occur annually. Among them, up to 20% (approximately 700,000) of women experience postpartum depression (PPD) according to the Centers for Disease Control and Prevention. Absence of accurate reporting and diagnosis has made phenotyping of patients with PPD difficult. Existing literature has shown that factors such as race, socioeconomic status, and history of substance abuse are associated with the differential risks of PPD. However, limited research has considered differential temporal associations with the outcome. OBJECTIVE This study aimed to estimate the disparities in the risk of PPD and time to diagnosis for patients of different racial and socioeconomic backgrounds. METHODS This is a longitudinal retrospective study using the statewide hospital discharge data from Maryland. We identified 160,066 individuals who had a hospital delivery from 2017 to 2019. We applied logistic regression and Cox regression to study the risk of PPD across racial and socioeconomic strata. Multinomial regression was used to estimate the risk of PPD at different postpartum stages. RESULTS The cumulative incidence of PPD diagnosis was highest for White patients (8779/65,028, 13.5%) and lowest for Asian and Pacific Islander patients (248/10,760, 2.3%). Compared with White patients, PPD diagnosis was less likely to occur for Black patients (odds ratio [OR] 0.31, 95% CI 0.30-0.33), Asian or Pacific Islander patients (OR 0.17, 95% CI 0.15-0.19), and Hispanic patients (OR 0.21, 95% CI 0.19-0.22). Similar findings were observed from the Cox regression analysis. Multinomial regression showed that compared with White patients, Black patients (relative risk 2.12, 95% CI 1.73-2.60) and Asian and Pacific Islander patients (relative risk 2.48, 95% CI 1.46-4.21) were more likely to be diagnosed with PPD after 8 weeks of delivery. CONCLUSIONS Compared with White patients, PPD diagnosis is less likely to occur in individuals of other races. We found disparate timing in PPD diagnosis across different racial groups and socioeconomic backgrounds. Our findings serve to enhance intervention strategies and policies for phenotyping patients at the highest risk of PPD and to highlight needs in data quality to support future work on racial disparities in PPD.
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Affiliation(s)
- Star Liu
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Xiyu Ding
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Anas Belouali
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Haibin Bai
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kanimozhi Raja
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hadi Kharrazi
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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Njoroge WFM, White LK, Waller R, Forkpa M, Himes MM, Morgan K, Seidlitz J, Chaiyachati BH, Barzilay R, Kornfield SL, Parish-Morris J, Rodriguez Y, Riis V, Burris HH, Elovitz MA, Gur RE. Association of COVID-19 and Endemic Systemic Racism With Postpartum Anxiety and Depression Among Black Birthing Individuals. JAMA Psychiatry 2022; 79:600-609. [PMID: 35416928 PMCID: PMC9008565 DOI: 10.1001/jamapsychiatry.2022.0597] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE The intersection of endemic structural racism and the global health crisis secondary to the COVID-19 pandemic represents a syndemic, defined as the aggregation of 2 or more endemic and epidemic conditions leading to adverse repercussions for health. Long-standing inequities have placed Black individuals at disproportionate risk for negative postpartum mental health outcomes. Studies are urgently needed to understand how the COVID-19 pandemic has added to this risk (eg, syndemic associations). OBJECTIVE To examine the association between the syndemic and the postpartum mental health of Black birthing individuals. DESIGN, SETTING, AND PARTICIPANTS A longitudinal cohort of Black birthing individuals were followed up from pregnancy (April 17 to July 8, 2020) through the early postpartum period (August 11, 2020, to March 2, 2021) from urban university medical center prenatal clinics. Pregnant Black participants were recruited via email and completed 2 online surveys. MAIN OUTCOMES AND MEASURES Composite variables capturing negative experiences of the COVID-19 pandemic and racism (structural racism [general], structural racism [neighborhood], and interpersonal racism) were created. Logistic regressions examined main and interactive associations between these variables and postpartum depression (Edinburgh Postnatal Depression Scale) and anxiety (Generalized Anxiety Disorder 7-item scale). RESULTS The mean (SD) age of 151 Black participants was 30.18 (5.65) years. The association between higher negative COVID-19 pandemic experiences and postpartum depression may be influenced by experiences of interpersonal racism and general systemic racism. Negative COVID-19 pandemic experiences were associated with greater likelihood of screening positive for depression only at higher levels of systemic racism (odds ratio, 2.52; 95% CI, 1.38-4.60) and interpersonal racism (odds ratio, 1.90; 95% CI, 1.04-3.48) but not at lower levels of systemic or interpersonal racism. Similarly, negative COVID-19 experiences were associated with anxiety only at higher levels of interpersonal racism (odds ratio, 1.85; 95% CI, 0.86-4.01) but not at lower levels of interpersonal racism. Overall, 44 (29%) met screening criteria for postpartum depression and 20 (13%) for postpartum anxiety. CONCLUSIONS AND RELEVANCE In this longitudinal cohort study of Black birthing individuals, the experience of the syndemic was associated with negative postpartum mental health. Associations between interpersonal racism, structural racism, and negative COVID-19 pandemic experiences were associated with greater risk for postpartum depression and anxiety. Research is needed to address how systemic racism perturbs biobehavioral pathways to magnify associations between acute stressors and mental health. Such research can inform the creation of effective, culturally informed preventive interventions to improve the postpartum mental health of Black individuals.
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Affiliation(s)
- Wanjikũ F. M. Njoroge
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Policy Lab, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia
| | - Lauren K. White
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia
| | - Rebecca Waller
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia,Department of Psychology, University of Pennsylvania, Philadelphia
| | - Markolline Forkpa
- Dornsife School of Public Health Drexel University, Philadelphia, Pennsylvania
| | - Megan M. Himes
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia
| | | | - Jakob Seidlitz
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia
| | - Barbara H. Chaiyachati
- Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia,Center for Pediatric Clinical Effectiveness, Division General Pediatrics, Children’s Hospital Philadelphia, Philadelphia, Pennsylvania,Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ran Barzilay
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia
| | - Sara L. Kornfield
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Penn Center for Women’s Behavioral Wellness, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Parish-Morris
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Valerie Riis
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather H. Burris
- Center for Pediatric Clinical Effectiveness, Division General Pediatrics, Children’s Hospital Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michal A. Elovitz
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raquel E. Gur
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Lifespan Brain Institute, Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania, Philadelphia
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