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Fonseca A, Branquinho M, Monteiro F, Araújo-Pedrosa A, Bjørndal LD, Lupattelli A. Treatment options and their uptake among women with symptoms of perinatal depression: exploratory study in Norway and Portugal. BJPsych Open 2023; 9:e77. [PMID: 37139793 DOI: 10.1192/bjo.2023.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Perinatal depression is the most undertreated clinical condition during the perinatal period. Knowledge about women's decision-making in seeking and receiving treatment is scarce. AIMS To investigate and compare treatment option uptake in perinatal women with depressive symptoms in Portugal and Norway, and to identify sociodemographic and health-related factors associated with treatment uptake. METHOD Participants were women resident in Portugal or Norway (≥18 years) who were pregnant or had given birth in the past 12 months, who presented with active depressive symptoms (Edinburgh Postnatal Depression Scale score ≥10). In an electronic questionnaire, women reported treatment received and sociodemographic and health-related factors. RESULTS The sample included 416 women from Portugal and 169 from Norway, of which 79.8% and 53.9%, respectively, were not receiving any treatment. Most Portuguese women were receiving psychological treatment, either alone (45.2%) or combined with pharmacological treatment (21.4%). Most Norwegian participants were receiving only pharmacological (36.5%) or combined treatment (35.4%). Compared with the Portuguese sample, a higher proportion of Norwegian women started treatment before pregnancy (P < 0.001). In Portugal, lower depressive symptoms and self-reported psychopathology were significantly associated with higher likelihood of receiving treatment. CONCLUSIONS We found that, in both Norway and Portugal, a substantial number of perinatal women with depressive symptoms do not receive any treatment. Differences exist regarding the chosen treatment option and timing of treatment initiation in the two countries. Only mental health-related factors were associated with treatment uptake for perinatal depression in Portugal. Our results highlight the importance of implementing strategies aimed to improve help-seeking behaviours.
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Affiliation(s)
- Ana Fonseca
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Mariana Branquinho
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Portugal
| | - Fabiana Monteiro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Anabela Araújo-Pedrosa
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal; and Clinical Psychology Service, Department of Gynaecology, Obstetrics, Reproduction and Neonatology (Maternity Daniel de Matos), Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Ludvig D Bjørndal
- PROMENTA Research Center, Department of Psychology, University of Oslo, Norway
| | - Angela Lupattelli
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Norway
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Carona C, Pereira M, Araújo-Pedrosa A, Canavarro MC, Fonseca A. The Efficacy of Be a Mom, a Web-Based Intervention to Prevent Postpartum Depression: Examining Mechanisms of Change in a Randomized Controlled Trial. JMIR Ment Health 2023; 10:e39253. [PMID: 36930182 PMCID: PMC10139682 DOI: 10.2196/39253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 12/16/2022] [Accepted: 01/03/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Postpartum depression (PPD) is treatable and preventable, but most women do not seek professional help for their perinatal depressive symptoms. One increasingly popular approach of improving access to care is the use of web-based intervention programs. OBJECTIVE The objective of this study was 2-fold: first, to assess the efficacy of Be a Mom, a brief web-based selective or indicated preventive intervention, in reducing depressive and anxiety symptoms of women at high risk for PPD; and second, to examine mechanisms of change linking modifiable self-regulatory skills (ie, emotion regulation, self-compassion, and psychological flexibility) to improved perinatal mental health outcomes. METHODS This 2-arm, open-label randomized controlled trial involved a sample of 1053 perinatal women presenting high risk for PPD who were allocated to the Be a Mom intervention group or a waitlist control group and completed self-report measures at baseline and postintervention assessments. Univariate latent change score models were computed to determine changes over time in adjustment processes and outcomes, with a multigroup-model approach to detect differences between the intervention and control groups and a 2-wave latent change score model to examine whether changes in processes were related to changes in outcomes. RESULTS Be a Mom was found to be effective in reducing depressive (intervention group: µΔ=-3.35; P<.001 vs control group: µΔ=-1.48; P<.001) and anxiety symptoms (intervention group: µΔ=-2.24; P<.001 vs control group: µΔ=-0.43; P=.04) in comparison with the control group, where such changes were inexistent or much smaller. All 3 psychological processes under study improved statistically significantly in posttreatment assessments: emotion regulation ability (Δχ23=12.3; P=.007) and psychological flexibility (Δχ23=34.9; P<.001) improved only in the intervention group, and although self-compassion increased in both groups (Δχ23=65.6; P<.001), these improvements were considerably greater in the intervention group. CONCLUSIONS These results suggest that Be a Mom, a low-intensity cognitive behavioral therapy program, is a promising first-line intervention for helping perinatal women, particularly those with early-onset PPD symptoms. TRIAL REGISTRATION ClinicalTrials.gov NCT03024645; https://clinicaltrials.gov/ct2/show/NCT03024645.
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Affiliation(s)
- Carlos Carona
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Marco Pereira
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Anabela Araújo-Pedrosa
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, University of Coimbra, Coimbra, Portugal.,Obstetrics Unit A, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, University of Coimbra, Coimbra, Portugal
| | - Ana Fonseca
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, University of Coimbra, Coimbra, Portugal
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Carona C, Xavier S, Araújo-Pedrosa A, Canavarro MC, Fonseca A. Mental health profiles of women at high-risk for postpartum depression: a latent profile analysis. International Journal of Mental Health 2023. [DOI: 10.1080/00207411.2022.2163352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Carlos Carona
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Sandra Xavier
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Anabela Araújo-Pedrosa
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Clinical Psychology Service, Department of Gynecology, Obstetrics, Reproduction and Neonatology (Maternity Daniel de Matos), Coimbra Hospital and University Centre, Rua Miguel Torga, Coimbra, Portugal
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Ana Fonseca
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Monteiro F, Fernandes DV, Pires R, Moreira H, Melo C, Araújo-Pedrosa A. Exploring factors associated with complete mental health of pregnant women during the COVID-19 pandemic. Midwifery 2023; 116:103521. [PMID: 36288676 PMCID: PMC9578971 DOI: 10.1016/j.midw.2022.103521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/06/2022] [Accepted: 10/17/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore a wide range of factors associated with complete mental health (i.e., positive mental health - the presence of flourishing, and the absence of mental illness - depressive and anxious symptoms) among Portuguese pregnant women, during the COVID-19 pandemic. DESIGN Quantitative cross-sectional study. SETTING Data were collected through an online survey placed on social media websites targeting pregnant Portuguese adult women between October 2020 and April 2021. PARTICIPANTS The sample comprised 207 pregnant women. RESULTS A multivariate logistic regression model showed that higher levels of self-compassion and higher engagement in mindful self-care practices increased the likelihood of reporting complete mental health during pregnancy. CONCLUSIONS Promoting self-compassion and mindful self-care may be particularly important in pregnant women, as these psychological factors appear to contribute to complete mental health during COVID-19 pandemic. IMPLICATIONS FOR PRACTICE The COVID-19 pandemic represented a demanding period for pregnant women. Our findings highlight that targeting the promotion of self-compassion and mindful self-care practices during stressful periods could significantly contribute to their overall mental health.
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Affiliation(s)
- Fabiana Monteiro
- University of Coimbra, Centre for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, Coimbra 3000-115, Portugal,Corresponding author
| | - Daniela V. Fernandes
- University of Coimbra, Centre for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, Coimbra 3000-115, Portugal
| | - Raquel Pires
- University of Coimbra, Centre for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, Coimbra 3000-115, Portugal
| | - Helena Moreira
- University of Coimbra, Centre for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, Coimbra 3000-115, Portugal
| | - Claúdia Melo
- University of Coimbra, Centre for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, Coimbra 3000-115, Portugal
| | - Anabela Araújo-Pedrosa
- University of Coimbra, Centre for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, Rua do Colégio Novo, Coimbra 3000-115, Portugal,Clinical Psychology Service and Department of Gynecology, Obstetrics, Reproduction and Neonatology, Centro Hospitalar e Universitário de Coimbra, Portugal
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Xavier S, Branquinho M, Pires R, Moreira H, Coelho M, Araújo-Pedrosa A. Dysfunctional Attitudes Toward Motherhood and Depressive Symptoms in Portuguese Pregnant Women During COVID-19 Pandemic: the Mediating Roles of Self-Compassion and Mindful Self-Care. Mindfulness (N Y) 2023; 14:418-428. [PMID: 36597485 PMCID: PMC9798940 DOI: 10.1007/s12671-022-02049-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/31/2022]
Abstract
Objectives There is evidence that the coronavirus disease 2019 (COVID-19) pandemic had a negative impact on the mental health of pregnant women, such as an increase in the prevalence of depression. Given the negative consequences that depressive symptoms can pose for pregnant women, it is crucial to understand how cognitive processes influence women's depressive symptoms during the COVID-19 pandemic among this specific vulnerable population. The present study aimed to examine the relationship between pregnant women's dysfunctional attitudes toward motherhood and their depressive symptoms, considering the mediating roles of self-compassion and mindful self-care. Method A cross-sectional online survey was conducted in Portugal between October 2020 and April 2021. A sample of 244 pregnant women answered a set of questionnaires to assess dysfunctional attitudes toward motherhood, depressive symptoms, self-compassion, and mindful self-care. Results More dysfunctional attitudes toward motherhood were associated with higher levels of depressive symptoms, and this relation was mediated through self-compassion and mindful self-care. Conclusions These results highlight that self-compassion and mindful self-care are important psychological mechanisms and the importance of considering them in psychological interventions to prevent and/or treat depressive symptoms in pregnant women with dysfunctional attitudes toward motherhood during stressful events such as a pandemic.
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Affiliation(s)
- Sandra Xavier
- grid.8051.c0000 0000 9511 4342Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Mariana Branquinho
- grid.8051.c0000 0000 9511 4342Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Raquel Pires
- grid.8051.c0000 0000 9511 4342Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Helena Moreira
- grid.8051.c0000 0000 9511 4342Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Maria Coelho
- grid.8051.c0000 0000 9511 4342Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Anabela Araújo-Pedrosa
- grid.8051.c0000 0000 9511 4342Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
- grid.28911.330000000106861985Clinical Psychology Service & Department of Gynecology, Obstetrics, Reproduction and Neonatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Pires R, Araújo-Pedrosa A, Pereira J, Canavarro MC. How Can Unintended Pregnancies Be Prevented among Adolescents Who Engaged in Sexual Intercourse at Earlier Ages? The Role of Female Education and Partner Age Difference. Int J Environ Res Public Health 2021; 18:10631. [PMID: 34682377 PMCID: PMC8535923 DOI: 10.3390/ijerph182010631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/27/2021] [Accepted: 10/07/2021] [Indexed: 11/25/2022]
Abstract
Several studies have identified explicative factors for adolescents' sexual risk behaviors and related outcomes such as unintended pregnancy; however, less is known about the mechanisms through which such factors act. Our study explored the role of female education and partner age difference as explicative mechanisms of the association between age at first sexual intercourse (AFSI) and unintended pregnancy while controlling for the role of other contextual factors (i.e., socioeconomic status, ethnicity, religious beliefs, and place of residence) and sexual-related mechanisms (i.e., number of sexual partners) that are known to be associated with adolescent pregnancy. The sample consisted of 613 sexually experienced female adolescents who did not intend to become pregnant: 349 were pregnant for the first time, and 264 had never been pregnant. Mediation and moderation analyses were performed. An earlier AFSI was associated with unintended pregnancy 1-6 years after first sexual intercourse by increasing the adolescents' likelihood of having less education and being involved with partners older than themselves. There was no significant direct effect of AFSI on pregnancy occurrence after controlling for the mediators. Our findings bring to light nonsexual mechanisms that must be considered in public health interventions aimed at preventing unintended pregnancies among adolescents who engaged in sexual intercourse at early ages. Specific implications are discussed.
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Affiliation(s)
- Raquel Pires
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, 3000-115 Coimbra, Portugal; (A.A.-P.); (J.P.); (M.C.C.)
| | - Anabela Araújo-Pedrosa
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, 3000-115 Coimbra, Portugal; (A.A.-P.); (J.P.); (M.C.C.)
- Clinical Psychology Service Centro Hospitalar e Universitário de Coimbra, 3030-165 Coimbra, Portugal
| | - Joana Pereira
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, 3000-115 Coimbra, Portugal; (A.A.-P.); (J.P.); (M.C.C.)
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, 3000-115 Coimbra, Portugal; (A.A.-P.); (J.P.); (M.C.C.)
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Fonseca A, Pereira M, Araújo-Pedrosa A, Gorayeb R, Ramos MM, Canavarro MC. Be a Mom: Formative Evaluation of a Web-Based Psychological Intervention to Prevent Postpartum Depression. Cognitive and Behavioral Practice 2018. [DOI: 10.1016/j.cbpra.2018.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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