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Gorman LL, O'Hara MW, Figueiredo B, Hayes S, Jacquemain F, Kammerer MH, Klier CM, Rosi S, Seneviratne G, Sutter-Dallay AL. Adaptation of the Structured Clinical Interview for DSM-IV Disorders for assessing depression in women during pregnancy and post-partum across countries and cultures. Br J Psychiatry 2018; 46:s17-23. [PMID: 14754814 DOI: 10.1192/bjp.184.46.s17] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BackgroundTo date, no study has used standardised diagnostic assessment procedures to determine whether rates of perinatal depression vary across cultures.AimsTo adapt the Structured Clinical Interview for DSM–IV Disorders (SCID) for assessing depression and other non-psychotic psychiatric illness perinatally and to pilot the instrument in different centres and cultures.MethodAssessments using the adapted SCID and the Edinburgh Postnatal Depression Scale were conducted during the third trimester of pregnancy and at 6 months postpartum with 296 women from ten sites in eight countries. Point prevalence rates during pregnancy and the postnatal period and adjusted 6-month period prevalence rates were computed for caseness, depression and major depression.ResultsThe third trimester and 6-month point prevalence rates for perinatal depression were 6.9% and 8.0%, respectively. Postnatal 6-month period prevalence rates for perinatal depression ranged from 2.1% to 31.6% across centres and there were significant differences in these rates between centres.ConclusionsStudy findings suggest that the SCID was successfully adapted for this context. Further research on determinants of differences inprevalence of depression across cultures isneeded.
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LaCoursiere DY, Barrett-Connor E, O'Hara MW, Hutton A, Varner MW. The association between prepregnancy obesity and screening positive for postpartum depression. BJOG 2010; 117:1011-8. [PMID: 20536433 DOI: 10.1111/j.1471-0528.2010.02569.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the association between reported prepregnancy body mass index (BMI) and screening positive for depression. DESIGN Cohort study. SETTING Four urban hospitals in Utah, USA. POPULATION Women delivering a term, singleton, live-born infant at one of four urban hospitals in Utah in the period 2005-2007. METHODS Women were enrolled immediately postpartum. Demographic, anthropometric, stressors, psychiatric, and medical/obstetric and family-history data were obtained. Prepregnancy height, weight, and pregnancy weight gain were self-reported. The primary exposure variable, prepregnancy BMI, was calculated. Women were stratified into the six World Health Organization BMI categories (underweight, normal weight, pre-obese, or obese class 1-3). MAIN OUTCOME MEASURE At 6-8 weeks postpartum, women were screened for depression using the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome measure was a prespecified EPDS score of > or =12. RESULTS Among the 1053 women studied, 14.4% of normal weight women screened positive for postpartum depression. This proportion was greater in women classed as underweight (18.0%, n = 11), pre-obese (18.5%, n = 38), obese class 1 (18.8%, n = 16), obese class 2 (32.4%, n = 11), and obese class 3 (40.0%, n = 8) (P < 0.01). Controlling for demographic, psychological, and medical/obstetric factors, prepregnancy class-2 (aOR 2.87, 95% CI 1.21-6.81) and class-3 (aOR 3.94, 95% CI 1.38-11.23) obesity remained strongly associated with screening positive for postpartum depression, compared with women of normal weight. CONCLUSIONS Self-reported prepregnancy obesity may be associated with screening positive for depression when measured postpartum.
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Pearlstein TB, Zlotnick C, Battle CL, Stuart S, O'Hara MW, Price AB, Grause MA, Howard M. Patient choice of treatment for postpartum depression: a pilot study. Arch Womens Ment Health 2006; 9:303-8. [PMID: 16932988 DOI: 10.1007/s00737-006-0145-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 07/19/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The lack of systematic efficacy research makes the selection of optimal treatment for postpartum depression (PPD) difficult. Moreover, the treatment decisions for women with PPD who are breastfeeding are heavily influenced by their concerns about infant exposure to antidepressant medication. The objective of this pilot trial was to examine the clinical characteristics of women with PPD associated with treatment selection. METHOD This open pilot trial offered 23 women with PPD one of 3 treatment options: sertraline, interpersonal psychotherapy (IPT), or their combination administered in an outpatient mental health setting over 12 weeks. Baseline and treatment outcome measures included the Hamilton Rating Scale for Depression (HRSD), the Beck Depression Inventory (BDI) and the Edinburgh Postnatal Depression Scale (EPDS). RESULTS Completers across all 3 treatment groups (n = 18) experienced significant clinical improvement with each of the 3 treatment modalities on the HRSD (p < 0.001), BDI (p < 0.001) and EPDS (p < 0.001). There were trends for women with a prior depression to more frequently choose sertraline as a treatment (alone or with IPT, p = 0.07), and for women who were breastfeeding to choose sertraline (alone or with IPT, p = 0.10) less frequently. CONCLUSION In this small sample of women with PPD, most women chose IPT with or without sertraline. A larger randomized study could further confirm the suggested predictors of treatment selection identified in this study: previous depression and breastfeeding status.
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O'Hara MW. Festschrift in honor of Professor Ian F. Brockington. Arch Womens Ment Health 2006; 9:229-31. [PMID: 16937311 DOI: 10.1007/s00737-006-0151-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2006] [Accepted: 07/31/2006] [Indexed: 10/24/2022]
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Moran TE, O'Hara MW. A partner-rating scale of postpartum depression: the Edinburgh Postnatal Depression Scale - Partner (EPDS-P). Arch Womens Ment Health 2006; 9:173-80. [PMID: 16755331 DOI: 10.1007/s00737-006-0136-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2005] [Accepted: 04/21/2006] [Indexed: 10/24/2022]
Abstract
Partners could be useful as informants of postpartum women's depressive symptoms; however, currently no partner-ratings exist. The Edinburgh Postnatal Depression Scale - Partner (EPDS-P) is a 10-item measure adapted from the Edinburgh Postnatal Depression Scale (EPDS). The EPDS-P is expected to converge with the EPDS and other measures of depressive symptoms and to demonstrate incremental validity in the prediction of depressive symptoms. 101 women and their partners completed multiple measures of depressive symptoms during the first six weeks postpartum. Initial results suggest adequate reliability and validity for the EPDS-P. The EPDS-P showed moderate convergent correlations with other depression measures. Longitudinal correlations showed a link between the two-week EPDS-P and the six-week EPDS. The EPDS-P demonstrated incremental validity over and above the EPDS. Results supported the use of the EPDS-P as a valid partner-rating scale. The findings confirm that partners of postpartum women are valuable resources when assessing depressive symptoms.
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Stuart S, O'Hara MW, Gorman LL. The prevention and psychotherapeutic treatment of postpartum depression. Arch Womens Ment Health 2003; 6 Suppl 2:S57-69. [PMID: 14615924 DOI: 10.1007/s00737-003-0003-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The efficacy of psychotherapeutic interventions for the acute treatment of postpartum depression is strongly supported by empirical data, which suggest that counseling is of benefit as a stand-alone treatment for postpartum depression. Given the paucity of treatment trials using medication for postpartum depression, and the fact that psychotherapeutic interventions do not confer any "exposure" risks to breastfeeding infants, the data also suggest that psychotherapy should be considered a first-line treatment, rather than as an adjunct to medication treatment. There is also some data supporting the use of psychotherapy as a means of preventing postpartum depression, though research is still needed regarding the type of interventions to be used and the types of patients towards whom the interventions should be directed.
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O'Hara MW, Stuart S, Gorman LL, Wenzel A. Efficacy of interpersonal psychotherapy for postpartum depression. ARCHIVES OF GENERAL PSYCHIATRY 2000; 57:1039-45. [PMID: 11074869 DOI: 10.1001/archpsyc.57.11.1039] [Citation(s) in RCA: 371] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Postpartum depression causes women great suffering and has negative consequences for their social relationships and for the development of their infants. Research is needed to evaluate the efficacy of psychotherapy for postpartum depression. METHODS A total of 120 postpartum women meeting DSM-IV criteria for major depression were recruited from the community and randomly assigned to 12 weeks of interpersonal psychotherapy (IPT) or to a waiting list condition (WLC) control group. Subjects completed interview and self-report assessments of depressive symptoms and social adjustment every 4 weeks. RESULTS Ninety-nine of the 120 patients completed the protocol. Hamilton Rating Scale for Depression (HRSD) scores of women receiving IPT declined from 19.4 to 8.3, a significantly greater decrease than occurred in the WLC group (19.8 to 16.8). The Beck Depression Inventory (BDI) scores of women who received IPT declined from 23.6 to 10.6 over 12 weeks, a significantly greater decrease than occurred in the WLC group (23.0 to 19.2). A significantly greater proportion of women who received IPT recovered from their depressive episode based on HRSD scores of 6 or lower (37. 5%) and BDI scores of 9 or lower (43.8%) compared with women in the WLC group (13.7% and 13.7%, respectively). Women receiving IPT also had significant improvement on the Postpartum Adjustment Questionnaire and the Social Adjustment Scale-Self-Report relative to women in the WLC group. CONCLUSIONS These findings suggest that IPT is an efficacious treatment for postpartum depression. Interpersonal psychotherapy reduced depressive symptoms and improved social adjustment, and represents an alternative to pharmacotherapy, particularly for women who are breastfeeding.
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Stuart S, O'Hara MW, Blehar MC. Mental disorders associated with childbearing: report of the Biennial Meeting of the Marcé Society. PSYCHOPHARMACOLOGY BULLETIN 1998; 34:333-8. [PMID: 9803766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
This article presents highlights from an international conference focused on mental disorders in association with childbearing. Findings from related research on diagnosis, classification, epidemiology, child outcome, prevention, and treatment are summarized. A need is seen for more research on prevention of childbearing disorders, on the effectiveness of interventions in reducing maternal and child morbidity, on the development of new psychosocial interventions, and on the assessment of the efficacy and safety of somatic treatments in pregnant and lactating women. Mental disorders associated with childbearing are a significant public health problem. Antenatal and postpartum mental disorders are not only associated with morbidity and mortality in affected women, but also with increased morbidity in their children. Despite their prevalence, they are often not recognized by primary care providers, and are hence undertreated. Moreover, physicians are reluctant to treat women with medication during pregnancy and the postpartum for fear of adverse effects on the fetus and the breastfeeding newborn. Little information is available to inform clinicians about the relative risks and benefits of pharmacological treatments. Psychosocial interventions for mental disorders associated with childbearing have not been widely investigated, leaving few options for treatment. The Biennial Meeting of the Marcé Society was convened in Iowa City, Iowa, from June 24 to June 28, 1998. The meeting was jointly sponsored by the University of Iowa Department of Psychology, the Colleges of Medicine and Nursing, Postpartum Support International, and by the National Institute of Mental Health, Division of Mental Disorders, Behavioral Research, and AIDS. The Marcé Society is a multi-disciplinary organization that aims to improve the understanding, prevention, and treatment of mental illnesses related to childbearing. International and U.S. participants met to present new research on the epidemiology, identification, and treatments for childbearing women with mental disorders. Highlights of the meeting are summarized below.
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Stuart S, Couser G, Schilder K, O'Hara MW, Gorman L. Postpartum anxiety and depression: onset and comorbidity in a community sample. J Nerv Ment Dis 1998; 186:420-4. [PMID: 9680043 DOI: 10.1097/00005053-199807000-00006] [Citation(s) in RCA: 159] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A community-based sample of 107 women completed the Beck Anxiety Inventory, Beck Depression Inventory, State-Trait Anxiety Inventory, and Edinburgh Postnatal Depression Scale at 14 weeks postpartum and at 30 weeks postpartum. The point prevalence of anxiety was 8.7% at 14 weeks and 16.8% at 30 weeks postpartum. The point prevalence of depression was 23.3% at 14 weeks and 18.7% at 30 weeks postpartum. The incidence of anxiety during this time period was 10.28%, and the incidence of depression was 7.48%, indicating high incidences of both postpartum anxiety and depression later in the postpartum period. The Edinburgh Postnatal Depression Scale was found to have a strong correlation with the State Anxiety Scale of the State-Trait Anxiety Inventory (r = .73 at 14 weeks, r = .82 at 30 weeks), suggesting that the Edinburgh Postnatal Depression Scale may be a good screening instrument for anxiety as well as depression.
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Foertsch CE, O'Hara MW, Stoddard FJ, Kealey GP. Treatment-resistant pain and distress during pediatric burn-dressing changes. THE JOURNAL OF BURN CARE & REHABILITATION 1998; 19:219-24. [PMID: 9622466 DOI: 10.1097/00004630-199805000-00007] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recent research has suggested some efficacy for the use of hypnosis in the control of pain and distress in a pediatric population undergoing painful medical procedures. Here, we study a sample (N=23) of pediatric subjects undergoing burn-dressing changes and receiving either an imagery-based or control (social-support) treatment. Subjects' levels of distress were assessed with the Observational Scale of Behavioral Distress. Results indicated that distress behaviors in this population can be measured reliably using this scale. However, no support was found for the main hypothesis that imagery treatment would be superior to control treatment in the alleviation of distress, nor were these treatments effective in comparison to baseline conditions. We discuss the formidable problem that burn and dressing-change pain presents, as well as the reasons why this treatment attempt might have failed to have the predicted effects. We also discuss important developmental considerations regarding the adequate assessment of pain and distress.
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Swain AM, O'Hara MW, Starr KR, Gorman LL. A prospective study of sleep, mood, and cognitive function in postpartum and nonpostpartum women. Obstet Gynecol 1997; 90:381-6. [PMID: 9277648 DOI: 10.1016/s0029-7844(97)89252-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the sleep patterns, mood states, and cognitive functioning of primiparous mothers during the first 3 weeks postpartum with those of a control group of nonpostpartum women and to assess the relationships among these variables. METHODS For the first 3 weeks postpartum, 30 primiparous women and 28 nonpostpartum mothers completed daily assessments of mood and recorded multiple aspects of sleep including time of retiring, occurrence and duration of sleep interruption, time of awakening, and morning alertness. Objective measures of memory, attention/concentration, and psychomotor performance were obtained on three occasions. RESULTS Postpartum women reported more evening awakenings, more time awake after retiring, and more naps than controls, but overall sleep time was similar. New mothers experienced a higher level of dysphoric mood during the first week than nonpostpartum controls; however, controlling for the effect for "time awake" at night eliminated the significant effect for dysphoric mood. Few differences were observed on the multiple assessments of cognitive function; however, performances of new mothers on memory and psychomotor tasks were likely to be influenced by sleep loss. CONCLUSION Women must make important adjustments in their sleep patterns during the postpartum period. In the study group, these adjustments were largely successful, particularly after the first week postpartum, in avoiding the negative consequences of sleep disturbances such as dysphoric mood and impaired cognitive function. Nevertheless, the significant associations between sleep indices and mood and objective measures of cognitive function point to the importance of encouraging appropriate amounts of sleep for recently delivered women.
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Foertsch CE, O'Hara MW, Stoddard FJ, Kealey GP. Parent participation during burn debridement in relation to behavioral distress. THE JOURNAL OF BURN CARE & REHABILITATION 1996; 17:372-7; discussion 371. [PMID: 8844360 DOI: 10.1097/00004630-199607000-00016] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The data on the benefits of parent participation during pediatric medical procedures are mixed. Although a wealth of clinical experience and survey data strongly recommend parent participation in a child's medical care, the mere presence of a parent, particularly during medical procedures, may be insufficient to decrease behavioral distress. This study examined a sample of children aged 3 through 12 undergoing three successive burn dressing changes. For some sessions, parents were present, and for others, they were not. A valid and reliable measure of behavioral distress was taken, as was an informal measure of the level of parent participation. Results indicated no differences between mothers and fathers in the level or the nature of participation, little change in the level of participation across time, and higher levels of physical comforting than verbal comforting. Results also indicated higher levels of behavioral distress in subjects when parents were present versus when absent, which extends previous findings. Results are discussed in terms of the literature on parent and child preferences for parent involvement and parent coaching programs.
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O'Hara MW, Gorman LL, Wright EJ. Description and evaluation of the Iowa Depression Awareness, Recognition, and Treatment Program. Am J Psychiatry 1996; 153:645-9. [PMID: 8615409 DOI: 10.1176/ajp.153.5.645] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The National Institute of Mental Health developed the Depression Awareness, Recognition, and Treatment Program to provide up-to-date information and training to health, mental health, and social service professionals regarding the identification and treatment of depression. This study was undertaken to evaluate a series of these programs for professionals who provide services to rural residents in the Midwest. METHOD The 18 2-day training programs were attended by a total of 1,221 participants, physicians, psychologists, social workers, and nurses. Participants' knowledge regarding depression was assessed both before and after each program. Practice characteristics and perceived ability to assess and treat depression were assessed. Finally, 6-month follow-up evaluations of the usefulness of the training to the participants were undertaken. RESULTS Following the programs, participants evidenced significant increases in levels of knowledge of depression and a high degree of satisfaction with most elements of the program. Six-month follow-up evaluations indicated a continued positive evaluation of the program. CONCLUSIONS These outcomes suggest that the goals of the Depression Awareness, Recognition, and Treatment Program were met and provide support for the wider dissemination of these training programs.
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Foertsch CE, O'Hara MW, Kealey GP, Foster LD, Schumacher EA. A quasi-experimental, dual-center study of morphine efficacy in patients with burns. THE JOURNAL OF BURN CARE & REHABILITATION 1995; 16:118-26. [PMID: 7775504 DOI: 10.1097/00004630-199503000-00005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The efficacy of morphine sulfate for the relief of pain and anxiety in patients with burns was investigated in a quasiexperimental, dual-center study. More than 100 patients at two burn centers in Iowa were studied. One of the units used no morphine or morphine derivatives for the control of pain (the no-morphine unit), and the other used moderate to high doses of morphine for the relief of pain (the morphine unit). Patients were asked to rate their pain and anxiety after hydrotherapy and at rest in the afternoon on a daily basis throughout their stays. Side effects were also measured, and nurses made ratings of the patients' pain and anxiety during morning hydrotherapy. Results indicated that pain and anxiety decreased significantly from hydrotherapy to afternoon assessments and decreased significantly during the patient's hospital stay. Unexpectedly, however, patients at the no-morphine unit consistently reported lower levels of pain and anxiety than did patients at the morphine unit. These results could not be explained by differences in burn size or number of surgeries across units. Other possible explanations are offered.
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Stuart S, O'Hara MW. Treatment of postpartum depression with interpersonal psychotherapy. ARCHIVES OF GENERAL PSYCHIATRY 1995; 52:75-6. [PMID: 7811164 DOI: 10.1001/archpsyc.1995.03950130075009] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Stuart S, O'Hara MW. Interpersonal psychotherapy for postpartum depression : a treatment program. THE JOURNAL OF PSYCHOTHERAPY PRACTICE AND RESEARCH 1995; 4:18-29. [PMID: 22700210 PMCID: PMC3330386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/18/1994] [Revised: 06/09/1994] [Accepted: 06/22/1994] [Indexed: 06/01/2023]
Abstract
Postpartum depression is a frequent complication of childbirth. Postpartum depression is associated with disruptions in interpersonal relationships, and the puerperium is a period of major role transition. In contrast to other subtypes of depression, however, postpartum depression often is not treated with medication, which is relatively contraindicated for women who are breastfeeding. Interpersonal psychotherapy (IPT) focuses specifically on the effects of depression on interpersonal functioning; this focus renders IPT a potentially useful psychosocial treatment for postpartum depression. The authors describe the use of IPT for the treatment of women with postpartum depression and present preliminary results from an open treatment trial of IPT.
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Walling MK, O'Hara MW, Reiter RC, Milburn AK, Lilly G, Vincent SD. Abuse history and chronic pain in women: II. A multivariate analysis of abuse and psychological morbidity. Obstet Gynecol 1994; 84:200-6. [PMID: 8041530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To assess the potential role of childhood and adulthood physical and sexual abuse and complaints of chronic pain in accounting for psychiatric symptomatology in adult women. METHODS We assessed sexual abuse, physical abuse, depression, anxiety, and somatization in 64 women with chronic pelvic pain, 42 women with chronic headache, and 46 women without chronic pain complaints. Using multiple regression analyses, we tested a model comprising sociodemographic, chronic pain, childhood sexual abuse and physical abuse, and adulthood sexual abuse and physical abuse variables in the prediction of depression, anxiety and somatization. RESULTS This model significantly predicted all three outcomes. However, childhood sexual abuse was not significant in the prediction of any of the outcome variables, whereas childhood physical abuse was significant in the prediction of all three. Further, the adulthood abuse variable set contributed significantly to the prediction of somatization, and the individual variable of adulthood sexual abuse was predictive of anxiety. CONCLUSIONS The relation observed between childhood sexual abuse and the outcomes of depression, anxiety, and somatization in women may be a function of its association with other forms of abuse, particularly childhood physical abuse. Further investigation is clearly needed of the nature of the relations between the various categories of abuse and psychological morbidity.
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Walling MK, Reiter RC, O'Hara MW, Milburn AK, Lilly G, Vincent SD. Abuse history and chronic pain in women: I. Prevalences of sexual abuse and physical abuse. Obstet Gynecol 1994; 84:193-9. [PMID: 8041529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To compare the prevalences of childhood and adult physical and sexual abuse in women with chronic pelvic pain to those in women with chronic nonpelvic pain (headache) and pain-free women. METHODS Using a structured interview, we assessed the prevalence rates of both sexual abuse and physical abuse in 64 women with chronic pelvic pain, 42 women with chronic headache, and 46 pain-free women. Abuse histories were stratified by age at occurrence and severity. Demographic characteristics of the three groups were also assessed. RESULTS Women with chronic pelvic pain were found to have a higher lifetime prevalence of sexual abuse, involving penetration or other contact with the unclothed genitals or anus (ie, major sexual abuse), than either comparison group. Further, more women in the chronic pelvic pain group had experienced major sexual abuse in both childhood and adulthood than women in the headache group, but there was no difference with the pain-free group. With respect to physical abuse, women in the chronic pelvic pain group had a higher lifetime prevalence than pain-free women, but not compared to those with chronic headache. In addition, more women with chronic pelvic pain reported physical abuse in both childhood and adulthood and both major sexual abuse and physical abuse at some time in their lives than did either comparison group. CONCLUSIONS These results support a specific association between major sexual abuse and chronic pelvic pain and a more general association between physical abuse and chronic pain. Moreover, the global nature of the abuse histories of the women in the chronic pelvic pain group suggests that more rigorous studies of the relation between abuse history and chronic pelvic pain are needed.
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Scott L, O'Hara MW. Self-discrepancies in clinically anxious and depressed university students. JOURNAL OF ABNORMAL PSYCHOLOGY 1993. [PMID: 8315140 DOI: 10.1037//0021-843x.102.2.282] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Self-discrepancy theory proposes that anxiety and depression are the result of different types of conflicting self-beliefs. This study examined self-discrepancies in four groups of university students who completed a questionnaire assessing levels of self-discrepancy and were characterized by the following disorders: (a) depression, (b) anxiety, (c) both anxiety and depression, or (d) no psychiatric disorder. As predicted, subjects with anxiety or depressive disorders had higher levels of self-discrepancy than normal subjects. Depressive subjects had higher levels of actual:ideal discrepancies than nondepressive subjects. Anxious subjects (with or without depressive disorders) had higher levels of actual:ought discrepancies than nonanxious subjects (normals and depressed-only subjects). Results provided general support for self-discrepancy theory in accounting for depressive and anxiety disorders.
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Scott L, O'Hara MW. Self-discrepancies in clinically anxious and depressed university students. JOURNAL OF ABNORMAL PSYCHOLOGY 1993; 102:282-7. [PMID: 8315140 DOI: 10.1037/0021-843x.102.2.282] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Self-discrepancy theory proposes that anxiety and depression are the result of different types of conflicting self-beliefs. This study examined self-discrepancies in four groups of university students who completed a questionnaire assessing levels of self-discrepancy and were characterized by the following disorders: (a) depression, (b) anxiety, (c) both anxiety and depression, or (d) no psychiatric disorder. As predicted, subjects with anxiety or depressive disorders had higher levels of self-discrepancy than normal subjects. Depressive subjects had higher levels of actual:ideal discrepancies than nondepressive subjects. Anxious subjects (with or without depressive disorders) had higher levels of actual:ought discrepancies than nonanxious subjects (normals and depressed-only subjects). Results provided general support for self-discrepancy theory in accounting for depressive and anxiety disorders.
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Wallace J, O'Hara MW. Increases in depressive symptomatology in the rural elderly: results from a cross-sectional and longitudinal study. JOURNAL OF ABNORMAL PSYCHOLOGY 1992. [PMID: 1500597 DOI: 10.1037//0021-843x.101.3.398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Depressive symptomatology was examined in a large sample of noninstitutionalized older adults using the Center for Epidemiological Studies-Depression scale (CES-D). Both cross-sectional and longitudinal data showed age-related increases in mean CES-D scores and increases in the percentage of respondents scoring at or above the cutoff score of 16. Variables collected at baseline in the longitudinal study from 2,032 participants 65 years of age and older were significant predictors of depressive symptomatology 3 and 6 years later. Baseline CES-D scores accounted for the largest proportion of the variance.
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Wallace J, O'Hara MW. Increases in depressive symptomatology in the rural elderly: Results from a cross-sectional and longitudinal study. JOURNAL OF ABNORMAL PSYCHOLOGY 1992; 101:398-404. [PMID: 1500597 DOI: 10.1037/0021-843x.101.3.398] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Depressive symptomatology was examined in a large sample of noninstitutionalized older adults using the Center for Epidemiological Studies-Depression scale (CES-D). Both cross-sectional and longitudinal data showed age-related increases in mean CES-D scores and increases in the percentage of respondents scoring at or above the cutoff score of 16. Variables collected at baseline in the longitudinal study from 2,032 participants 65 years of age and older were significant predictors of depressive symptomatology 3 and 6 years later. Baseline CES-D scores accounted for the largest proportion of the variance.
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O'Hara MW, Schlechte JA, Lewis DA, Wright EJ. Prospective study of postpartum blues. Biologic and psychosocial factors. ARCHIVES OF GENERAL PSYCHIATRY 1991; 48:801-6. [PMID: 1929770 DOI: 10.1001/archpsyc.1991.01810330025004] [Citation(s) in RCA: 244] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Potential biologic and psychosocial causative factors for the postpartum blues were tested in a prospective study of 182 women followed up from the second trimester of pregnancy until postpartum week 9. Personal and family history of depression, depressive symptoms, stressful life events, and social adjustment were all assessed during the second trimester. Levels of progesterone, prolactin, estradiol, free and total estriol, and free and total cortisol were measured on several occasions during late pregnancy and early puerperium. Obstetric and child-care stressors and the postpartum blues were assessed after delivery. Predictors of the postpartum blues were personal and family history of depression, social adjustment, stressful life events, and levels of free and total estriol. Our results support the hypothesis that the postpartum blues is within the spectrum of affective disorders.
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Philipps LH, O'Hara MW. Prospective study of postpartum depression: 4½-year follow-up of women and children. JOURNAL OF ABNORMAL PSYCHOLOGY 1991; 100:151-5. [PMID: 2040765 DOI: 10.1037/0021-843x.100.2.151] [Citation(s) in RCA: 115] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The consequences of maternal postpartum depression for mothers and children were investigated in a 4 1/2-year follow-up study, which included 70 of 99 women who had participated in an earlier study of postpartum depression. Information about maternal adjustment and depression during the follow-up period and child adjustment at age 4 1/2 years was obtained. Women who had experienced a postpartum depression were predicted to be at increased risk for subsequent depression and poor adjustment of their child. Postpartum depression was directly related to subsequent depression but not child problems. Later depression was related to child problems at 4 1/2 years. We concluded that postpartum depression may increase risk for later maternal depression and in turn increases risk for child behavior problems. Intervening with women who have experienced a postpartum depression may reduce likelihood of future depressions and child behavior problems.
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O'Hara MW, Schlechte JA, Lewis DA, Varner MW. Controlled prospective study of postpartum mood disorders: Psychological, environmental, and hormonal variables. JOURNAL OF ABNORMAL PSYCHOLOGY 1991; 100:63-73. [PMID: 2005273 DOI: 10.1037/0021-843x.100.1.63] [Citation(s) in RCA: 241] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Demographic, psychiatric, social, cognitive, and life stress variables were used to determine the etiology of depression in childbearing (CB; n = 182) and nonchildbearing (NCB; n = 179) women. Hormonal variables in postpartum depression were also evaluated. In the CB group predictors of depression diagnosis were previous depression, depression during pregnancy, and a Vulnerability (V) x Life Stress (LS) interaction; predictors of depressive symptomatology were previous depression, depressive symptoms during pregnancy, life events, and V x LS. Only estradiol was associated with postpartum depression diagnosis. In the NCB group V X LS was the only predictor of depression diagnosis; depressive symptoms during pregnancy and life events were predictors of depressive symptomatology. Previous findings about depression vulnerability were replicated. The significant V x LS interactions support the vulnerability-stress model of postpartum depression.
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