Listening Visits for maternal depression: a meta-analysis

Does the 2-week postpartum health checkup for term deliveries prevent postpartum depression? Analysis using a 10-year database from a university hospital in Japan

BACKGROUND

Postpartum depression (PPD) is a significant public health concern with adverse outcomes for both mothers and offspring. This study examined the association between a two-week postpartum health checkup (HC) and PPD prevalence at one month.

METHODS

This retrospective cohort study from Japan included 6681 women who delivered full-term singleton babies between January 1, 2012, and August 31, 2021. The HC group received a two-week HC from January 2019, whereas those who delivered before this period were in the non-HC (control) group. PPD was assessed using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS) at discharge and one month postpartum. Logistic regression analysis identified factors associated with an EPDS score ≥ 9 at one month postpartum.

RESULTS

The average maternal age of participants was 32.5 ± 5.6 years; 51.8 % (n = 3463) were primiparous, and 27.8 % (n = 1856) were in the HC group. The HC group demonstrated a significantly lower proportion of women with EPDS score ≥ 9 at one month postpartum than the non-HC group (8.9 % vs. 13.8 %, p < 0.001). Factors associated with an EPDS score ≥ 9 at one month postpartum included attending the two-week postpartum HC (adjusted odds ratio [aOR] = 0.502, p < 0.001), EPDS score at discharge (aOR = 5.574, p < 0.001), psychiatric disorder history (aOR = 2.732, p < 0.001), cesarean section (aOR = 0.762, p = 0.006), and exclusive formula feeding (aOR = 1.368, p = 0.005).

CONCLUSION

Two-week postpartum HC was associated with a lower prevalence of PPD risk at one month postpartum. Early postpartum HC may be valuable for identifying women at risk of PPD and supporting timely interventions.

"I Want More People Like Y'all to be Willing to Listen to People Like Us": A Qualitative Study Exploring Barriers and Facilitators to Care With Autistic Women and Caregivers

Recent surveillance data indicate an estimated 1 in 36 children are diagnosed with autism spectrum disorder (ASD). More males than females are diagnosed with ASD and children of color are less likely to be identified with ASD than White children. Given the rising prevalence estimates and persistent gender and racial/ethnic differences in diagnostic rates, it is time that we seek to better understand ASD as it relates to culture, care, and lived experience from the perspective of those we serve. Utilizing qualitative methods, the current research study sought to understand the lived experiences of three autistic women and three women caregivers of autistic children as it relates to the identification, diagnostic, and service delivery processes. In-depth focus group research revealed five major themes ranging from feelings associated with the diagnosis, dissatisfaction with services, the perspective of culture within autism and the family, and how culture should be considered by service providers in treatment planning and implementation. These results are discussed in the context of future research, and implications for autism service providers are provided.

Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for the Management of Perinatal Mood, Anxiety, and Related Disorders: Guide de pratique 2024 du Canadian Network for Mood and Anxiety Treatments pour le traitement des troubles de l'humeur, des troubles anxieux et des troubles connexes périnatals

BackgroundThe Canadian Network for Mood and Anxiety Treatments (CANMAT) publishes clinical practice guidelines for mood and anxiety disorders. This CANMAT guideline aims to provide comprehensive clinical guidance for the pregnancy and postpartum (perinatal) management of mood, anxiety and related disorders.MethodsCANMAT convened a core editorial group of interdisciplinary academic clinicians and persons with lived experience (PWLE), and 3 advisory panels of PWLE and perinatal health and perinatal mental health clinicians. We searched for systematic reviews of prevention and treatment interventions for perinatal depressive, bipolar, anxiety, obsessive-compulsive and post-traumatic stress disorders (January 2013-October 2023). We prioritized evidence from reviews of randomized controlled trials (RCTs), except for the perinatal safety of medications where reviews of large high-quality observational studies were prioritized due to the absence of RCT data. Targeted searches for individual studies were conducted when systematic reviews were limited or absent. Recommendations were organized by lines of treatment based on CANMAT-defined levels of evidence quality, supplemented by editorial group consensus to balance efficacy, safety, tolerability and feasibility considerations.ResultsThe guideline covers 10 clinical sections in a question-and-answer format that maps onto the patient care journey: case identification; organization and delivery of care; non-pharmacological (lifestyle, psychosocial, psychological), pharmacological, neuromodulation and complementary and alternative medicine interventions; high-risk clinical situations; and mental health of the father or co-parent. Equity, diversity and inclusion considerations are provided.ConclusionsThis guideline's detailed evidence-based recommendations provide clinicians with key information to promote the delivery of effective and safe perinatal mental healthcare. It is hoped that the guideline will serve as a valuable tool for clinicians in Canada and around the world to help optimize clinical outcomes in the area of perinatal mental health.

Exploring Factors Affecting Parental Psychological Vulnerability During Their Child's PICU Admission: A Prospective Pilot Cohort Study

INTRODUCTION

Parental psychological responses during their child's pediatric intensive care unit (PICU) admission are often overlooked. This study aimed to identify pre-existing and peri-traumatic factors explaining parental stress and anxiety during their child's PICU admission and one-month follow-up.

METHOD

A prospective pilot study included 60 PICU parents. Parental Stressors Scale and State-trait Anxiety Inventory measured stress and anxiety during PICU admission, and the State-trait Anxiety Inventory and Perceived Stress Scale at a one-month follow-up.

RESULTS

During PICU admission, parental stress correlated with age, race, and adverse childhood experiences (ACEs), anxiety was linked to income. At one-month follow-up, anxiety related to child's health worries, perceived stress was linked to parental ACEs and education. Parental ACEs predicted perceived stress (b = 0.83, p = .028). Children's diagnoses explained anxiety, particularly respiratory and cardiac diagnoses (b = -13.44, p = .023; -10.03, p = .045).

DISCUSSION

Identifying factors helps teams understand parental vulnerability and provide appropriate support.

Compassionate Care: Listening Visits Provided by Neonatal Intensive Care Unit Nurses

PURPOSE

Although mothers of infants hospitalized in a neonatal intensive care unit (NICU) often experience clinically significant levels of depression symptoms, accessing mental-health treatment may be difficult. NICU mothers need emotional support that is conveniently delivered at the infant's point-of-care by a trusted professional who is knowledgeable about the medical and nursing care in the NICU. Listening Visits are an effective and accessible, nurse-delivered depression intervention, yet little is known about what mothers discuss during these sessions. This analysis of sessions recorded during the randomized controlled trial evaluation of Listening Visits in the NICU provides a glimpse into NICU mothers' concerns and experiences.

STUDY DESIGN AND METHODS

This is a secondary, qualitative case analysis of the recorded Listening Visits sessions of four depressed NICU mothers as indicated by a score of 12 or above on the Edinburgh Postnatal Depression Scale. The mothers, who were all White, varied in their economic resources, educational level, availability of support, and infant illness severity.

RESULTS

Mothers discussed similar concerns and experiences, often at analogous temporal points in the six Listening Visit sessions, as well as one common concern they voiced throughout: family and friends do not understand what it is like to have an infant in the NICU.

CLINICAL IMPLICATIONS

For mildly to moderately depressed mothers of infants hospitalized in the NICU, Listening Visits provide a way for bedside nurses to deliver compassionate care by listening to mothers' concerns and experiences.

Pre-intervention child maltreatment risks, intervention engagement, and effects on child maltreatment risk within an RCT of MHealth and parenting intervention

Introduction

Evidence-based mental health and parenting support services for mothers postpartum can reduce risk for child maltreatment. However, women suffering economic and cultural stressors disproportionately shoulder the burden of infant caregiving while experiencing profound barriers to accessing mental health and parenting services. This article reports on an MHealth and parenting intervention targeting maternal mood and positive parent practices within a randomized controlled trial, which provided a unique opportunity to view pre-intervention child maltreatment risk, its relationship to subsequent intervention engagement, and intervention engagement effects on pre-post child maltreatment risk reduction.

Method

Principal component factor analysis was conducted to identify a modifiable pre-intervention child maltreatment risk construct within a combined MHealth and parenting intervention sample of 184 primarily Black mothers and their infants. An independent t-test was conducted to compare pre-intervention child maltreatment risk levels between mothers who went on to complete at least two-thirds of the intervention and those who did not. A GLM repeated measures analysis of variance was conducted to determine effects of intervention engagement on child maltreatment risk reduction.

Results

Pre-intervention child maltreatment risk did not differentiate subsequent maternal intervention completion patterns. Mothers who completed two-thirds of the intervention, compared to those who did not, demonstrated significant reductions in pre-post child maltreatment risk.

Discussion

Findings underscore the potential of MHealth parenting interventions to reduce substantial child maltreatment risk through service delivery addressing a range of positive parenting and behavioral health needs postpartum, a particularly vulnerable developmental period for maternal depression and child maltreatment risk.

A Randomized Controlled Trial of Listening Visits for Mothers of Hospitalized Newborns

BACKGROUND

Emotional distress is frequently experienced by mothers whose newborns are hospitalized in a neonatal intensive care unit (NICU). Among these women, there is a critical need for emotional support conveniently delivered at the newborn's point of care by a trusted and medically knowledgeable professional: a NICU nurse. One promising way to enhance in situ delivery of emotional care is to have a NICU nurse provide Listening Visits (LVs), a brief support intervention developed expressly for delivery by nurses to depressed postpartum women.

OBJECTIVES

This trial assessed the feasibility of having NICU nurses deliver LVs to emotionally distressed mothers of hospitalized newborns and compared depression outcomes in a small sample of participants randomized to LVs or usual care (UC).

METHODS

In this pilot randomized controlled trial, emotionally distressed mothers of hospitalized newborns were randomized to receive up to six LVs from a NICU nurse or UC from a NICU social worker. To assess change in depression symptoms, women were invited to complete the Inventory of Depression and Anxiety Symptoms-General Depression Scale at enrollment and 4 and 8 weeks post-enrollment.

RESULTS

Depression symptoms declined over time for both groups, with no difference between the two groups. A post hoc analysis of reliable change found higher rates of improvement at the 4-week assessment among recipients of LVs than UC.

DISCUSSION

NICU nurses successfully implemented LVs during this trial. Depression symptom scores did not significantly differ in the two groups posttreatment or at follow-up. Nevertheless, post hoc analyses indicated comparatively higher rates of clinical improvement immediately after LVs, suggesting the intervention can reduce maternal depression early on when women are most distressed.

Telehealth Listening Visits for emotionally distressed mothers of hospitalized newborns: Proof-of-concept

Problem

Newborn admission to the neonatal intensive care unit (NICU) is stressful. Yet in clinical practice, at best, NICU mothers are screened for depression and if indicated, referred to a mental-health specialist. At worst, no action is taken. Listening Visits, an empirically supported nurse-delivered intervention addressing emotional distress, can be conveniently provided by a NICU nurse. Prompted by the need to minimize face-to-face contacts during the pandemic, the primary purpose of this small pilot trial was to assess the feasibility of having nurses provide Listening Visits to NICU mothers over Zoom. Secondarily, we assessed pre-to post-Listening Visits depression symptom scores as a preliminary evaluation of the effectiveness of this type of support.

Materials and methods

Nine NICU mothers with mildly to moderately severe depression symptoms received up to six Listening Visits sessions from a NICU nurse via Zoom. Participants completed the Inventory Depression and Anxiety Symptoms-General Depression scale (IDAS-GD) at study entry and 4- and 8-weeks post enrollment. They completed the Client Satisfaction Questionnaire (CSQ) at the 8-week assessment.

Results

Using an intent-to-treat approach, the effect of time from the mixed model analysis of IDAS-GD was statistically significant (F(2,26) = 10.50, p < 0.001), indicating improvement in IDAS-GD scores from baseline to follow-up. The average CSQ score was high (M = 29.0, SD = 3.3), with 75% of participants rating the quality of help they received as "excellent".

Discussion

In this pilot trial, we learned it is feasible to provide Listening Visits over Zoom, that this mode of delivery is associated with a significant decrease in depression symptom scores, and that women value this approach.

Clinical trial registration

[https://clinicaltrials.gov/], identifier [#201805961].

Receiving screened donor human milk for their infant supports parental wellbeing: a mixed-methods study

BACKGROUND

Access to donor human milk (DHM) has primarily been based on the health and development outcomes of premature infants but there has been little examination of the broader impact of an infant receiving it upon parental mental health. Breastfeeding and mental health are closely tied with women who experience breastfeeding difficulties or are unable to meet their own breastfeeding goals often experiencing feelings of guilt, sadness and anger, alongside an increased risk of postnatal depression. The aim of the current study was to explore how experience of receiving DHM for their baby affected the wellbeing of parents.

METHODS

UK parents of infants aged 0 - 12 months who had received screened DHM from a milk bank (typically on the neonatal unit or in some cases in the community) completed an online questionnaire exploring their experiences. The questionnaire included Likert scale items examining perceived impact upon infant health, own wellbeing and family functioning alongside open-ended questions exploring perceptions of how receiving DHM affected wellbeing.

RESULTS

Almost all of the 107 participants (women = 102) agreed that receiving DHM had a positive impact upon infant health and development, their own mental and physical health, and their family's wellbeing. Parents felt relieved that their infant was receiving DHM for health reasons but also due to the experience of being listened to, supported and having their infant feeding decisions facilitated. Receiving DHM helped mothers to process some of their emotions at not being able to breastfeed, in part because knowing their baby was being fed gave them the space to focus on recovery and bonding with their baby. Some parents did experience challenges, feeling guilty at receiving DHM, insecure that another woman was able to feed their baby when they could not, or negative reactions from family. Although the impact of receiving DHM upon breastfeeding was not measured, some women who were working to build their own milk supply noted that it helped motivate them to continue.

CONCLUSIONS

DHM may play an important role not only in protecting infant health and development but in supporting the mental health and wellbeing of mothers for whom their infant receiving human milk is important.

Depressive symptoms during pregnancy and after birth in women living in Sweden who received treatments for fear of birth

The aim of this study was to investigate the prevalence of depressive symptoms and associated factors in women who underwent treatments for fear of birth; internet-based cognitive therapy, counseling with midwives, continuity with a known midwife or standard care. A secondary analysis was performed using data collected from four samples of women identified with fear of birth and receiving treatment with different methods. A questionnaire was used to collect data in mid-pregnancy and at follow-up 2 months after birth. Depressive symptoms were assessed using the Edinburgh Postnatal Depressive Scale. In mid-pregnancy, 32% of the 422 women with fear of birth also reported a co-morbidity with depressive symptoms. At postpartum follow-up, 19% reported depressive symptoms 2 months after birth, and 12% showed continued or recurrent depressive symptoms identified both during pregnancy and postpartum. A history of mental health problems was the strongest risk factor for presenting with depressive symptoms. None of the treatment options in this study was superior in reducing depressive symptoms. This study showed a significant co-morbidity and overlap between fear of birth and depressive symptoms. Screening for depressive symptoms and fear of birth during pregnancy is important to identify women at risk and offer specific treatment.