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Motrico E, Bina R, Kassianos AP, Le HN, Mateus V, Oztekin D, Rodriguez-Muñoz MF, Moreno-Peral P, Conejo-Cerón S. Effectiveness of interventions to prevent perinatal depression: An umbrella review of systematic reviews and meta-analysis. Gen Hosp Psychiatry 2023; 82:47-61. [PMID: 36958130 PMCID: PMC10183436 DOI: 10.1016/j.genhosppsych.2023.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND To date, dozens of systematic reviews (SRs) and meta-analyses (MAs) summarize the effectiveness of preventive interventions for perinatal depression. However, the results are inconclusive, making an urgent need to step up to higher levels of evidence synthesis. AIMS To summarize and compare the evidence from the SR&MA examining the effectiveness of all types of interventions for preventing perinatal depression. METHOD PubMed, PsycINFO, Cochrane Database of Systematic Reviews and OpenGrey were searched from inception to December 2022. We selected SR&MA of randomized controlled trials (RCTs) that compared all types of preventive interventions for perinatal depression with control groups whose outcome was the reduction of depressive symptoms and/or incidence of new cases of perinatal depression (PROSPERO: CRD42020173125). RESULTS A total of 19 SRs and MAs evaluated 152 unique RCTs that included 83,408 women from 26 countries and five continents. The median effect size for any intervention was SMD = 0.29 (95% CI: 0.20 to 0.38). Exercise/physical activity-based, psychological, and any type of intervention showed median effect sizes of 0.43, 0.28 and 0.36, respectively. The degree of overlap among RCTs was slight. According to AMSTAR-2, 79% of them were rated as low or critically low-quality. The strength of evidence, according to GRADE, was poorly reported and, in most cases, was low. CONCLUSIONS Exercise/physical activity-based and psychological interventions have a small-to-medium effect on reducing perinatal depressive symptoms. There is insufficient evidence to conclude that dietary supplements and pharmacological interventions are effective in preventing perinatal depression. There is a need for high-quality SR&MA of RCTs, mainly focusing on universal preventive interventions.
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Affiliation(s)
- Emma Motrico
- Department of Psychology, University Loyola Andalucía, Spain.
| | - Rena Bina
- School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Angelos P Kassianos
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 7HB, UK; Department of Nursing, Cyprus University of Technology, 30 Archbishop Kyprianos, Limassol 3036, Cyprus
| | - Huynh-Nhu Le
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
| | - Vera Mateus
- Portucalense Institute for Human Development (INPP), Department of Psychology and Education, Universidade Portucalense, Porto, Portugal; Center for Research in Neuropsychology and Cognitive Behavioural Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Deniz Oztekin
- Department of Obstetrics and Gynecology, İzmir Bakircay University, İzmir, Turkey
| | | | - Patricia Moreno-Peral
- Biomedical Research Institute of Malaga (IBIMA plataforma Bionand), Málaga, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Spain; Department of Personality, Evaluation and Psychological Treatment, University of Málaga (UMA), Spain
| | - Sonia Conejo-Cerón
- Biomedical Research Institute of Malaga (IBIMA plataforma Bionand), Málaga, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Spain
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Uphoff EP, Zamperoni V, Yap J, Simmonds R, Rodgers M, Dawson S, Seymour C, Kousoulis A, Churchill R. Mental health promotion and protection relating to key life events and transitions in adulthood: a rapid systematic review of systematic reviews. J Ment Health 2022:1-14. [PMID: 35658814 DOI: 10.1080/09638237.2022.2069724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND During the decades representing working-age adulthood, most people will experience one or several significant life events or transitions. These may present a challenge to mental health. AIM The primary aim of this rapid systematic review of systematic reviews was to summarise available evidence on the effectiveness of interventions to promote and protect mental health relating to four key life events and transitions: pregnancy and early parenthood, bereavement, unemployment, and housing problems. This review was conducted to inform UK national policy on mental health support. METHODS We searched key databases for systematic reviews of interventions for working-age adults (19 to 64 years old) who had experienced or were at risk of experiencing one of four key life events. Titles and abstracts were screened by two reviewers in duplicate, as were full-text manuscripts of relevant records. We assessed the quality of included reviews and extracted data on the characteristics of each literature review. We prioritised high quality, recent systematic reviews for more detailed data extraction and synthesis. RESULTS The search and screening of 3997 titles/abstracts and 239 full-text papers resulted in 134 relevant studies, 68 of which were included in a narrative synthesis. Evidence was strongest and of the highest quality for interventions to support women during pregnancy and after childbirth. For example, we found benefits of physical activity and psychological therapy for outcomes relating to mental health after birth. There was high quality evidence of positive effects of online bereavement interventions and psychological interventions on symptoms of grief, post-traumatic stress, and depression. Evidence was inconclusive and of lower quality for a range of other bereavement interventions, unemployment support interventions, and housing interventions. CONCLUSIONS Whilst evidence based mental health prevention and promotion is available during pregnancy and early parenthood and for bereavement, it is unclear how best to support adults experiencing job loss, unemployment, and housing problems.
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Affiliation(s)
| | | | - Jade Yap
- Mental Health Foundation, London, UK
| | | | - Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
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Armstrong B, Weaver RG, Beets MW, Østbye T, Kravitz RM, Benjamin-Neelon SE. Use of Child Care Attenuates the Link Between Decreased Maternal Sleep and Increased Depressive Symptoms. J Dev Behav Pediatr 2022; 43:e330-e338. [PMID: 35075045 PMCID: PMC9177505 DOI: 10.1097/dbp.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/12/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Sleep disruption is common among postpartum women and is linked with depression. Child care may alleviate parenting stress and protect new mothers against symptoms of depression. METHODS Mothers from the NURTURE study, a birth cohort of 666 women of full-term infants, completed questionnaires during home visits when their infants were 3, 6, 9, and 12 months old. The Edinburgh Postnatal Depression Scale and the Perceived Stress Scale were used to measure depressive symptoms and stress, respectively. Mothers reported total nightly sleep duration for themselves and their infants, child care arrangements, marital status, and income. We used mixed-effects models adjusting for income, marital status, and child age to examine the indirect effect of infants' sleep on maternal mental health through mothers' sleep and assessed whether patterns differed depending on child care. RESULTS Decreased maternal sleep mediated the association between infant sleep and maternal mental health. When infants slept 1 hour less than usual, mothers slept 7 fewer minutes (B = 0.19, 95% confidence interval [CI], 0.01 to 0.27) and reported more depressive symptoms (B = -0.27, 95% CI, -0.43 to -0.11) and stress (B = -0.33, 95% CI -0.58 to -0.09). Child care moderated the indirect effect; decreased maternal sleep was not associated with increased depressive symptoms (and was not a mediator) when mothers had child care (indirect effect = -0.001, 95% CI, -0.03 to 0.03). CONCLUSION Use of infant child care reduced the link between maternal sleep and depressive symptoms. Regular access to child care may be a method to mitigate feelings of depression for new mothers.
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Affiliation(s)
- Bridget Armstrong
- University of South Carolina, Department of Exercise
Science, Columbia, South Carolina, USA
| | - R. Glenn Weaver
- University of South Carolina, Department of Exercise
Science, Columbia, South Carolina, USA
| | - Michael W. Beets
- University of South Carolina, Department of Exercise
Science, Columbia, South Carolina, USA
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Tebeka S, Godin O, Mazer N, Bellivier F, Courtet P, Etain B, Gard S, Leboyer M, Llorca PM, Loftus J, Olié E, Passerieux C, Polosan M, Schwan R, Belzeaux R, Dubertret C. Clinical characteristics of bipolar disorders with postpartum depressive onset. Prog Neuropsychopharmacol Biol Psychiatry 2021; 107:110225. [PMID: 33347983 DOI: 10.1016/j.pnpbp.2020.110225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/30/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Postpartum period is associated with an increased risk of bipolar disorder diagnosis and relapse, mainly major depressive episode. Onset during this period might be associated with specific characteristics. AIM To compare the socio-demographic and clinical characteristics of parous women presenting with bipolar disorder and an index depressive episode occurring during or outside the postpartum period. METHODS Using the multicenter cohort FACE-BD (FondaMental Academic Centers of Expertise for Bipolar Disorders), we considered all women who started their BD with a major depressive episode and have at least one child. We compared two groups depending on the onset: in or outside the postpartum period. RESULTS Among the 759 women who started BD with a major depressive episode, 93 (12.2%) had a postpartum onset, and 666 (87.8%) had not. Women who started BD in the postpartum period with a major depressive episode have a more stable family life, more children, an older age at onset, more Bipolar 2 disorder, less history of suicide attempts, less depressive episodes and more mood stabilizer treatments as compared to those who started with a major depressive episode outside the postpartum period. The multivariable logistic regression showed that women with an onset in the postpartum period had significantly more children, less lifetime depressive episodes and a lower rate of history of suicide attempts as compared to women with an onset outside the postpartum period. DISCUSSION Our results suggest that women starting their BD with postpartum depression have a more favorable course of BD, especially less history of suicide attempt and less lifetime depressive episodes.
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Affiliation(s)
- Sarah Tebeka
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, service de Psychiatrie et Addictologie, Hopital Louis Mourier, Colombes, Inserm U1266, Faculté de médecine, Université de Paris, France; Fondation Fondamental, Creteil 94000, France.
| | - Ophelia Godin
- Fondation Fondamental, Creteil 94000, France; Univ Paris Est Créteil, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, F-94010, Créteil, France
| | - Nicolas Mazer
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, service de Psychiatrie et Addictologie, Hopital Louis Mourier, Colombes, Inserm U1266, Faculté de médecine, Université de Paris, France; Fondation Fondamental, Creteil 94000, France
| | - Frank Bellivier
- Fondation Fondamental, Creteil 94000, France; AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, GH Saint-Louis - Lariboisière - Fernand Widal, Centre Expert Troubles Bipolaires, INSERM UMRS 1144, Université de Paris, Paris, France
| | - Philippe Courtet
- Fondation Fondamental, Creteil 94000, France; PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Bruno Etain
- Fondation Fondamental, Creteil 94000, France; AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU Neurosciences, GH Saint-Louis - Lariboisière - Fernand Widal, Centre Expert Troubles Bipolaires, INSERM UMRS 1144, Université de Paris, Paris, France
| | - Sébastien Gard
- Fondation Fondamental, Creteil 94000, France; Centre de référence régional des pathologies anxieuses et de la dépression, Centre Expert dépression Résistante, Pôle de Psychiatrie générale et universitaire, CH Charles-Perrens, NutriNeuro (UMR INRAE 1286), Université de Bordeaux, Bordeaux, France
| | - Marion Leboyer
- Fondation Fondamental, Creteil 94000, France; Univ Paris Est Créteil, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, F-94010, Créteil, France
| | - Pierre-Michel Llorca
- Fondation Fondamental, Creteil 94000, France; Centre Hospitalier et Universitaire, Département de Psychiatrie, Université d'Auvergne, EA 7280, 63000 Clermont-Ferrand, France
| | - Joséphine Loftus
- Fondation Fondamental, Creteil 94000, France; Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - Emilie Olié
- Fondation Fondamental, Creteil 94000, France; PSNREC, Univ Montpellier, INSERM, CHU de Montpellier, Montpellier, France Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Christine Passerieux
- Fondation Fondamental, Creteil 94000, France; Service Universitaire de Psychiatrie d'Adultes, Centre Hospitalier de Versailles, Le Chesnay, Université Paris-Saclay, UVSQ, Inserm, CESP, Team "DevPsy", 94807 Villejuif, France
| | - Mircea Polosan
- Fondation Fondamental, Creteil 94000, France; Université Grenoble Alpes, CHU de Grenoble et des Alpes, Grenoble Institut des Neurosciences (GIN) Inserm U1216, Grenoble, France
| | - Raymund Schwan
- Fondation Fondamental, Creteil 94000, France; Pôle Hospitalo-Universitaire de Psychiatrie et d'Addictologie du Grand Nancy Centre Psychothérapique de Nancy, Nancy France, Inserm U1114 Strasbourg France, Université de Lorraine Nancy, France
| | - Raoul Belzeaux
- Fondation Fondamental, Creteil 94000, France; Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Caroline Dubertret
- AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, service de Psychiatrie et Addictologie, Hopital Louis Mourier, Colombes, Inserm U1266, Faculté de médecine, Université de Paris, France; Fondation Fondamental, Creteil 94000, France
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Ashford MT, Olander EK, Ayers S. Computer- or web-based interventions for perinatal mental health: A systematic review. J Affect Disord 2016; 197:134-46. [PMID: 26991368 DOI: 10.1016/j.jad.2016.02.057] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/12/2016] [Accepted: 02/26/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Treating prenatal mental health issues is of great importance, but access to treatment is often poor. One way of accessing treatment is through computer- or web-based interventions. Reviews have shown that these interventions can be effective for a variety of mental health disorder across different populations. However, their effectiveness for women in the perinatal period has not been reviewed. This review therefore aimed to provide a first overview of computer- or web-based interventions for women's perinatal mental health issues by systematically identifying and reviewing their characteristics and efficacy. METHODS Twelve electronic databases were searched for published and unpublished literature using keywords, supplemented by hand searches. Data were extracted for characteristics of the intervention and the study, study findings and the methodological quality was assessed. RESULTS The majority of the eleven eligible studies were randomized controlled trials. Interventions were targeted at depression, stress, and complicated grief during the antenatal or postpartum period or the time after pregnancy loss. Findings suggest that computer- or web-based interventions targeted at improving mental health, especially depression and complicated grief, may be effective. LIMITATIONS Findings and their generalizability is limited by the heterogeneity of reviewed interventions and study designs, as well as methodological limitations. CONCLUSIONS This systematic review constitutes the first synthesis of research on computer- or web-based interventions for perinatal mental health issues and provides preliminary support that this could be a promising form of treatment during this period. However, there are significant gaps in the current evidence-base so further research is needed.
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Affiliation(s)
- Miriam T Ashford
- Centre for Maternal and Child Health Research, City University, London, UK.
| | - Ellinor K Olander
- Centre for Maternal and Child Health Research, City University, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, City University, London, UK
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Do psychosocial sleep interventions improve infant sleep or maternal mood in the postnatal period? A systematic review and meta-analysis of randomised controlled trials. Sleep Med Rev 2015; 29:15-22. [PMID: 26555938 DOI: 10.1016/j.smrv.2015.08.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 06/24/2015] [Accepted: 08/07/2015] [Indexed: 12/14/2022]
Abstract
Sleep complaints are common amongst mothers of infants and insufficient, inefficient or fragmented sleep is associated with postnatal depression. The aim of this review is to determine whether psychosocial sleep-focused interventions offered in the perinatal period improve infant sleep or maternal mood. We searched PubMed, PsycInfo, EMBASE and CINAHL with no date restriction. We reviewed 1097 articles, resulting in nine papers (n = 1,656) that fit the eligibility criteria for inclusion in the analyses. The primary outcome was infant sleep, defined as maternal reports of infant nocturnal total sleep time and number of night-time wakes. The secondary outcome was maternal mood. The meta-analysis indicated improvements in reported infant nocturnal total sleep time (Hedge's g = 0.204, p < 0.01). However, there was no evidence for reducing infant night wakes (Hedge's g = 0.103, p = 0.134). There was evidence of maternal mood improvements (Hedge's g = 0.152, p = 0.014), however, this could have been influenced by publication bias. Psychosocial sleep interventions appear to impact the amount of sleep that a mother reports her baby to have, although the infants continue to wake as frequently. More research is needed to confirm whether sleep-related improvements can translate into improvements in maternal mood.
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Abstract
Although qualitative researches (QR) are invaluable in understanding complex healthcare situations, the quantitative systematic reviews could not treat them. To improve quality of healthcare services, results of QR should be considered in healthcare decision-making processes. Several methods and theories for synthesizing evidences of QR have been developed. In order to activate the narrative reviews and mixed methods reviews in Korean healthcare academies, I arranged the related nomenclatures and suggested some issues to conduct them.
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Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
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Ramírez-Vélez R, Rincón-Pabón D. Depresión posparto en mujeres colombianas: análisis secundario de la Encuesta Nacional de Demografía y Salud-2010. Rev Salud Publica (Bogota) 2014. [DOI: 10.15446/rsap.v16n4.40673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
Postnatal depression is a common condition that may have a significant negative impact on both infant and mother, often remaining undiagnosed and untreated. Development of effective means of detection, prevention and treatment of postnatal depression is a major health challenge. The objective of this article is to critically review pharmacological, psychological and psychosocial approaches of prevention and treatment for postnatal depression. There is little evidence of short-term success for preventive interventions and some evidence of short-term success for treatment interventions. No preventive or therapeutic studies, however, have provided evidence for long-term success. There is a need for future research into the prevention and treatment of postnatal depression including the assessment of long-term effects on the child's development as well as feasibility in relation to cost-effectiveness.
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Sockol LE, Epperson CN, Barber JP. Preventing postpartum depression: a meta-analytic review. Clin Psychol Rev 2013; 33:1205-17. [PMID: 24211712 PMCID: PMC4104584 DOI: 10.1016/j.cpr.2013.10.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 10/08/2013] [Accepted: 10/12/2013] [Indexed: 11/16/2022]
Abstract
This meta-analysis assessed the efficacy of a wide range of preventive interventions designed to reduce the severity of postpartum depressive symptoms or decrease the prevalence of postpartum depressive episodes. A systematic review identified 37 randomized or quasi-randomized controlled trials in which an intervention was compared to a control condition. Differences between treatment and control conditions in the level of depressive symptoms and prevalence of depressive episodes by 6 months postpartum were assessed in separate analyses. Depressive symptoms were significantly lower at post-treatment in intervention conditions, with an overall effect size in the small range after exclusion of outliers (Hedges' g=0.18). There was a 27% reduction in the prevalence of depressive episodes in intervention conditions by 6 months postpartum after removal of outliers and correction for publication bias. Later timing of the postpartum assessment was associated with smaller differences between intervention and control conditions in both analyses. Among studies that assessed depressive symptoms using the EPDS, higher levels of depressive symptoms at pre-treatment were associated with smaller differences in depressive symptoms by 6 months postpartum. These findings suggest that interventions designed to prevent postpartum depression effectively reduce levels of postpartum depressive symptoms and decrease risk for postpartum depressive episodes.
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Affiliation(s)
- Laura E Sockol
- Williams College, Department of Psychology, United States; Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, United States; University of Pennsylvania, Department of Psychology, United States.
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Impact of a manualized multifocal perinatal home-visiting program using psychologists on postnatal depression: the CAPEDP randomized controlled trial. PLoS One 2013; 8:e72216. [PMID: 23977257 PMCID: PMC3747116 DOI: 10.1371/journal.pone.0072216] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 07/07/2013] [Indexed: 12/02/2022] Open
Abstract
Context Postnatal maternal depression (PND) is a significant risk factor for infant mental health. Although often targeted alongside other factors in perinatal home-visiting programs with vulnerable families, little impact on PND has been observed. Objective This study evaluates the impact on PND symptomatology of a multifocal perinatal home-visiting intervention using psychologists in a sample of women presenting risk factors associated with infant mental health difficulties. Methods 440 primiparous women were recruited at their seventh month of pregnancy. All were future first-time mothers, under 26, with at least one of three additional psychosocial risk factors: low educational level, low income, or planning to raise the child without the father. The intervention consisted of intensive multifocal home visits through to the child’s second birthday. The control group received care as usual. PND symptomatology was assessed at baseline and three months after birth using the Edinburgh Postnatal Depression Scale (EPDS). Results At three months postpartum, mean (SD) EPDS scores were 9.4 (5.4) for the control group and 8.6 (5.4) for the intervention group (p = 0.18). The difference between the mean EPDS scores was 0.85 (95% CI: 0.35; 1.34). The intervention group had significantly lower EPDS scores than controls in certain subgroups: women with few depressive symptoms at inclusion (EPDS <8): difference = 1.66 (95%CI: 0.17; 3.15), p = 0.05, adjusted for baseline EPDS score), women who were planning to raise the child with the child’s father: difference = 1.45 (95%CI: 0.27; 2.62), p = 0.04 (adjusted); women with a higher educational level: difference = 1.59 (95%CI: 0.50; 2.68) p = 0.05 (adjusted). Conclusion CAPEDP failed to demonstrate an overall impact on PND. However, post-hoc analysis reveals the intervention was effective in terms of primary prevention and in subgroups of women without certain risk factors. Effective overall reduction of PND symptomatology for young, first-time mothers presenting additional psychosocial risk factors may require more tailored interventions. Trial registration ClinicalTrials.gov NCT00392847 Promoting Parental Skills and Enhancing Attachment in Early Childhood (CAPEDP)
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12
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A systematic review of systematic reviews of interventions to improve maternal mental health and well-being. Midwifery 2013; 29:389-99. [DOI: 10.1016/j.midw.2012.05.010] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 05/24/2012] [Accepted: 05/27/2012] [Indexed: 11/22/2022]
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Hübner-Liebermann B, Hausner H, Wittmann M. Recognizing and treating peripartum depression. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:419-24. [PMID: 22787503 DOI: 10.3238/arztebl.2012.0419] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 03/19/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND In this article, we review current data on the prevalence of, risk factors for, and treatment of peripartum depression. METHOD Pertinent publications were retrieved by searches in Medline and the Cochrane Library using the key words "peri/pre/post", "partum/partal/natal", "maternal/motherhood/pregnancy", and "depression/affective disorder". RESULTS Depression is the most common peripartal disease: The prevalence of depressive disorders is 18.4% during pregnancy and 19.2% in the puerperium. Prepartum depression is associated with preterm birth, low birth weight, and an abnormal fetal heart rate. In the long run, children of depressed mothers have been found to have impaired cognitive and emotional abilities. Risk factors for peripartal depression include prior depression, poor social support, poor quality of intimate relationship, and negative live events. Peripartum depression can be treated effectively with psychotherapy or drug therapy. Current data support the use of antidepressants during pregnancy and breastfeeding. In many places, pregnancy counseling centers offer low-threshold psychosocial assistance. Nonetheless, no more than 20% of the affected women are identified, even though rapid screening would be possible with instruments such as the Edinburgh Postnatal Depression Scale (EPDS) and the two Whooley questions. CONCLUSION Peripartum depression is both common and treatable. Screening for depression should become a routine part of both prepartum care by gynecologists and postpartum care by midwives. This will only be possible, however, with expanded availability of ambulatory and inpatient psychotherapy and psychiatric care for the affected women and their children.
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Abstract
Objective: The objective of this paper is to describe and discuss a municipal model for prevention, identification and treatment of postpartum depression (PPD). Major findings: The changed care in the municipality was associated with a significant difference in Edinburgh Postnatal Depression Scale scores between the intervention municipality and the usual care municipality at 6 weeks, 3, 6 and 12 months postpartum. The women who had been depressed at least once during the first postpartum year reported significantly higher levels of parenting stress at 12 months. The public health nurses found the scale easy to score and easy for the mothers to complete, and they were confident that they identified PPD more frequently than before. Conclusion: The results of the present study suggest a basis for a municipality model that gives the primary health care system better possibilities to help women with mental health problems in the postpartum period. The changed care consisted of several elements considered important for the result of this study. The results can be incorporated in a descriptive model for prevention, identification and treatment in municipalities. The components are (1) preconditions in the municipality, (2) initiatives to prevent PPD, (3) identification of women with PPD, (4) treatment of PPD and (5) follow-up.
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Affiliation(s)
- Kari Glavin
- Associate Professor, Department of Nursing, Diakonova University College, Norway
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Halford WK, Petch J. Couple psychoeducation for new parents: observed and potential effects on parenting. Clin Child Fam Psychol Rev 2011; 13:164-80. [PMID: 20390356 DOI: 10.1007/s10567-010-0066-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The transition to parenthood is a substantial challenge for many couples, and the extent to which the partners can support each other and their relationship is strongly related to the sensitivity and responsiveness of their parenting of their infant. This paper critically analyses the links between the couple relationship and parenting of infants and reviews the research evaluating couple psychoeducation (CP) to assist couples' parenting of their infant. It is concluded that CP has considerable potential to enhance couples' adaptation to parenthood and enhance the sensitivity and responsiveness of parenting of new infants.
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Affiliation(s)
- W Kim Halford
- School of Psychology, The University of Queensland, St. Lucia, QLD, Australia.
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Abstract
Major depression is a frequent complication of the postpartum period. Untreated postpartum depression increases the risk of maternal suicide and can impair parenting capability with resultant adverse effects on offspring development. A number of factors influence a woman's vulnerability to postpartum depressive episodes. This article summarizes processes for assessing these risk factors and implementing primary preventive interventions, and summarizes methods of early detection to promote secondary and tertiary prevention.
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Affiliation(s)
- Laura J Miller
- Department of Psychiatry, Brigham and Women's/Faulkner Hospitals, Harvard Medical School, 75 Francis Street, Boston, MA 02115,
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O'Mahony J, Donnelly T. Immigrant and refugee women's post-partum depression help-seeking experiences and access to care: a review and analysis of the literature. J Psychiatr Ment Health Nurs 2010; 17:917-28. [PMID: 21078007 DOI: 10.1111/j.1365-2850.2010.01625.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
ACCESSIBLE SUMMARY • This literature review on post-partum depression (PPD) presents an analysis of the literature about PPD and the positive and negative factors, which may influence immigrant and refugee women's health seeking behaviour and decision making about post-partum care. • A critical review of English language peer-reviewed publications from 1988 to 2008 was done by the researchers as part of a qualitative research study conducted in a western province of Canada. The overall goal of the study is to raise awareness and understanding of what would be helpful in meeting the mental health needs of the immigrant and refugee women during the post-partum period. • Several online databases were searched: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, MEDLINE (Ovid), EBM Reviews - Cochrane Database of Systematic Reviews. • Review of the literature suggests: 1 Needs, issues and specific risk factors for PPD among immigrant and refugee women have been limited. 2 Descriptive accounts regarding culture and PPD are found in the literature but impact of cultural factors upon PPD has not been well studied. 3 Few studies look at how social support, gender, and larger institutions or organizational structures may affect immigrant and refugee women's help-seeking and access to mental health care services. 4 More research is needed to hear the immigrant and refugee women's ideas about their social support needs, the difficulties they experience and their preferred ways of getting help with PPD. ABSTRACT This review and analysis of the literature is about the phenomenon of post-partum depression (PPD) and the barriers and facilitators, which may influence immigrant and refugee women's health seeking behaviour and decision making about post-partum care. As part of a qualitative research study conducted in a western province of Canada a critical review of English language peer-reviewed publications from 1988 to 2008 was undertaken by the researchers. The overall goal of the study is to raise awareness and understanding of what would be helpful in meeting the mental health needs of the immigrant and refugee women during the post-partum period. Several online databases were searched: Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, MEDLINE (Ovid), EBM Reviews - Cochrane Database of Systematic Reviews. Findings suggest: (1) needs, issues and specific risk factors for PPD among immigrant and refugee women have been limited; (2) descriptive accounts regarding culture and PPD are found in the literature but impact of cultural factors upon PPD has not been well investigated; (3) few studies examine how social support, gender, institutional and organizational structures present barriers to the women's health seeking behaviour; and (4) additional research is required to evaluate immigrant and refugee women's perspectives about their social support needs, the barriers they experience and their preferred support interventions.
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Affiliation(s)
- J O'Mahony
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
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Godderis R. Precarious beginnings: Gendered risk discourses in psychiatric research literature about postpartum depression. Health (London) 2010; 14:451-66. [DOI: 10.1177/1363459309358595] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The transition to motherhood in western society is particularly informed by risk-based scientific and medical discourses and, as a result, women are especially subject to rationalities and practices that are employed in the name of risk. The aim of this article is to examine the gendered risk discourses that are embedded in one aspect of medicalized mothering — the postpartum period. This article interrogates three key elements of the discursive construction of postpartum depression (PPD) in contemporary psychiatric research literature (~1980—2007). Specifically, I examine how risk-based reasoning is incorporated into the concepts of the postpartum triad and the high-risk mother, and how arguments about why PPD is a ‘significant social problem’ create a tension between the rights of the mother and those of the child. By placing women in a position to manage certain types of risks related to the postpartum period, these discourses serve to responsibilize women and structure their subjectivities in gendered ways.This analysis contributes to a growing literature that investigates how assumptions about gender, race, class and sexuality are produced and re-produced through the notion of risk.
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Glavin K, Smith L, Sørum R, Ellefsen B. Redesigned community postpartum care to prevent and treat postpartum depression in women--a one-year follow-up study. J Clin Nurs 2010; 19:3051-62. [PMID: 20726926 DOI: 10.1111/j.1365-2702.2010.03332.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate the effect of a redesigned follow-up care programme on prevention and treatment of postpartum depression. BACKGROUND Postpartum depression may have negative consequences on child development, maternal health and the relationship between parents. Early identification and treatment might prevent longer-term depression. DESIGN A quasi-experimental post-test design with non-equivalent groups. METHOD The study population was postpartum women with a live-born child, residing in one of two municipalities in Norway. A total of 2247 women were enrolled: 1806 in the experimental municipality and 441 in the comparison municipality. Public health nurses (26) in the experimental municipality were trained to identify postpartum depression using the Edinburgh Postnatal Depression Scale and clinical assessment and to provide supportive counselling. MEASUREMENTS The Edinburgh Postnatal Depression Scale at six weeks, three, six and 12 months postpartum and the Parenting Stress Index at 12 months postpartum. RESULTS The redesigned postpartum care programme yielded a significant group difference in the Edinburgh Postnatal Depression Scale score at six weeks (p < 0.01), odds ratio (OR) 0.6, three months (p < 0.01), OR 0.4, six months (p < 0.01), OR 0.5 and 12 months postpartum (p < 0.01), OR 0.6. Women who had been depressed at least once during the first postpartum year reported significantly higher levels of parenting stress at 12 months. CONCLUSION The findings of this study suggest that redesigned postpartum care comprising training of health professionals, increased focus on mental health problems and support for the parents is a useful approach to managing postpartum depression in the community. RELEVANCE TO CLINICAL PRACTICE Public health nurses are well positioned to identify and treat depressed mothers and provide referrals when needed. A small investment in training nurses to identify and treat postpartum depression can be cost-effective in the longer term. These findings have implications for service delivery in public health.
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Affiliation(s)
- Kari Glavin
- Department of Nursing Research, Diakonova University College, Oslo, Norway.
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Rowe HJ, Fisher JRW. Development of a universal psycho-educational intervention to prevent common postpartum mental disorders in primiparous women: a multiple method approach. BMC Public Health 2010; 10:499. [PMID: 20718991 PMCID: PMC2931475 DOI: 10.1186/1471-2458-10-499] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 08/18/2010] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Prevention of postnatal mental disorders in women is an important component of comprehensive health service delivery because of the substantial potential benefits for population health. However, diverse approaches to prevention of postnatal depression have had limited success, possibly because anxiety and adjustment disorders are also problematic, mental health problems are multifactorially determined, and because relationships amongst psychosocial risk factors are complex and difficult to modify. The aim of this paper is to describe the development of a novel psycho-educational intervention to prevent postnatal mental disorders in mothers of firstborn infants. METHODS Data from a variety of sources were synthesised: a literature review summarised epidemiological evidence about neglected modifiable risk factors; clinical research evidence identified successful psychosocial treatments for postnatal mental health problems; consultations with clinicians, health professionals, policy makers and consumers informed the proposed program and psychological and health promotion theories underpinned the proposed mechanisms of effect. The intervention was pilot-tested with small groups of mothers and fathers and their first newborn infants. RESULTS What Were We Thinking! is a psycho-educational intervention, designed for universal implementation, that addresses heightened learning needs of parents of first newborns. It re-conceptualises mental health problems in mothers of infants as reflecting unmet needs for adaptations in the intimate partner relationship after the birth of a baby, and skills to promote settled infant behaviour. It addresses these two risk factors in half-day seminars, facilitated by trained maternal and child health nurses using non-psychiatric language, in groups of up to five couples and their four-week old infants in primary care. It is designed to promote confidence and reduce mental disorders by providing skills in sustainable sleep and settling strategies, and the re-negotiation of the unpaid household workload in non-confrontational ways. Materials include a Facilitators' Handbook, creatively designed worksheets for use in seminars, and a book for couples to take home for reference. A website provides an alternative means of access to the intervention. CONCLUSIONS What Were We Thinking! is a postnatal mental health intervention which has the potential to contribute to psychologically-informed routine primary postnatal health care and prevent common mental disorders in women.
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Affiliation(s)
- Heather J Rowe
- Centre for Women's Health Gender and Society, Melbourne School of Population Health, University of Melbourne, Victoria 3010 Australia
| | - Jane RW Fisher
- Centre for Women's Health Gender and Society, Melbourne School of Population Health, University of Melbourne, Victoria 3010 Australia
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Applying new techniques to an old ally: A qualitative validation study of the Edinburgh Postnatal Depression Scale. Women Birth 2009; 22:17-23. [DOI: 10.1016/j.wombi.2008.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 10/17/2008] [Accepted: 10/23/2008] [Indexed: 11/22/2022]
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Corwin EJ, Johnston N, Pugh L. Symptoms of postpartum depression associated with elevated levels of interleukin-1 beta during the first month postpartum. Biol Res Nurs 2008; 10:128-33. [PMID: 18829596 DOI: 10.1177/1099800408323220] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Postpartum depression (PPD) is a devastating disorder that may carry lifetime consequences. Although several psychosocial risks for PPD have been identified, biological contributors are unclear. Elevated inflammatory cytokines contribute to depression in nonpregnant, nonpostpartum populations; yet, their role in PPD has been minimally studied. The objective of this study is to determine whether inflammatory cytokines early in the postpartum period contribute to the development of PPD. Women were recruited within 24 hr of delivery, and 26 provided urine for analysis of interleukin-1 beta (IL-1beta) and interleukin-6 (IL-6) on postpartum days 7, 14, and 28. Participants completed a depression symptom survey (Centers for Epidemiologic Studies Depression Scale; CES-D) on Day 28. An increase in IL-1beta was seen on Day 14 in women with symptoms of depression (CES-D > or = 11) on Day 28 compared to levels in women without depressive symptoms (F = 4.50, p = .045). These preliminary findings suggest elevated IL-1beta early in the postpartum period may increase the risk of PPD. Further studies involving a larger sample of women, including those clinically diagnosed with PPD, are required.
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Abstract
Postpartum depression (PPD) is a potentially debilitating disorder that develops in a significant percentage of women during the first year after giving birth. Women afflicted with PPD experience long-term consequences, including sadness, guilt, and despair. Offspring may be affected as well. Several investigators have tested psychosocial risk factors for the development of PPD; however, substantial amounts of variance in PPD have gone unexplained with regression on psychosocial variables alone. Likewise, interventions for PPD that have focused on psychosocial risk factors alone have been largely unsuccessful. The unexplained variance and disappointing treatment success could well be due to investigators' failure to address relevant biological changes occurring during the postpartum period. Two biological systems that are affected significantly and remain in flux during the postpartum period are the innate immune system and the hypothalamic-pituitary-adrenal (HPA) axis. Bidirectional interactions between these two systems are well established, and it is generally acknowledged that dysfunction in either system can lead to depression in nonpregnant, nonpostpartum populations. To date, little research has pursued the contribution of these interacting systems to the development of PPD. The purpose of this paper is to review the psychoneuroimmunology of PPD. The central hypothesis presented is that dysregulation in either system individually or in their bidirectional interaction is associated with the development of PPD.
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Psycho-education to enhance couples' transition to parenthood. Clin Psychol Rev 2008; 28:1125-37. [DOI: 10.1016/j.cpr.2008.03.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Revised: 03/11/2008] [Accepted: 03/13/2008] [Indexed: 11/20/2022]
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McQueen K, Montgomery P, Lappan-Gracon S, Evans M, Hunter J. Evidence-based recommendations for depressive symptoms in postpartum women. J Obstet Gynecol Neonatal Nurs 2008; 37:127-36. [PMID: 18336436 DOI: 10.1111/j.1552-6909.2008.00215.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Postpartum depression is a serious health issue affecting 13% of women from diverse cultures. Despite the well-documented consequences of postpartum depression, it remains difficult to identify, and diverse practices relate to its prevention and treatment. Evidence-based interventions are essential to improve both maternal and infant health outcomes associated with pregnancy. This article describes the development process of an evidence-based practice guideline for postpartum depression and highlights the practice recommendations related to the confirmation, prevention, and treatment of depressive symptoms in postpartum mothers.
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Affiliation(s)
- Karen McQueen
- School of Nursing, Lakehead University, Thunder Bay, Ontario, Canada.
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Sheikh L, Johnston S, Thangaratinam S, Kilby MD, Khan KS. A review of the methodological features of systematic reviews in maternal medicine. BMC Med 2007; 5:10. [PMID: 17524137 PMCID: PMC1910604 DOI: 10.1186/1741-7015-5-10] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 05/24/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In maternal medicine, research evidence is scattered making it difficult to access information for clinical decision making. Systematic reviews of good methodological quality are essential to provide valid inferences and to produce usable evidence summaries to guide management. This review assesses the methodological features of existing systematic reviews in maternal medicine, comparing Cochrane and non-Cochrane reviews in maternal medicine. METHODS Medline, Embase, Database of Reviews of Effectiveness (DARE) and Cochrane Database of Systematic Reviews (CDSR) were searched for relevant reviews published between 2001 and 2006. We selected those reviews in which a minimum of two databases were searched and the primary outcome was related to the maternal condition. The selected reviews were assessed for information on framing of question, literature search and methods of review. RESULTS Out of 2846 citations, 68 reviews were selected. Among these, 39 (57%) were Cochrane reviews. Most of the reviews (50/68, 74%) evaluated therapeutic interventions. Overall, 54/68 (79%) addressed a focussed question. Although 64/68 (94%) reviews had a detailed search description, only 17/68 (25%) searched without language restriction. 32/68 (47%) attempted to include unpublished data and 11/68 (16%) assessed for the risk of missing studies quantitatively. The reviews had deficiencies in the assessment of validity of studies and exploration for heterogeneity. When compared to Cochrane reviews, other reviews were significantly inferior in specifying questions (OR 20.3, 95% CI 1.1-381.3, p = 0.04), framing focussed questions (OR 30.9, 95% CI 3.7- 256.2, p = 0.001), use of unpublished data (OR 5.6, 95% CI 1.9-16.4, p = 0.002), assessment for heterogeneity (OR 38.1, 95%CI 2.1, 688.2, p = 0.01) and use of meta-analyses (OR 3.7, 95% CI 1.3-10.8, p = 0.02). CONCLUSION This study identifies areas which have a strong influence on maternal morbidity and mortality but lack good quality systematic reviews. Overall quality of the existing systematic reviews was variable. Cochrane reviews were of better quality as compared to other reviews. There is a need for good quality systematic reviews to inform practice in maternal medicine.
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Affiliation(s)
- Lumaan Sheikh
- Academic Unit, Birmingham Women's Hospital, University of Birmingham, Birmingham B15 2 TG, UK
| | - Shelley Johnston
- Academic Unit, Birmingham Women's Hospital, University of Birmingham, Birmingham B15 2 TG, UK
| | - Shakila Thangaratinam
- Academic Unit, Birmingham Women's Hospital, University of Birmingham, Birmingham B15 2 TG, UK
- Clinical Lecturer in Obstetrics and Gynaecology and Clinical Epidemiology, Academic Unit, 3rd floor, Birmingham Women's Hospital, Birmingham B15 2TG, UK
| | - Mark D Kilby
- Academic Unit, Birmingham Women's Hospital, University of Birmingham, Birmingham B15 2 TG, UK
| | - Khalid S Khan
- Academic Unit, Birmingham Women's Hospital, University of Birmingham, Birmingham B15 2 TG, UK
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Hornstein C, Trautmann-Villalba P. Infantizid als Folge einer postpartalen Bindungsstörung. DER NERVENARZT 2007; 78:580-3. [PMID: 17464496 DOI: 10.1007/s00115-006-2250-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Parental killing of their own children in the 1st year constitutes a rare phenomenon. Studies on infanticide show that mothers who kill their children are frequently psychiatrically disturbed. Depression is the most common postpartum disorder and may represent a vital danger for both mother and child. The association between depression and infanticide can usually be explained by maternal psychopathologic symptoms. The importance of a mother's bonding to her infant has not often been examined in respect to infanticide. The present case report underlines the importance of postpartum bonding disorder and its relation to a higher risk of infanticide.
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Affiliation(s)
- C Hornstein
- Allgemeinpsychiatrie und Psychotherapie 1, Mutter-Kind-Behandlung (Station 43), Psychiatrisches Zentrum Nordbaden, Akademisches Lehrkrankenhaus der Universität Heidelberg, Heidelberger Strasse 1a, 69168, Wiesloch.
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Abstract
PURPOSE OF REVIEW Common and important psychosomatic disorders in pregnancy reviewed here include perinatal depression, posttraumatic stress disorders, anxiety disorders, eating disorders, and postpartum psychosis. RECENT FINDINGS Research has focused on antenatal depression as postpartum depression often has onset prior to delivery. Certain psychosocial and psychological interventions can effectively prevent postnatal depression. Although the use of selective serotonin reuptake inhibitors was associated with miscarriage, preterm delivery, and fetal death, discontinuation of antidepressants also increased the relapse rate during pregnancy. Studies also show that about 8% of mothers had eating problems during their pregnancy, which increased to 19% in the postpartum period. Postpartum psychosis is an important diagnosis related to maternal death from suicide. Personal and family history of bipolar disorders are important risk factors. SUMMARY Recent findings highlight the importance of correct diagnosis and awareness of serious mental illness. In view of the higher rate of relapse, women should be counselled carefully regarding discontinuation of antidepressants during pregnancy. Differentiation of posttraumatic stress disorders with comorbid anxiety and depression, awareness of risk factors, and clinical features of psychosis are important in the management of psychosomatic disorders in pregnancy.
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Affiliation(s)
- Wing Hung Tam
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong.
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Abstract
Postpartum depression is a crippling mood disorder, historically neglected in health care, leaving mothers to suffer in fear, confusion, and silence. Undiagnosed it can adversely affect the mother-infant relationship and lead to long-term emotional problems for the child. This article differentiates postpartum depression from other postpartum mood and anxiety disorders and addresses these aspects of postpartum depression: symptoms, prevalence, risk factors, interventions, and the effects on relationships and child development. Instruments available to screen for postpartum depression are also reviewed.
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