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Ertmann RK, Lyngsøe BK, Nicolaisdottir DR, Kragstrup J, Siersma V. Mental vulnerability before and depressive symptoms during pregnancy and postpartum: a prospective population-based cohort study from general practice. Nord J Psychiatry 2022; 76:243-249. [PMID: 34355638 DOI: 10.1080/08039488.2021.1953583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim was to investigate and compare the prevalence of symptoms of depression throughout pregnancy and postpartum among women who at the first pregnancy consultation had (1) record of mental disease, (2) self-reported psychological difficulties but no record of mental disease, or (3) no mental vulnerability. MATERIALS AND METHODS Prospective cohort study. An electronic questionnaire containing the Major Depression Inventory (MDI) was e-mailed to 1494 pregnant women after the first, second and third prenatal care consultation and eight weeks postpartum. High depression score was considered present with MDI scores of 21 or more. Information on sociodemographic, somatic comorbidities and previous psychiatric disorders was collected. We used logistic regression to estimate odds ratios with 95% confidence intervals. RESULTS The overall prevalence of symptoms of depression (MDI ≥ 21) dropped throughout pregnancy. At the first prenatal care consultation the prevalence was 15.3%, 10.7% in the second trimester, 9.3% in the third trimester and 5.6% postpartum. Logistic regression showed increased risk of symptoms of depression throughout pregnancy and postpartum for both women with mental disease and psychological difficulties. For each outcome, the increase in odds for the psychological difficulties group was about one third of the increase in odds for the mental illness group. CONCLUSIONS Self-reported psychological difficulties may indicate higher odds of depressive symptoms. The healthcare staff meeting the pregnant women in early pregnancy have a good opportunity to identify this subgroup of vulnerable women by means of the Pregnancy Health Records and additional questions exploring women's experiences with previous psychological difficulties.
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Affiliation(s)
- Ruth K Ertmann
- Research Unit for General Practice and Section for General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bente K Lyngsøe
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Dagny R Nicolaisdottir
- Research Unit for General Practice and Section for General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kragstrup
- Research Unit for General Practice and Section for General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section for General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
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Ertmann RK, Nicolaisdottir DR, Kragstrup J, Siersma V, Lutterodt MC, Bech P. Physical discomfort in early pregnancy and postpartum depressive symptoms. Nord J Psychiatry 2019; 73:200-206. [PMID: 30848973 DOI: 10.1080/08039488.2019.1579861] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Pregnancy examinations conducted in general practice focus mainly on identifying high-risk pregnancies and pregnancy complications. The pregnancy health record has a biomedical focus, and consequently the woman's mental well-being may receive less attention. The aim of this study was to evaluate the extent to which early pregnancy-related symptoms should be considered as indicators of an increased risk of postpartum depression. MATERIALS AND METHODS For a prospective cohort of 1508 pregnant women, the presence of 11 pregnancy-related symptoms was recorded at the first prenatal care consultation together with background information about socio-demography and health. Depression was assessed 8 weeks postpartum with the major depression inventory (MDI) and depression was considered present if MDI > 20. Multivariable logistic regression was used to assess the association between pregnancy-related symptoms and postpartum depressive symptoms, and to adjust for potential confounders. RESULTS A high depression score (MDI score >20) 8 weeks postpartum was found among 6.6% of the women and showed apparent associations with physical discomfort in early pregnancy, such as back pain and pelvic cavity pain. Analysis of confounding revealed, however, that signs of vulnerable mental health, present in early pregnancy, explained most of these associations. CONCLUSIONS Indicators of an increased risk of postpartum depressive symptoms may be found in early pregnancy. Pregnancy-related pain in the first trimester may be a sign of psychological vulnerability or an aspect of an existing depressive state that calls for attention.
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Affiliation(s)
- Ruth K Ertmann
- a Research Unit for General Practice and Section for General Practice, Institute of Public Health , University of Copenhagen, Psychiatric Research Unit Mental Health Centre North Zealand, University of Copenhagen , Copenhagen , Denmark
| | - Dagny R Nicolaisdottir
- a Research Unit for General Practice and Section for General Practice, Institute of Public Health , University of Copenhagen, Psychiatric Research Unit Mental Health Centre North Zealand, University of Copenhagen , Copenhagen , Denmark
| | - Jakob Kragstrup
- a Research Unit for General Practice and Section for General Practice, Institute of Public Health , University of Copenhagen, Psychiatric Research Unit Mental Health Centre North Zealand, University of Copenhagen , Copenhagen , Denmark
| | - Volkert Siersma
- a Research Unit for General Practice and Section for General Practice, Institute of Public Health , University of Copenhagen, Psychiatric Research Unit Mental Health Centre North Zealand, University of Copenhagen , Copenhagen , Denmark
| | - Melissa C Lutterodt
- a Research Unit for General Practice and Section for General Practice, Institute of Public Health , University of Copenhagen, Psychiatric Research Unit Mental Health Centre North Zealand, University of Copenhagen , Copenhagen , Denmark
| | - Per Bech
- a Research Unit for General Practice and Section for General Practice, Institute of Public Health , University of Copenhagen, Psychiatric Research Unit Mental Health Centre North Zealand, University of Copenhagen , Copenhagen , Denmark
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Valkonen-Korhonen M, Leinola H, Könönen M, Niskanen E, Purhonen M, Pakarinen M, Ruusunen A, Lehto SM, Mervaala E, Honkalampi K, Koivumaa-Honkanen H, Viinamäki H. Bifrontal active and sham rTMS in treatment-resistant unipolar major depression. Nord J Psychiatry 2018; 72:586-592. [PMID: 30348049 DOI: 10.1080/08039488.2018.1500640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIM Prevention of the recurrence of major depression and its residual symptoms requires effective treatment. Our aim was to study the effects of bifrontal active rTMS controlled by sham rTMS in treatment-resistant unipolar major depressive disorder (MDD). METHODS Thirty-seven patients with treatment-resistant MDD were randomized into two groups. One group received a total of 30 sessions of active bifrontal rTMS (10 Hz rTMS on left dorsolateral prefrontal cortex (DLPFC) and 1 Hz rTMS on right DLPFC) and the other group received bilateral sham rTMS on five days a week for six weeks. RESULTS Depressive symptoms significantly improved in both the groups, but without a significant group difference. Furthermore, patients with psychotic depression improved similarly to those with moderate or severe depression. CONCLUSIONS The results of present study indicate a large sham effect of stimulation treatment. The intensive structured treatment protocol may explain the positive outcome in both the groups. It is important to recognize, appreciate, and utilize placebo effects as a significant means of rehabilitation in psychiatric care.
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Affiliation(s)
- Minna Valkonen-Korhonen
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.,b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland
| | - Hanna Leinola
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland
| | - Mervi Könönen
- b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland.,c Department of Clinical Neurophysiology , Kuopio University Hospital , Kuopio , Finland
| | - Eini Niskanen
- d Department of Applied Physics , University of Eastern Finland , Kuopio , Finland
| | - Maija Purhonen
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.,b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland
| | - Maarit Pakarinen
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.,b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland
| | - Anu Ruusunen
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.,b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland.,e Food and Mood Centre/IMPACT SRC School of Medicine , Deakin University , Geelong , Australia
| | - Soili M Lehto
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.,b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland.,f Department of Psychology and Logopedics Faculty of Medicine , University of Helsinki , Helsinki , Finland
| | - Esa Mervaala
- b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland.,c Department of Clinical Neurophysiology , Kuopio University Hospital , Kuopio , Finland.,g Institute of Clinical Medicine/Clinical Neurophysiology , University of Eastern Finland , Kuopio , Finland
| | - Kirsi Honkalampi
- h School of Educational Sciences and Psychology , University of Eastern Finland , Joensuu , Finland
| | - Heli Koivumaa-Honkanen
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.,b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland.,i Departments of Psychiatry: North Karelia Central Hospital , Joensuu , Finland.,j SOTE , Iisalmi , Finland.,k South-Savonia Hospital District , Mikkeli , Finland.,l Lapland Hospital District , Rovaniemi , Finland
| | - Heimo Viinamäki
- a Department of Psychiatry , Kuopio University Hospital , Kuopio , Finland.,b Institute of Clinical Medicine/Psychiatry , University of Eastern Finland , Kuopio , Finland
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