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Gureje O, Oladeji BD, Kola L, Bello T, Ayinde O, Faregh N, Bennett I, Zelkowitz P. Effect of intervention delivered by frontline maternal care providers to improve outcome and parenting skills among adolescents with perinatal depression in Nigeria (the RAPiD study): A cluster randomized controlled trial. J Affect Disord 2022; 312:169-176. [PMID: 35752215 DOI: 10.1016/j.jad.2022.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/12/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Perinatal depression is more common and is associated with greater negative consequences among adolescents than adults. Psychosocial interventions designed for adults may be inadequate at addressing the unique features of adolescent perinatal depression. METHODS In a two-arm parallel cluster randomized trial conducted in thirty primary maternal care clinics in Ibadan, Nigeria (15-intervention and 15-control) we compared age-appropriate intervention consisting of problem-solving therapy, behavioral activation, parenting skills training, and parenting support from a self-identified adult to care as usual. Pregnant adolescents (aged <20 years) at fetal gestational age16-36 weeks with moderate to severe depression were recruited. Primary outcomes were depression symptoms (Edinburgh Postnatal Depression Scale, EPDS) and parenting practices (Infant-Toddler version of the Home Inventory for Measurement of the Environment, HOME-IT) at six-months postnatal. RESULTS There were 242 participants (intervention arm: 141; Control arm: 101), with a mean age of 18∙0 (SD-1∙2). Baseline mean EPDS score was 14∙2 (SD-2.1); 80∙1 % completed the six-month postnatal follow-up. The intervention group had lower level of depressive symptoms than the control group, mean EPDS scores: 5∙5 (SD-3∙6) versus 7∙2 (SD-4∙0) (adjusted mean difference -1∙84 (95%CI- 3∙06 to -0∙62; p = 0∙003) and better parenting practices, mean total HOME-IT scores: 29∙8 (SD-4∙4) versus 26∙4 (SD-4∙2) (adjusted mean difference 3∙4 (95%Cl- 2∙12 to 4∙69, p = 0∙001). LIMITATIONS This study explored the effect of complex interventions making it difficult to know precisely what aspects produced the outcomes. CONCLUSIONS An age-appropriate psychosocial intervention package holds promise for scaling up care for adolescents with perinatal depression especially in resource-constrained settings. TRIAL REGISTRATION ISRCTN16775958. Registered on 30 April 2019.
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Affiliation(s)
- Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria.
| | - Bibilola D Oladeji
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Lola Kola
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Toyin Bello
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Olatunde Ayinde
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Neda Faregh
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - Ian Bennett
- Department of Family Medicine, Psychiatry and Behavioral Sciences, and Global Health, University of Washington, Seattle, USA
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Worthen RJ, Beurel E. Inflammatory and neurodegenerative pathophysiology implicated in postpartum depression. Neurobiol Dis 2022; 165:105646. [PMID: 35104645 PMCID: PMC8956291 DOI: 10.1016/j.nbd.2022.105646] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/11/2022] [Accepted: 01/27/2022] [Indexed: 12/17/2022] Open
Abstract
Postpartum depression (PPD) is the most common psychiatric complication associated with pregnancy and childbirth with debilitating symptoms that negatively impact the quality of life of the mother as well as inflict potentially long-lasting developmental impairments to the child. Much of the theoretical pathophysiology put forth to explain the emergence of PPD overlaps with that of major depressive disorder (MDD) and, although not conventionally described in such terms, can be seen as neurodegenerative in nature. Framing the disorder from the perspective of the well-established inflammatory theory of depression, symptoms are thought to be driven by dysregulation, and subsequent hyperactivation of the body's immune response to stress. Compounded by physiological stressors such as drastic fluctuations in hormone signaling, physical and psychosocial stressors placed upon new mothers lay bare a number of significant vulnerabilities, or points of potential failure, in systems critical for maintaining healthy brain function. The inability to compensate or properly adapt to meet the changing demands placed upon these systems has the potential to damage neurons, hinder neuronal growth and repair, and disrupt neuronal circuit integrity such that essential functional outputs like mood and cognition are altered. The impact of this deterioration in brain function, which includes depressive symptoms, extends to the child who relies on the mother for critical life-sustaining care as well as important cognitive stimulation, accentuating the need for further research.
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Blanc J, Rességuier N, Lorthe E, Goffinet F, Sentilhes L, Auquier P, Tosello B, d'Ercole C. Association between extremely preterm caesarean delivery and maternal depressive and anxious symptoms: a national population-based cohort study. BJOG 2020; 128:594-602. [PMID: 32931138 DOI: 10.1111/1471-0528.16499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate whether caesarean delivery before 26 weeks of gestation was associated with symptoms of depression and anxiety in mothers in comparison with deliveries between 26 and 34 weeks. DESIGN Prospective national population-based EPIPAGE-2 cohort study. SETTING 268 neonatology departments in France, March to December 2011. POPULATION Mothers who delivered between 22 and 34 weeks and whose self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale: CES-D) and anxiety (State-Trait Anxiety Inventory: STAI) were assessed at the moment of neonatal discharge. METHODS The association of caesarean delivery before 26 weeks with severe symptoms of depression (CES-D ≥16) and anxiety (STAI ≥45) was assessed by weighted and design-based log-linear regression model. MAIN OUTCOME MEASURES Severe symptoms of depression and anxiety in mothers of preterm infants. RESULTS Among the 2270 women completing CES-D and STAI questionnaires at the time of neonatal discharge, severe symptoms of depression occurred in 25 (65.8%) women having a caesarean before 26 weeks versus in 748 (50.6%) women having a caesarean after 26 weeks. Caesarean delivery before 26 weeks was associated with severe symptoms of depression compared with caesarean delivery after 26 weeks (adjusted relative risk [aRR] 1.42, 95% CI 1.12-1.81) adjusted to neonatal birthweight and severe neonatal morbidity among other factors. There was no evidence of an association between mode of delivery and symptoms of anxiety. CONCLUSIONS Mothers having a caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression and may benefit from specific preventive care. TWEETABLE ABSTRACT Mothers having caesarean delivery before 26 weeks' gestation are at high risk of symptoms of depression.
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Affiliation(s)
- J Blanc
- Department of Obstetrics and Gynaecology, APHM, Nord Hospital, Marseille, France.,EA3279, CEReSS, Health Service Research and Quality of Life Centre, Aix-Marseille University, Marseille, France
| | - N Rességuier
- EA3279, CEReSS, Health Service Research and Quality of Life Centre, Aix-Marseille University, Marseille, France
| | - E Lorthe
- INSERM, INRA, Epidemiology and Statistics Research Centre/CRESS, Université de Paris, Paris, France.,EPIUnit - Institute of Public Health, University of Porto, Porto, Portugal
| | - F Goffinet
- INSERM, INRA, Epidemiology and Statistics Research Centre/CRESS, Université de Paris, Paris, France.,Maternité Port-Royal, AP-HP, AP-HP Centre-Université de Paris, Paris, France
| | - L Sentilhes
- Department of Obstetrics and Gynaecology, Bordeaux University Hospital, Bordeaux, France
| | - P Auquier
- EA3279, CEReSS, Health Service Research and Quality of Life Centre, Aix-Marseille University, Marseille, France
| | - B Tosello
- Department of Neonatology, Assistance Publique des Hôpitaux de Marseille, North Hospital, France.,CNRS, EFS, ADES, Aix-Marseille University, Marseille, France
| | - C d'Ercole
- Department of Obstetrics and Gynaecology, APHM, Nord Hospital, Marseille, France.,EA3279, CEReSS, Health Service Research and Quality of Life Centre, Aix-Marseille University, Marseille, France
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Gureje O, Kola L, Oladeji BD, Abdulmalik J, Ayinde O, Zelkowitz P, Bennett I. Responding to the challenge of Adolescent Perinatal Depression (RAPiD): protocol for a cluster randomized hybrid trial of psychosocial intervention in primary maternal care. Trials 2020; 21:231. [PMID: 32106885 PMCID: PMC7047361 DOI: 10.1186/s13063-020-4086-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 01/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent pregnancy is a pressing public health issue globally, and particularly in low and middle-income countries. Depression occurring in the perinatal period is common among women and more so among adolescent mothers. Effective treatments for the condition have been demonstrated in adults but the needs of adolescents are often unique, making such treatments unlikely to meet those needs. METHOD/STUDY DESIGN A hybrid effectiveness-implementation research study is described in which a cluster randomized trial design is used to explore the effectiveness as well as the utility in routine practice of an intervention package specifically designed for adolescents with perinatal depression. Consenting pregnant adolescents (aged less than 20 years) who are newly registered for antenatal care are enrolled into the trial if their fetal gestational age is less than 36 weeks and they score 12 or more on the Edinburgh Postnatal Depression Scale (EPDS). The intervention package consists of structured sessions of behavior activation, problem-solving treatment, and parenting skills training, and is delivered by primary maternal health care providers, complemented by support provided by a "neighborhood mother" identified by the adolescent. Mothers in the control arm receive care as usual. The trial is conducted in clinics where the maternal providers are trained to deliver routine depression care with the use of the WHO Mental Health Gap Action Programme, intervention guide. Assessments are undertaken by trained blinded assessors at baseline, at childbirth, and at 3 and 6 months postpartum. The primary outcome, assessed at 6 months, is the level of maternal depression (measured with the EPDS). The secondary outcome is parenting skills (assessed with the Home Observation Measurement of the Environment, Infant-Toddler version), while tertiary outcomes include measures of disability, quality of life, mother-child bonding, as well as infants' nutritional and growth indices. DISCUSSION This, to the best of our knowledge, will be the first fully-powered trial of an intervention package specifically designed to address the unique needs of adolescents with perinatal depression. TRIAL REGISTRATION ISRCTN16775958. Registered on 30 April 2019.
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Affiliation(s)
- Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
| | - Lola Kola
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | | | | | - Olatunde Ayinde
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Phyllis Zelkowitz
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada.,Department of Psychiatry, Jewish General Hospital, Montreal, Canada
| | - Ian Bennett
- Departments of Family Medicine, Psychiatry and Behavioural Science, and Global Health, University of Washington, Seattle, WA, USA
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Petit AC, Eutrope J, Thierry A, Bednarek N, Aupetit L, Saad S, Vulliez L, Sibertin-Blanc D, Nezelof S, Rolland AC. Mother's Emotional and Posttraumatic Reactions after a Preterm Birth: The Mother-Infant Interaction Is at Stake 12 Months after Birth. PLoS One 2016; 11:e0151091. [PMID: 27022953 PMCID: PMC4811536 DOI: 10.1371/journal.pone.0151091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/22/2016] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Very preterm infants are known to be at risk of developmental disabilities and behavioural disorders. This condition is supposed to alter mother-infant interactions. Here we hypothesize that the parental coping with the very preterm birth may greatly influence mother-infant interactions. METHODS 100 dyads were included in 3 university hospitals in France. Preterm babies at higher risk of neurodevelopmental sequelae (PRI>10) were excluded to target the maternal determinants of mother-infant interaction. We report the follow-up of this cohort during 1 year after very preterm birth, with regular assessment of infant somatic state, mother psychological state and the assessment of mother-infant interaction at 12 months by validated scales (mPPQ, HADS, EPDS, PRI, DDST and PIPE). RESULTS We show that the intensity of post-traumatic reaction of the mother 6 months after birth is negatively correlated with the quality of mother-infant interaction at 12 months. Moreover, the anxious and depressive symptoms of the mother 6 and 12 months after birth are also correlated with the quality of mother-infant interaction at 12 months. By contrast, this interaction is not influenced by the initial affective state of the mother in the 2 weeks following birth. In this particular population of infants at low risk of sequelae, we also show that the quality of mother-infant interaction is not correlated with the assessment of the infant in the neonatal period but is correlated with the fine motor skills of the baby 12 months after birth. CONCLUSIONS This study suggests that mothers' psychological condition has to be monitored during the first year of very preterm infants' follow-up. It also suggests that parental interventions have to be proposed when a post-traumatic, anxious or depressive reaction is suspected.
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Affiliation(s)
- Anne-Cécile Petit
- CHU Reims, Hôpital Robert Debré, Service de Psychothérapie de l’Enfant et de l’Adolescent, Reims, France
| | - Julien Eutrope
- CHU Reims, Hôpital Robert Debré, Service de Psychothérapie de l’Enfant et de l’Adolescent, Reims, France
| | - Aurore Thierry
- CHU Reims, Hôpital Robert Debré, Unité d’aide méthodologique, Reims, France
| | - Nathalie Bednarek
- CHU Reims, American-Memorial-Hospital, Service de réanimation néonatale et néonatologie, Reims, France
| | | | - Stéphanie Saad
- CHU Nancy, Centre psychothérapique de Nancy, Service de pédopsychiatrie, Laxou, France
| | - Lauriane Vulliez
- CHU de Besançon, Hôpital Saint Jacques, Service de psychiatrie de l’enfant et de l’adolescent, Besançon, France
| | - Daniel Sibertin-Blanc
- CHU Nancy, Centre psychothérapique de Nancy, Service de pédopsychiatrie, Laxou, France
| | - Sylvie Nezelof
- CHU de Besançon, Hôpital Saint Jacques, Service de psychiatrie de l’enfant et de l’adolescent, Besançon, France
| | - Anne-Catherine Rolland
- CHU Reims, Hôpital Robert Debré, Service de Psychothérapie de l’Enfant et de l’Adolescent, Reims, France
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Reay RE, Mulcahy R, Wilkinson RB, Owen C, Shadbolt B, Raphael B. The Development and Content of an Interpersonal Psychotherapy Group for Postnatal Depression. Int J Group Psychother 2015; 62:221-51. [DOI: 10.1521/ijgp.2012.62.2.221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Murray-Kolb LE, Rasmussen ZA, Scharf RJ, Rasheed MA, Svensen E, Seidman JC, Tofail F, Koshy B, Shrestha R, Maphula A, Vasquez AO, da Costa HP, Yousafzai AK, Oria RB, Roshan R, Bayyo EB, Kosek M, Shrestha S, Schaefer BA, Bessong P, Ahmed T, Lang D. The MAL-ED cohort study: methods and lessons learned when assessing early child development and caregiving mediators in infants and young children in 8 low- and middle-income countries. Clin Infect Dis 2015; 59 Suppl 4:S261-72. [PMID: 25305296 DOI: 10.1093/cid/ciu437] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
More epidemiological data are needed on risk and protective factors for child development. In The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study, we assessed child development in a harmonious manner across 8 sites in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa, and Tanzania. From birth to 24 months, development and language acquisition were assessed via the Bayley Scales of Infant and Toddler Development and a modified MacArthur Communicative Development Inventory. Other measures were infant temperament, the child's environment, maternal psychological adjustment, and maternal reasoning abilities. We developed standard operating procedures and used multiple techniques to ensure appropriate adaptation and quality assurance across the sites. Test adaptation required significant time and human resources but is essential for data quality; funders should support this step in future studies. At the end of this study, we will have a portfolio of culturally adapted instruments for child development studies with examination of psychometric properties of each tool used.
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Affiliation(s)
| | - Zeba A Rasmussen
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | | | | | - Erling Svensen
- University of Bergen, Norway Haydom Lutheran Hospital, Haydom, Tanzania
| | - Jessica C Seidman
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Fahmida Tofail
- icddr,b (formerly the International Centre for Diarrhoeal Disease Research, Bangladesh), Dhaka, Bangladesh
| | | | - Rita Shrestha
- Institute of Medicine, Kathmandu, Nepal Royal Thai Army-Armed Forces Research Institute of Medical Sciences, Nepal and Thailand
| | | | - Angel Orbe Vasquez
- Asociacion Benefica PRISMA, Iquitos, Peru Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | | | - Margaret Kosek
- Asociacion Benefica PRISMA, Iquitos, Peru Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Sanjaya Shrestha
- Institute of Medicine, Kathmandu, Nepal Royal Thai Army-Armed Forces Research Institute of Medical Sciences, Nepal and Thailand
| | | | | | | | - Dennis Lang
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland The Foundation for the National Institutes of Health, Bethesda, Maryland
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Eutrope J, Thierry A, Lempp F, Aupetit L, Saad S, Dodane C, Bednarek N, De Mare L, Sibertin-Blanc D, Nezelof S, Rolland AC. Emotional reactions of mothers facing premature births: study of 100 mother-infant dyads 32 gestational weeks. PLoS One 2014; 9:e104093. [PMID: 25153825 PMCID: PMC4143228 DOI: 10.1371/journal.pone.0104093] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 07/09/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This current study has been conducted to clarify the relationship between the mother's post-traumatic reaction triggered by premature birth and the mother-infant interactions. In this article, the precocious maternal feelings are described. METHODS A multicenter prospective study was performed in three French hospitals. 100 dyads with 100 very premature infants and their mothers were recruited. Mothers completed, at two different times self-questionnaires of depression/anxiety, trauma and social support. The quality of interactions in the dyads was evaluated. RESULTS Thirty-nine percent of the mothers obtained a score at HADS suggesting a high risk of depression at the first visit and approximately one-third at visit two. Seventy-five percent of the mothers were at risk of suffering from an anxiety disorder at visit one and half remained so at visit two. A "depressed" score at visits one and two correlated with a hospitalization for a threatened premature labor. We noted a high risk of trauma for 35% of the mothers and high interactional synchrony was observed for approximately two-thirds of the dyads. The mothers' psychological reactions such as depression and anxiety or postnatal depression correlate strongly with the presence of an initial trauma. At visit one and visit two, a high score of satisfaction concerning social support correlates negatively with presence of a trauma. A maternal risk of trauma is more frequent with a C-section delivery. CONCLUSIONS Mothers' psychological reactions such as depression and anxiety correlate greatly with the presence of an initial trauma. The maternal traumatic reaction linked to premature birth does not correlate with the term at birth, but rather with the weight of the baby. Social support perceived by the mother is correlated with the absence of maternal trauma before returning home, and also seems to inhibit from depressive symptoms from the time of the infant's premature birth.
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Affiliation(s)
- Julien Eutrope
- CHU Reims, Hôpital Robert Debré, Structure interne de Psychothérapie de l'Enfant et de l'Adolescent, Reims, F-51092, France
| | - Aurore Thierry
- CHU Reims, Hôptal Robert Debré, Unité d'aide méthodologique, REIMS, F-51092, France
| | - Franziska Lempp
- CHU Reims, Hôpital Robert Debré, Structure interne de Psychothérapie de l'Enfant et de l'Adolescent, Reims, F-51092, France
| | | | - Stéphanie Saad
- CHU Nancy, Centre psychothérapique de Nancy, Service de pédopsychiatrie, Laxou, F-54521, France
| | - Catherine Dodane
- CHU de Besançon, Hôpital Saint Jacques, Service de psychiatrie de l'enfant et de l'adolescent, Besancon, F-25030, France
| | - Nathalie Bednarek
- CHU de Reims, Hôpital Maison Blanche, Structure Interne de Pédiatrie B, Reims, F-51092, France
| | | | - Daniel Sibertin-Blanc
- CHU Nancy, Centre psychothérapique de Nancy, Service de pédopsychiatrie, Laxou, F-54521, France
| | - Sylvie Nezelof
- CHU de Besançon, Hôpital Saint Jacques, Service de psychiatrie de l'enfant et de l'adolescent, Besancon, F-25030, France
| | - Anne-Catherine Rolland
- CHU Reims, Hôpital Robert Debré, Structure interne de Psychothérapie de l'Enfant et de l'Adolescent, Reims, F-51092, France
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Abstract
AbstractObjectives:To estimate the prevalence of postnatal depression in a community sample of women in a disadvantaged urban area in West Dublin, and to examine the factors which may be associated with it.Method: All women who had a live birth in the area over a one year period were identified (944) and the self-rated Edinburgh Postnatal Depression Scale (EPDS) was distributed to those who could be contacted by the public health nurses. Those scoring in the depressed range (> 12) were compared to non-depressed for age, marital status, employment, parity, presence of a confidant, mode of delivery, previous miscarriage and previous psychiatric history.Results: Contact was made with 596 women and 377 responded. Responders were older and more likely to be first time mothers, but there was no significant difference between responders and eligible population for marital status. One hundred and eight women (28.6%) scored in the depressed range. Ten sociodemographic and clinical variables were entered into a logistic regression. Scores over the threshold (> 12), suggesting clinical depression, were significantly associated with four variables, lower age, absence of a confidant, previous miscarriage and previous treatment for depression by a GP.Conclusions: A high prevalence of postnatal depression of 28.6% was reported, which may be associated with overall high levels of social disadvantage in this sample. There were implications for the targeting of resources into such areas. The associated factors are discussed.
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Miller BJ, Murray L, Beckmann MM, Kent T, Macfarlane B. Dietary supplements for preventing postnatal depression. Cochrane Database Syst Rev 2013:CD009104. [PMID: 24158923 PMCID: PMC10166593 DOI: 10.1002/14651858.cd009104.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Postnatal depression is a medical condition that affects many women and the development of their infants. There is a lack of evidence for treatment and prevention strategies that are safe for mothers and infants. Certain dietary deficiencies in a pregnant or postnatal woman's diet may cause postnatal depression. By correcting these deficiencies postnatal depression could be prevented in some women. Specific examples of dietary supplements aimed at preventing postnatal depression include: omega-3 fatty acids, iron, folate, s-adenosyl-L-methionine, cobalamin, pyridoxine, riboflavin, vitamin D and calcium. OBJECTIVES To assess the benefits of dietary supplements for preventing postnatal depression either in the antenatal period, postnatal period, or both. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2013). SELECTION CRITERIA Randomised controlled trials, involving women who were pregnant or who had given birth in the previous six weeks, who were not depressed or taking antidepressants at the commencement of the trials. The trials could use as intervention any dietary supplementation alone or in combination with another treatment compared with any other preventive treatment, or placebo, or standard clinical care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and assessed the risk of bias for the two included studies. Two review authors extracted data and the data were checked for accuracy. MAIN RESULTS We included two randomised controlled trials.One trial compared oral 100 microgram (µg) selenium yeast tablets with placebo, taken from the first trimester until birth. The trial randomised 179 women but outcome data were only provided for 85 women. Eighty-three women were randomised to each arm of the trial. Sixty-one women completed the selenium arm, 44 of whom completed an Edinburgh Postnatal Depression Scale (EPDS). In the placebo arm, 64 women completed the trial, 41 of whom completed an EPDS. This included study (n = 85) found selenium had an effect on EPDS scores but did not reach statistical significance (P = 0.07). There was a mean difference (MD) of -1.90 (95% confidence interval (CI) -3.92 to 0.12) of the self-reported EPDS completed by participants within eight weeks of delivery. There was a high risk of attrition bias due to a large proportion of women withdrawing from the study or not completing an EPDS. This included study did not report on any of the secondary outcomes of this review.The other trial compared docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA) with placebo. The trial randomised 126 women at risk of postpartum depression to three arms: 42 were allocated to EPA, 42 to DHA, and 42 to placebo. Three women in the EPA arm, four in the DHA arm, and one woman in the placebo arm were lost to follow-up. Women who were found to have major depressive disorder, bipolar disorder, current substance abuse or dependence, suicidal ideation or schizophrenia at recruitment were excluded from the study. The women who discontinued the intervention (five in the EPA arm, four in the DHA arm and seven in the placebo arm) were included in the intention-to-treat analysis, while those who were lost to follow-up were not. Women received supplements or placebo from recruitment at a gestational age of 12 to 20 weeks until their final review visit six to eight weeks postpartum. The primary outcome measure was the Beck Depression Inventory (BDI) score at the fifth visit (six to eight weeks postpartum). No benefit was found for EPA-rich fish oil (MD 0.70, 95% CI -1.78 to 3.18) or DHA-rich fish oil supplementation (MD 0.90, 95% CI -1.33 to 3.13) in preventing postpartum depression. No difference was found in the effect on postnatal depression comparing EPA with DHA (MD -0.20, 95% CI -2.61 to 2.21). No benefit or significant effect was found in terms of the secondary outcomes of the presence of major depressive disorder at six to eight weeks postpartum, the number of women who commenced antidepressants, maternal estimated blood loss at delivery or admission of neonates to the neonatal intensive care unit. AUTHORS' CONCLUSIONS There is insufficient evidence to conclude that selenium, DHA or EPA prevent postnatal depression. There is currently no evidence to recommend any other dietary supplement for prevention of postnatal depression.
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Affiliation(s)
- Brendan J Miller
- Department of Obstetrics and Gynaecology, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia, 5042
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Levy Y, Austin MP, Halliday G. Use of ultra-brief pulse electroconvulsive therapy to treat severe postnatal mood disorder. Australas Psychiatry 2012; 20:429-32. [PMID: 23014119 DOI: 10.1177/1039856212458979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the use of ultra-brief electroconvulsive therapy (ECT) in three postnatal women with severe, treatment resistant depression. The indications and evidence for the use of ECT in the treatment of postnatal depression are discussed. METHOD We present a case series and review relevant literature. RESULTS Three patients with severe episodes of depression postnatally, not responding to medication, presented to a private mother-baby inpatient unit. All three patients had significant suicidal ideation and two underwent involuntary treatment in public hospitals during the course of their presenting illnesses. They were treated with right unilateral ultra-brief ECT and a range of medications. All women began to respond within 3-6 treatments and no significant cognitive side effects were observed. CONCLUSIONS Our findings suggest that right unilateral ultra-brief ECT is a useful treatment modality for severe and treatment resistant depression in the postnatal period. ECT is a useful option in women who have experienced significant medication side effects, or for those whose severity of illness necessitates rapid symptom resolution. Ultra-brief ECT caused minimal clinically observable side effects, which may assist mothers to resume care of their infants more rapidly.
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Affiliation(s)
- Yael Levy
- St John of God Hospital, Burwood, NSW, Australia.
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Dennis CL, Ravitz P, Grigoriadis S, Jovellanos M, Hodnett E, Ross L, Zupancic J. The effect of telephone-based interpersonal psychotherapy for the treatment of postpartum depression: study protocol for a randomized controlled trial. Trials 2012; 13:38. [PMID: 22515528 PMCID: PMC3404910 DOI: 10.1186/1745-6215-13-38] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 04/19/2012] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Substantial data indicate potential health consequences of untreated postpartum depression (PPD) on the mother, infant, and family. Studies have evaluated interpersonal psychotherapy (IPT) as treatment for PPD; however, the results are questionable due to methodological limitations. A comprehensive review of maternal treatment preferences suggests that mothers favor 'talking therapy' as a form of PPD treatment. Unfortunately, IPT is not widely available, especially in rural and remote areas. To improve access to care, telepsychiatry has been introduced, including the provision of therapy via the telephone. METHODS/DESIGN The purpose of this randomized controlled trial is to evaluate the effect of telephone-based IPT on the treatment of PPD. Stratification is based on self-reported history of depression and province. The target sample is 240 women. Currently, women from across Canada between 2 and 24 weeks postpartum are able to either self-identify as depressed and refer themselves to the trial or they may be referred by a health professional based on a score >12 on the Edinburgh Postnatal Depression Scale (EPDS). Following contact by the trial coordinator, a detailed study explanation is provided. Women who fulfill the eligibility criteria (including a positive diagnostic assessment for major depression) and consent to participate are randomized to either the control group (standard postpartum care) or intervention group (standard postpartum care plus 12 telephone-based IPT sessions within 12 to 16 weeks, provided by trained nurses). Blinded research nurses telephone participants at 12, 24, and 36 weeks post-randomization to assess for PPD and other outcomes including depressive symptomatology, anxiety, couple adjustment, attachment, and health service utilization. Results from this ongoing trial will: (1) develop the body of knowledge concerning the effect of telephone-based IPT as a treatment option for PPD; (2) advance our understanding of training nurses to deliver IPT; (3) provide an economic evaluation of an IPT intervention; (4) investigate the utility of the EPDS in general clinical practice to identify depressed mothers; and (5) present valuable information regarding PPD, along with associated couple adjustment, co-morbid anxiety and self-reported attachment among a mixed rural and urban Canadian population. TRIAL REGISTRATION Current Controlled Trials Ltd. ISRCTN88987377.
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Affiliation(s)
- Cindy-Lee Dennis
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada
- Women’s College Hospital, Women’s College Research Institute, 790 Bay Street, Toronto, ON, Canada
| | - Paula Ravitz
- Department of Psychiatry, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, 600 University Avenue, Toronto, ON, M5G 1X5, Canada
| | - Sophie Grigoriadis
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Melissa Jovellanos
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada
| | - Ellen Hodnett
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada
| | - Lori Ross
- Centre for Addiction and Mental Health, 455 Spadina Avenue, Suite 302, Toronto, ON, M5S 2G8, Canada
| | - John Zupancic
- Department of Neonatology, Beth Israel Deaconess Medical Center, Rose 318, 330 Brookline Avenue, Boston, MA, 02115, USA
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deCastro F, Hinojosa-Ayala N, Hernandez-Prado B. Risk and protective factors associated with postnatal depression in Mexican adolescents. J Psychosom Obstet Gynaecol 2011; 32:210-7. [PMID: 22050327 DOI: 10.3109/0167482x.2011.626543] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We explored factors associated with postnatal depression and further evaluated whether any of these risk and protective factors are specific for adolescent mothers. Data concerning depression levels, family and individual factors were collected in a cross-sectional study which surveyed 298 women in Monterrey, N.L., Mexico. Mean maternal age was 24.64 years, and 27.18% of the mothers were between 14 and 19 years old. Prevalence of postnatal depression was higher in adolescents (16.05%) than in adult mothers (14.29%) but, on average, this difference was not significant. The association between individual factors and postnatal depression for both adult and adolescent mothers was explored. Our results revealed that social support is significantly associated with less possibility of postnatal depression in both groups, and that this effect is stronger for adolescents (OR=0.81) than for adults (OR=0.92). For the sample as a whole postnatal depression was associated with lower levels of education, reported fear during labor and living with partner. We also found that having a girl greatly increased the possibility of postnatal depression. We conclude that social support is a protective factor associated with postnatal depression, especially for adolescents.
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Affiliation(s)
- Filipa deCastro
- Reproductive Health Division, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
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Letourneau N, Watson B, Duffett-Leger L, Hegadoren K, Tryphonopoulos P. Cortisol patterns of depressed mothers and their infants are related to maternal–infant interactive behaviours. J Reprod Infant Psychol 2011. [DOI: 10.1080/02646838.2011.649474] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Records K, Keller C, Ainsworth B, Permana P. Instrument selection for randomized controlled trials: why this and not that? Contemp Clin Trials 2011; 33:143-50. [PMID: 21986392 DOI: 10.1016/j.cct.2011.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 09/20/2011] [Indexed: 10/17/2022]
Abstract
A fundamental linchpin for obtaining rigorous findings in quantitative research involves the selection of survey instruments. Psychometric recommendations are available for the processes for scale development and testing and guidance for selection of established scales. These processes are necessary to address the validity link between the phenomena under investigation, the empirical measures and, ultimately, the theoretical ties between these and the world views of the participants. Detailed information is most often provided about study design and protocols, but far less frequently is a detailed theoretical explanation provided for why specific instruments are chosen. Guidance to inform choices is often difficult to find when scales are needed for specific cultural, ethnic, or racial groups. This paper details the rationale underlying instrument selection for measurement of the major processes (intervention, mediator and moderator variables, outcome variables) in an ongoing study of postpartum Latinas, Madres para la Salud [Mothers for Health]. The rationale underpinning our choices includes a discussion of alternatives, when appropriate. These exemplars may provide direction for other intervention researchers who are working with specific cultural, racial, or ethnic groups or for other investigators who are seeking to select the 'best' instrument. Thoughtful consideration of measurement and articulation of the rationale underlying our choices facilitates the maintenance of rigor within the study design and improves our ability to assess study outcomes.
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Affiliation(s)
- Kathie Records
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, United States.
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Letourneau N, Stewart M, Dennis CL, Hegadoren K, Duffett-Leger L, Watson B. Effect of home-based peer support on maternal-infant interactions among women with postpartum depression: a randomized, controlled trial. Int J Ment Health Nurs 2011; 20:345-57. [PMID: 21385294 DOI: 10.1111/j.1447-0349.2010.00736.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Approximately 15% of new mothers experience postpartum depression, representing the most common source of maternal morbidity post-delivery. Postpartum depression may impair maternal-infant interactions, contributing to poor developmental outcomes in the offspring of mothers with depression. The purpose of this study was to test the effectiveness of home-based peer support that included maternal-infant interaction teaching for mothers with symptoms of postpartum depression and their infants. Mothers with postpartum depression were randomly assigned to control (n = 33) or intervention groups (n = 27). Intervention group mothers received 12 weeks of home-based peer support that included maternal-infant interaction teaching; peers were mothers who had recovered from postpartum depression and were trained to provide support. Data were collected from all mothers at baseline, as well as 6 and 12 weeks' post-randomization. Contrary to the hypothesized direction of relationships, results favoured the control group. A significant difference between the groups was observed for one of the two measures of maternal-infant interactions. Several other measures favoured the control group, including mothers' depressive symptoms and social support scores. No significant treatment effects were observed in infant IQ scores or diurnal salivary cortisol levels in mothers or infants. The findings suggest that maternal-infant interaction teaching by peers is not well received by mothers with postpartum depression and might be more optimally delivered by professional nurses.
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Miller BJ, Murray L, Beckmann MM, Kent T, Macfarlane B. Dietary supplements for preventing postnatal depression. Cochrane Database Syst Rev 2011. [DOI: 10.1002/14651858.cd009104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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18
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Keller C, Records K, Ainsworth B, Belyea M, Permana P, Coonrod D, Vega-López S, Nagle-Williams A. Madres para la Salud: design of a theory-based intervention for postpartum Latinas. Contemp Clin Trials 2011; 32:418-27. [PMID: 21238614 DOI: 10.1016/j.cct.2011.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 12/29/2010] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Weight gain in young women suggests that childbearing may be an important contributor to the development of obesity in women. Depressive symptoms can interfere with resumption of normal activity levels following childbirth or with the initiation of or adherence to physical activity programs essential for losing pregnancy weight. Depression symptoms may function directly to promote weight gain through a physiologic mechanism. Obesity and its related insulin resistance may contribute to depressed mood physiologically. Although physical activity has well-established beneficial effects on weight management and depression, women tend to under participate in physical activity during childbearing years. Further, the mechanisms underpinning the interplay of overweight, obesity, physical activity, depression, and inflammatory processes are not clearly explained. OBJECTIVES This report describes the theoretical rationale, design considerations, and cultural relevance for "Madres para la Salud" [Mothers for Health]. DESIGN AND METHODS Madres para la Salud is a 12 month prospective, randomized controlled trial exploring the effectiveness of a culturally specific intervention using "bouts" of physical activity to effect changes in body fat, systemic and fat tissue inflammation, and postpartum depression symptoms in sedentary postpartum Latinas. SUMMARY The significance and innovation of Madres para la Salud includes use of a theory-driven approach to intervention, specification and cultural relevance of a social support intervention, use of a Promotora model to incorporate cultural approaches, use of objective measures of physical activity in post partum Latinas women, and the examination of biomarkers indicative of cardiovascular risk related to physical activity behaviors in postpartum Latinas.
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Affiliation(s)
- Colleen Keller
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA.
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19
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Logsdon MC, Myers JA. Comparative Performance of Two Depression Screening Instruments in Adolescent Mothers. J Womens Health (Larchmt) 2010; 19:1123-8. [DOI: 10.1089/jwh.2009.1511] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - John A. Myers
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, Kentucky
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A randomised control trial for the effectiveness of group Interpersonal Psychotherapy for postnatal depression. Arch Womens Ment Health 2010; 13:125-39. [PMID: 19697094 DOI: 10.1007/s00737-009-0101-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 08/05/2009] [Indexed: 01/03/2023]
Abstract
This study is a randomised controlled trial comparing outcomes from an 8-week Interpersonal Psychotherapy group (IPT-G) for postnatal depression with 'treatment as usual' (TAU), conducted in a routine community setting in the Australian Capital Territory (ACT). Eligible women were recruited and randomly assigned to either IPT-G or TAU conditions. This study compared outcomes on such variables as depressive symptoms, marital adjustment, social support and mother-infant bond at baseline, mid-treatment, end-of-treatment and 3 months follow-up. Participants were also independently assessed using the Hamilton Depression Rating Scale (HAM-D). 50 women completed baseline assessments and were included in the analysis. Comparisons of treatment conditions showed that by end of treatment both the TAU and IPT-G groups significantly improved in terms of mean depression scores, however, the IPT-G women improved significantly more and had continued improvements at 3 months post therapy. Furthermore, women who received IPT-G displayed significant improvement in terms of marital functioning and perceptions of the mother-infant relationship compared to TAU participants. These findings highlight the potential benefits of an interpersonally based treatment, which not only improves outcomes for the mother but also potentially for the couple and the infant when compared to usual care.
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Affiliation(s)
- Ricardo F. Muñoz
- Department of Psychiatry at San Francisco General Hospital, University of California, San Francisco, California 94110; ,
| | - Pim Cuijpers
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, 1081 BT The Netherlands; , ,
| | - Filip Smit
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, 1081 BT The Netherlands; , ,
| | - Alinne Z. Barrera
- Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, California 94304;
| | - Yan Leykin
- Department of Psychiatry at San Francisco General Hospital, University of California, San Francisco, California 94110; ,
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22
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Wisner KL, Logsdon MC, Shanahan BR. Web-based education for postpartum depression: conceptual development and impact. Arch Womens Ment Health 2008; 11:377-85. [PMID: 18784975 DOI: 10.1007/s00737-008-0030-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Accepted: 08/17/2008] [Indexed: 11/30/2022]
Abstract
Postpartum depression (PPD) is a major public health problem that occurs in one of every seven women in the first 3 months after birth. Left untreated, PPD can persist for months to years and lead to adverse consequences for both mother and child. Primary care providers have the most medical contact with postpartum women and are well positioned to screen for and identify PPD. However, PPD recognition and treatment is generally not included in physician training, and few continuing education programs on PPD are available. Developed with support from NIMH SBIR contract (# HHSN278200554096C), the Web site MedEdPPD was designed to provide professionals with the tools to successfully engage, screen, diagnose, treat, and refer women with PPD. Resources on the site include CME/CE modules; interactive case studies; classic papers and current literature; provider tools; a comprehensive slide library; events calendar; and resources. MedEdPPD also contains materials for women with PPD, their friends and family members. As of March 2008, the site had over 17,000 visitors who represented both consumers and a broad distribution of health care professional disciplines. The nine CME/CE learning modules on MedEdPPD have been particularly heavily utilized by nurses. The number of repeat and new visitors has increased steadily since the site's launch. User feedback has been consistently positive. Based upon theories of adult education, MedEdPPD offers diverse strategies to facilitate learning. The site promotes education and training in PPD treatment that is flexible, cost-effective, and meets the needs of health care professionals.
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Affiliation(s)
- Katherine L Wisner
- Epidemiology and Women's Studies, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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23
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Davies J, Slade P, Wright I, Stewart P. Posttraumatic stress symptoms following childbirth and mothers' perceptions of their infants. Infant Ment Health J 2008. [PMID: 28636249 DOI: 10.1002/imhj.20197] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Postpartum psychological distress can adversely affect the early mother-infant relationship; however, this has not been investigated in relation to posttraumatic stress disorder (PTSD) following childbirth. This article explores whether PTSD symptoms relating to labor and delivery are associated with mothers' early perceptions of their infant. Using labor and childbirth as the stressor criterion, 211 women were assessed at 6 weeks' postpartum for symptoms of intrusions, avoidance, and hyperarousal. Their perceptions of their infants, of mother-to-infant attachment, and infant behavioral characteristics also were evaluated. In sum, 3.8% of the women fulfilled full diagnostic criteria, and a further 21.3% reported clinically significant symptoms on at least one dimension of PTSD. Those meeting full or partial criteria perceived their attachment relationships to be significantly less optimal and reported more negative maternal representations in terms of their infants being less warm and more invasive. They also rated them as being temperamentally more difficult, prone to distress, and less easy to soothe. However, when the effects of depression were partialled, only the effect for perceived warmth remained. Posttraumatic stress symptoms relating to labor and delivery may adversely influence maternal perceptions of infants, with potentially adverse implications for the developing mother-infant relationship. The overlap with depressive symptoms requires further exploration.
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Affiliation(s)
- John Davies
- Norfolk and Waveney Mental Health Partnership NHS Trust, United Kingdom
| | | | | | - Peter Stewart
- Sheffield Teaching Hospitals Foundation NHS Trust, United Kingdom
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Wisner KL, Scholle SH, Stein B. Perinatal disorders: advancing public health opportunities. J Clin Psychiatry 2008; 69:1602-5. [PMID: 19192443 PMCID: PMC7077030 DOI: 10.4088/jcp.v69n1010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Katherine L. Wisner
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Bradley Stein
- University of Pittsburgh School of Medicine, Community Care Behavioral Health, RAND Corporation, Pittsburgh, Pennsylvania
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Santos IS, Matijasevich A, Tavares BF, Barros AJD, Botelho IP, Lapolli C, Magalhães PVDS, Barbosa APPN, Barros FC. Validation of the Edinburgh Postnatal Depression Scale (EPDS) in a sample of mothers from the 2004 Pelotas Birth Cohort Study. CAD SAUDE PUBLICA 2008; 23:2577-88. [PMID: 17952250 DOI: 10.1590/s0102-311x2007001100005] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 02/14/2007] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the Edinburgh Postnatal Depression Scale (EPDS) for screening and diagnosis of postpartum depression. Three months after delivery, EPDS was administered to 378 mothers from the 2004 Pelotas Birth Cohort Study, Rio Grande do Sul State, Brazil. Up to 15 days later, mothers were re-interviewed by mental health care professionals using a semi-structured interview based on ICD-10 (gold standard). We calculated the sensitivity and specificity of each cutoff point, and values were plotted as a receiver operator characteristic curve. The best cutoff point for screening postpartum depression was > 10, with 82.6% (75.3-89.9%) sensitivity and 65.4% (59.8-71.1%) specificity. For screening moderate and severe cases, the best cutoff point was > 11, with 83.8% (73.4-91.3%) sensitivity and 74.7% (69.4-79.5%) specificity. For diagnosis, EPDS was valid only for prevalence of postpartum depression in the 20-25% range, with 60% PPV for the > 13 cutoff point (59.5% sensitivity; 88.4% specificity). The specificities and PPVs for all cutoff points were below those reported by other authors. Small numbers and the calculation of PPV in samples with overrepresentation of cases in the majority of studies appear to account for these differences.
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Affiliation(s)
- Iná S Santos
- Faculdade de Medicina, Universidade Federal de Pelotas, Avenida Duque de Caxias 250, Pelotas, RS, Brazil
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Hanusa BH, Scholle SH, Haskett RF, Spadaro K, Wisner KL. Screening for depression in the postpartum period: a comparison of three instruments. J Womens Health (Larchmt) 2008; 17:585-96. [PMID: 18345995 PMCID: PMC7083208 DOI: 10.1089/jwh.2006.0248] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Postpartum depression, the most prevalent complication of childbirth, is often unrecognized. Our objective was to compare the effectiveness of three screening instruments--Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ-9), and the 7-item screen of the Postpartum Depression Screening Scale (PDSS)--for identifying women with postpartum depression in the first 6 months after delivery. METHODS We administered the three instruments via telephone to women who were > or =18 years and had delivered infants 6-8 weeks earlier. We arranged home interviews to confirm DSM-IV criteria current major depressive disorder (MDD) in women who had an above-threshold score on any of the instruments. For women who screened negative on the 6-8 week call, we repeated the screening at 3 months and 6 months to identify emergent symptoms. The primary outcome measures were the screening scores and DSM-IV diagnoses. RESULTS Of 135 women reached, 123 (91%) were screened, 29 (24%) had home visits, and 13 (11%) had an MDD within 6 months of delivery. Analyses of the scores at 6-8 weeks postpartum and the DSM-IV diagnoses indicated the EPDS at a cutoff point of > or =10 identified 8 (62%) of cases, the PHQ-9 at a cutoff point of > or =10 identified 4 (31%), and the PDSS 7-item Short Form (PDSS_SF) at a cutoff point of > or =14 identified 12 (92%). However, 15 of 16 (94%) women without current MDD screened positive on the PDSS_SF. The EPDS was significantly more accurate (p = 0.01) than the PDSS_SF and PHQ-9 with the cutoff points used. After correcting for verification bias, we found the EPDS and the PDSS_SF were significantly more accurate than the PHQ-9 (p < 0.03). CONCLUSIONS Administering the EPDS by phone at 6-8 weeks postpartum is an efficient and accurate way to identify women at high risk for postpartum depression within the first 6 months after delivery.
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Affiliation(s)
- Barbara H Hanusa
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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McGrath JM, Records K, Rice M. Maternal depression and infant temperament characteristics. Infant Behav Dev 2007; 31:71-80. [PMID: 17714790 PMCID: PMC2268864 DOI: 10.1016/j.infbeh.2007.07.001] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2006] [Revised: 02/15/2007] [Accepted: 07/03/2007] [Indexed: 01/17/2023]
Abstract
One hundred-thirty-nine women participated in this longitudinal study from the third trimester of pregnancy through 8-months postpartum. Women completed depression scales at several time points and rated their infant's characteristics and childcare stress at 2- and 6-months postpartum. Mothers' reports of infant temperament were significantly different for depressed and non-depressed mothers, with depressed mothers reporting more difficult infants at both measurement points. These differences remained after controlling for histories of maternal abuse or prenatal anxiety, which occurred more often in the depressed mothers. There were no significant differences in childcare stress or perceived support between the groups. Infant temperament and childcare stress did not change over time. Recommendations for practice include consistent ongoing evaluations of the "goodness of fit" within the dyad and exploring interventions for depressed mothers that provide guidance about interactions with their infants and the appropriateness of the infant behaviors.
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Affiliation(s)
- Jacqueline M McGrath
- School of Nursing, Virginia Commonwealth University, P.O. Box 980567, Richmond, VA 23298, USA.
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28
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Affiliation(s)
- Mary Ross-Davie
- NHS Borders in Scotland and is seconded as the Practice Development Midwife with NHS Quality Improvement Scotland
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Buultjens M, Liamputtong P. When giving life starts to take the life out of you: women's experiences of depression after childbirth. Midwifery 2007; 23:77-91. [PMID: 16934378 DOI: 10.1016/j.midw.2006.04.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 03/24/2006] [Accepted: 04/08/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To capture the missing voices of mothers who are suffering postnatal depression. DESIGN Qualitative methodology using in-depth interviews. SETTING Melbourne, Victoria, Australia. PARTICIPANTS 10 women who had been clinically diagnosed and admitted to a large hospital mother and baby unit in Australia. FINDINGS Stigma is frequently attached to women who are unhappy after the birth of their child, because they are not coping with the demands of motherhood or do not instantly bond with, and love, their baby. As a result, postnatal depression can be a terrifying and isolating experience for women. It is also a complex illness with varying degrees, reasons for onset and medical treatments. IMPLICATIONS FOR PRACTICE In this study, we have captured the emotions and feelings of women first hand, allowing us and health-care practitioners who are treating women to truly understand this debilitating illness. It is hoped that, in making the wider community aware of depression after childbirth, fewer women will suffer in silence.
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Affiliation(s)
- Melissa Buultjens
- School of Public Health, La Trobe University, Bundoora, Victoria, Australia, 3086
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30
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Cuijpers P, Brännmark JG, van Straten A. Psychological treatment of postpartum depression: a meta-analysis. J Clin Psychol 2007; 64:103-18. [DOI: 10.1002/jclp.20432] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Tezel A, Gözüm S. Comparison of effects of nursing care to problem solving training on levels of depressive symptoms in post partum women. PATIENT EDUCATION AND COUNSELING 2006; 63:64-73. [PMID: 16448799 DOI: 10.1016/j.pec.2005.08.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 08/24/2005] [Accepted: 08/25/2005] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The aim of this study was to compare the effect of nursing intervention to the effect of problem solving training on the level of postpartum depressive symptom. METHODS We utilized a pretest-posttest mutual controlled semi experimental model for this study. The study consisted of 62 women (30 in care group and 32 in training group), all of who were at risk for postpartum depression, but without major depressive symptoms. These women were not undergoing pharmacologic or psychotherapeutic treatment, were all literate and consented to join the study in Erzurum, Turkey. Participants (N=62), recruited over a 9 month, were randomly assigned to one of two groups. Women in care group (average age=21, 33.3% primaparus) were given nursing care for her depressive symptoms. Women in training group (average age=25, 33.9% primaparus) were taught problem solving skills. RESULTS Depressive symptoms were assessed before and after nursing interventions. We found that nursing care was effective women for with depressive symptoms (McNemar test, p<0.001), and problem-solving training was also effective (McNemar test, p<0.05). When the effectiveness of nursing care and the problem solving education was compared utilizing the BDI, it was found out that the nursing care was more effective than education alone (t=4.529, p<0.05). CONCLUSION Results from this study suggest that nursing care and problem solving training may be use confidently in the primary care setting by nurses for women with postpartum depressive symptoms. PRACTICE IMPLICATION Nurses play on important role in its detection and can reduce depressive symptoms. Public health nurses are equipped with care paths addressing specific health needs of depressed women in the primary care setting. Our finding indicate that these two programs of study can converge with meaningful results, and perhaps future research could address these points in a theoretical framework.
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Affiliation(s)
- Ayfer Tezel
- Atatürk University Erzurum Health School, Nursing Department, Erzurum, Turkey.
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Ross-Davie M, Elliott S, Sarkar A, Green L. A public health role in perinatal mental health: Are midwives ready? ACTA ACUST UNITED AC 2006. [DOI: 10.12968/bjom.2006.14.6.21181] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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DeRosa N, Logsdon MC. A Comparison of Screening Instruments for Depression in Postpartum Adolescents. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2006; 19:13-20. [PMID: 16464212 DOI: 10.1111/j.1744-6171.2006.00037.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
TOPIC It is important to screen postpartum adolescents for depression during routine healthcare visits so that depression can be identified and treated. PURPOSE The purpose of the manuscript is to compare available depression screening instruments and to provide guidance to healthcare providers on choice of instrument. SOURCES USED Published studies. CONCLUSIONS In order to capture the common symptoms of adolescent and postpartum depression, a combination of screening instruments should be used.
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Affiliation(s)
- Nancy DeRosa
- University of Louisville and Women's Care Physicians in Louisville, KY, USA
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Davey SJ, Dziurawiec S, O'Brien-Malone A. Men's voices: postnatal depression from the perspective of male partners. QUALITATIVE HEALTH RESEARCH 2006; 16:206-20. [PMID: 16394210 DOI: 10.1177/1049732305281950] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Postnatal depression (PND) is a serious and debilitating condition that is recognized as being disruptive to women's lives at a time when they are already under stress adapting to the demands that a new baby creates. What has not always been fully acknowledged is that PND is linked with elevated levels of depression in male partners. In this article, the authors report on men's experiences of PND and of participation in a 6-week group treatment program specifically designed for male partners. The men experienced their partners' PND as overwhelming, isolating, stigmatizing, and frustrating. Coping with PND was assisted by participation in the men's group. Men reported lowered levels of depression and stress, and higher levels of social support, as a result of their participation. The men valued highly the opportunity to share experiences with peers, to hear strategies for engaging in their relationship, and to gain factual information.
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Affiliation(s)
- Sarah J Davey
- South Metropolitan Child and Adolescent Mental Health Service, Fremantle, Australia
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Records K, Rice MJ. A comparative study of postpartum depression in abused and non-abused women. Arch Psychiatr Nurs 2005; 19:281-90. [PMID: 16308128 DOI: 10.1016/j.apnu.2005.07.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2004] [Revised: 07/07/2005] [Accepted: 07/27/2005] [Indexed: 11/24/2022]
Abstract
Because of a rise in postpartum depression (PPD), the U.S. Department of Health and Human Services recently indicated a need for more studies of possible risk factors for PPD. PPD can continue for months or years after birth and has consequences for the family as a whole. Past research has not investigated the relationships between abuse, whether physical, sexual, or emotional, and PPD. The aim of this pilot study was to compare the prevalence of PPD among abused and non-abused women during the first 4 months after birth. Although 89 women initially enrolled in the study, only 50 participants completed the 1-week data collection. Of these 50, 30% reported previous or current physical or sexual abuse. Of these 50 participants, 22 dropped out during the 4-month-long study, resulting in a final sample size of 28. Abused women were significantly more depressed at 1 week and 2 and 3 months postpartum than the non-abused group until their depression scores at entry into the study and 1 week were statistically controlled. An unexpected finding was the prevalence of depression at 1 week after birth, indicative of unresolved prenatal depression, "baby blues," or true PPD. In addition, emotional abuse was reported by both groups and was significantly higher for the previously abused women. Although sample size and high attrition limit generalization, there was no significant difference in the prevalence of PPD between the two groups. Future research should explore the relationships between abuse and depression with larger samples and include pregnant subjects.
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Affiliation(s)
- Kathie Records
- Intercollegiate College of Nursing, Washington State University, Spokane, WA 99224-5291, USA.
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Adewuya AO, Fatoye FO, Ola BA, Ijaodola OR, Ibigbami SMO. Sociodemographic and obstetric risk factors for postpartum depressive symptoms in Nigerian women. J Psychiatr Pract 2005; 11:353-8. [PMID: 16184076 DOI: 10.1097/00131746-200509000-00009] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Studies from the Western culture have emphasized psychosocial risk factors for the development of postnatal depression (PND). In Africa, poor obstetrics practice and sociodemographic factors may contribute significantly to the risk of PND. The goal of this study was to examine sociodemographic and obstetric risk factors for postnatal depressive symptoms in a Nigerian community. METHODS 876 women recruited at 6 weeks postpartum from the postnatal and infant immunization clinics of 5 participating health centers were screened with the Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic and obstetric information were also obtained through a structured questionnaire. RESULTS The mean EPDS score was 5.66 (SD = 4.20). Depression was diagnosed in 128 (14.6 %) of the postpartum women. The predictors of PND include hospital admissions during the pregnancy (OR 3.95, CI 2.57-6.07), female sex of the baby (OR 2.74, CI 1.87-4.03), preterm delivery (OR 4.21, CI 2.78-6.39), instrumental delivery (OR 3.32, CI 1.79-6.16), Cesarean section (OR 3.58, CI 1.72-7.48), and being single (OR 3.44, CI 2.15-5.53). CONCLUSION Although the prevalence of PND symptoms seems to be the same across cultures, risk factors differ significantly. This study identified certain sociodemographic and obstetric risk factors for postnatal depressive symptoms in an underdeveloped community. These factors must be taken into consideration when planning intervention and preventive strategies for these women.
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Affiliation(s)
- Abiodun O Adewuya
- Department of Mental Health, Obafemi Awolowo University, Teaching Hospitals Complex, Wesley Guild Hospital, Ile-Ife, ILESA 233001, Osun State, Nigeria
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Corwin EJ, Brownstead J, Barton N, Heckard S, Morin K. The Impact of Fatigue on the Development of Postpartum Depression. J Obstet Gynecol Neonatal Nurs 2005; 34:577-86. [PMID: 16227513 DOI: 10.1177/0884217505279997] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Previous research suggests early postpartum fatigue (PPF) plays a significant role in the development of postpartum depression (PPD). Predicting risk for PPD via early identification of PPF may provide opportunity for intervention. OBJECTIVE To replicate and extend previous studies concerning the impact of PPF on symptoms of PPD and to describe the relationships among PPF, PPD, and other variables using the theory of unpleasant symptoms. DESIGN Correlational, longitudinal study. SETTING Participants' homes. PARTICIPANTS Convenience sample of 42 community-dwelling women recruited before 36 weeks of pregnancy. MAIN OUTCOME MEASURES PPF, depressive symptoms, and stress measured during prenatal weeks 36 to 38, and on Days 7, 14, and 28 after childbirth. Salivary cortisol was measured as a physiological marker of stress. RESULTS Significant correlations were obtained between PPF and symptoms of PPD on Days 7, 14, and 28, with Day 14 PPF levels predicting future development of PPD symptoms in 10 of 11 women. Perceived stress, but not cortisol, was also correlated with symptoms of PPD on Days 7, 14, and 28. Women with a history of depression had elevated depression scores compared to women without, but no variable was as effective at predicting PPD as PPF. CONCLUSIONS Fatigue by Day 14 postpartum was the most predictive variable for symptoms of PPD on Day 28 in this population.
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Affiliation(s)
- Elizabeth J Corwin
- College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA.
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Carter FA, Carter JD, Luty SE, Wilson DA, Frampton CMA, Joyce PR. Screening and treatment for depression during pregnancy: a cautionary note. Aust N Z J Psychiatry 2005; 39:255-61. [PMID: 15777362 DOI: 10.1080/j.1440-1614.2005.01562.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the recruitment and retention of depressed pregnant women, identified initially through screening, to a randomized controlled psychotherapy trial. METHOD Consecutive pregnant women presenting for routine ultrasound scan were asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Women who scored greater than 12 on the EPDS and who agreed to contact were invited to attend an initial assessment to determine eligibility for the trial. Consenting, eligible women were randomized to either cognitive behaviour therapy (CBT) or routine clinical care (RCC). Follow-up assessments were conducted at mid (6 weeks following initial assessment), end (approximately 36 weeks gestation), and postpartum (approximately 4 months postdelivery) for all participants. RESULTS 400 women were offered the EPDS, and 93% completed the questionnaire (370/400). Thirteen percent (49/370) of these women scored greater than 12, although only a minority of these women agreed to be contacted (15/49). Of those who agreed to be contacted, less than half attended initial interview (7/15 attended; 3/15 ineligible; 5/15 declined). Upon interview, all women except for one, were eligible and consenting (6/7). Three women were randomized to CBT and three to RCC. Only one woman randomized to CBT chose to commence treatment, and only one woman randomized to RCC was offered treatment for her low mood by her lead maternity provider. CONCLUSIONS While the vast majority of pregnant women were willing to complete a depression screening questionnaire, most did not agree to additional contact or assessment, and either were not offered treatment or did not accept treatment. This was not an effective recruitment strategy for a randomized controlled psychotherapy trial.
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Affiliation(s)
- Frances A Carter
- Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand.
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Fisher JRW, Morrow MM, Ngoc NTN, Anh LTH. Prevalence, nature, severity and correlates of postpartum depressive symptoms in Vietnam. BJOG 2004; 111:1353-60. [PMID: 15663118 DOI: 10.1111/j.1471-0528.2004.00394.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine depressive symptomatology in women after childbirth in Ho Chi Minh City, Vietnam. DESIGN A cross sectional survey. SETTING Hung Vuong Obstetrics and Gynaecology Hospital and the Maternal, Child Health and Family Planning Center of Ho Chi Minh City, Vietnam. POPULATION Mothers of infants aged +/- six weeks attending well-baby clinics. METHOD Participants were recruited consecutively in the postnatal wards and invited to take part in the study at the first clinic visit. Individual structured interviews about health and social circumstances, including the Edinburgh Postnatal Depression Scale (EPDS) were administered during clinic visits. The interview schedule was translated into Vietnamese, back translated for verification and piloted. Interviewers were specifically trained members of staff of the two centres. MAIN OUTCOME MEASURES EPDS scores and responses to structured questions about specific and non-specific symptoms. RESULTS Of 506 women who participated, 166 (33%) had EPDS scores in the clinical range of > 12 and 99 (19%) acknowledged suicidal ideation. In a forward stepwise logistic regression analysis, 77% of cases with EPDS scores > 12 were correctly classified in a model which included unwelcome pregnancy, lack of a permanent job, < 30 days complete rest after childbirth, an unsettled baby, not being given special foods, avoiding proscribed foods and being unable to confide in their husbands. CONCLUSION Depressive symptomatology is more prevalent among parturient women in Ho Chi Minh City, Vietnam than reported rates in developed countries and is at present unrecognised.
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Affiliation(s)
- J R W Fisher
- Key Centre for Women's Health in Society, WHO Collaborating Centre in Women's Health, School of Population Health, University of Melbourne, Victoria 3010, Australia
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Abstract
BACKGROUND The cause of postpartum depression remains unclear, with extensive research suggesting a multi-factorial aetiology. However, epidemiological studies and meta-analyses of predictive studies have consistently demonstrated the importance of psychosocial and psychological variables. While interventions based on these variables may be effective treatment strategies, theoretically they may also be used in pregnancy and the early postpartum period to prevent postpartum depression. OBJECTIVES Primary: to assess the effect of diverse psychosocial and psychological interventions compared with usual antepartum, intrapartum, or postpartum care to reduce the risk of developing postpartum depression. Secondary: to examine (1) the effectiveness of specific types of psychosocial and psychological interventions, (2) the effectiveness of individual versus group-based interventions, (3) the effects of intervention onset and duration, and (4) whether interventions are more effective in women selected with specific risk factors. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group trials register (January 27 2004), the Cochrane Depression, Anxiety and Neurosis Group trials register (October 2003), the Cochrane Central Register of Controlled Trials (October 2003), MEDLINE (1966 to 2004), EMBASE (1980 to 2004) and CINAHL (1982 to 2004). We scanned secondary references and contacted experts in the field. SELECTION CRITERIA All published and unpublished randomised controlled trials of acceptable quality comparing a psychosocial or psychological intervention with usual antenatal, intrapartum, or postpartum care. DATA COLLECTION AND ANALYSIS Both reviewers participated in the evaluation of methodological quality and data extraction. Additional information was sought from several trial researchers. Results are presented using relative risk for categorical data and weighted mean difference for continuous data. MAIN RESULTS Fifteen trials, involving over 7600 women, were included. Overall, women who received a psychosocial intervention were equally likely to develop postpartum depression as those receiving standard care (relative risk (RR) 0.81, 95% confidence interval (CI) 0.65 to 1.02). One promising intervention appears to be the provision of intensive postpartum support provided by public health nurses or midwives (RR 0.68, 95% CI 0.55 to 0.84). Identifying mothers 'at-risk' assisted the prevention of postpartum depression (RR 0.67, 95% CI 0.51 to 0.89). Interventions with only a postnatal component appeared to be more beneficial (RR 0.76, 95% CI 0.58 to 0.98) than interventions that also incorporated an antenatal component. While individually-based interventions may be more effective (RR 0.76, 95% CI 0.59 to 1.00) than those that are group-based, women who received multiple-contact intervention were just as likely to experience postpartum depression as those who received a single-contact intervention. REVIEWERS' CONCLUSIONS Overall psychosocial interventions do not reduce the numbers of women who develop postpartum depression. However, a promising intervention is the provision of intensive, professionally-based postpartum support.
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Affiliation(s)
- C L Dennis
- Faculty of Nursing, University of Toronto, 50 St George Street, Toronto, Ontario, Canada, M5S 3H4
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Armstrong K, Edwards H. The effectiveness of a pram-walking exercise programme in reducing depressive symptomatology for postnatal women. Int J Nurs Pract 2004; 10:177-94. [PMID: 15265228 DOI: 10.1111/j.1440-172x.2004.00478.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The purpose of the research project was to examine the effects of exercise, social support and depression on postnatal women who reported experiencing postnatal depression. A 12-week randomized, controlled trial was conducted investigating the effects of an exercise intervention group (a pram-walking programme for mothers and their babies ) compared to a social support group (non-structured sessions, similar to a playgroup). Participants in both groups had given birth in the past 12 months. Pretest data of physical fitness and structured questionnaires were compared to post-test effects. The primary outcomes were to reduce the depressive symptomatology and improve fitness levels of participants in the pram-walking group. Secondary outcomes were to improve the social support levels of the participants in both groups and explore women's views about the programmes. It was hypothesized that the pram-walking group participants would improve their feelings of depression and fitness levels compared to the social support group, but that both groups would improve their perceived levels of social support. The results showed that mothers in the pram-walking intervention group improved their fitness levels and reduced their level of depressive symptomatology significantly more than the social support group. There were no significant changes to social support levels for both groups. Therefore, a direct association between improvement in fitness was related to improvement in depression for the pram-walking group. However, it is also suggested that other factors in combination with improvements in fitness influenced improvements in depression levels. It is recommended that pram-walking programmes for mothers with postnatal depression be implemented as pilot research into existing available services.
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Affiliation(s)
- Kylie Armstrong
- Centre for Nursing Research, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
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Dennis CLE. Preventing postpartum depression part II: A critical review of nonbiological interventions. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2004; 49:526-38. [PMID: 15453102 DOI: 10.1177/070674370404900804] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To critically review the literature to determine the current state of scientific knowledge concerning the prevention of postpartum depression (PPD) from a nonbiological perspective. METHODS Databases searched for this review include Medline, PubMed, Cinahl, PsycINFO, Embase, ProQuest, the Cochrane Library, and the World Health Organization Reproductive Health Library. Studies selected were peer-reviewed English-language articles published between January 1, 1966, and December 31, 2003. Criteria used to evaluate the interventions were derived from the standardized methodology developed by the Canadian Task Force on Preventive Health Care. RESULTS Twenty-nine studies that met criteria were examined. These included studies evaluating interpersonal psychotherapy, cognitive-behavioural therapy, psychological debriefing, antenatal classes, intrapartum support, supportive interactions, continuity of care, antenatal identification and notification, early postpartum follow-up, flexible postpartum care, educational strategies, and relaxation with guided imagery. CONCLUSIONS While this review demonstrates that no specific approach can be strongly recommended for clinical practice, many explicit research implications have been highlighted. To further address PPD as a public health problem, it is critical to include ethnically and socioeconomically diverse women in research efforts examining the differences among depression symptoms, intervention response rates, and health service use.
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Corwin EJ, Murray-Kolb LE, Beard JL. Low Hemoglobin Level Is a Risk Factor for Postpartum Depression. J Nutr 2003; 133:4139-42. [PMID: 14652362 DOI: 10.1093/jn/133.12.4139] [Citation(s) in RCA: 173] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The role of maternal anemia in the development of postpartum depression (PPD) is unclear. PPD is a serious disorder that may negatively affect the physical and emotional health of a new mother and her infant. Although psychosocial factors that increase the risk of developing PPD are known, few studies have identified physiologic factors that predispose a woman to PPD. New mothers were visited at home on d 7, 14 and 28 after an uncomplicated labor and delivery. Hemoglobin (Hb) concentration was measured via finger-prick blood at each visit, and the women completed the Center for Epidemiological Studies-Depressive Symptomatology Scale (CES-D) on d 28. There was a negative correlation between Hb concentration on d 7 postpartum and depressive symptoms on d 28 (r = -4.26; P = 0.009). CES-D scores (means +/- SEM) on d 7 of women with normal Hb levels > 120 g/L (12 g/dL) were significantly lower (6.90 +/- 1.04) than those of women with Hb levels < or = 120 g/L (12 g/dL) [16.36 +/- 3.34; t(35) = -3.632, P = 0.001]. Thus, women suffering early postpartum anemia may be at increased risk of developing PPD.
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Affiliation(s)
- Elizabeth J Corwin
- Intercollege Physiology Program and the School of Nursing, The Pennsylvania State University, University Park, PA 16802, USA.
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Heh SS, Fu YY. Effectiveness of informational support in reducing the severity of postnatal depression in Taiwan. J Adv Nurs 2003; 42:30-6. [PMID: 12641809 DOI: 10.1046/j.1365-2648.2003.02576.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The aim of the study was to investigate the effectiveness of informational support in reducing the Edinburgh Postnatal Depression Scale (EPDS) scores in Taiwan. METHODS Five hundred Taiwanese women were screened during the fourth week after giving birth and those with a score of over 10 on the EPDS were considered to be at risk of postnatal depression. Seventy postpartum women were randomly allocated to the experimental or control group. Only those in the experimental group received informational support about postnatal depression during the sixth week postpartum. Two groups were assessed by the EPDS at 3 months postpartum to explore their depressive status. RESULTS Taiwanese women who received informational support about postnatal depression 6 weeks after giving birth experienced lower EPDS scores at 3 months postpartum than those who did not receive this information. CONCLUSIONS The findings suggest that informational support about postnatal depression given to women in the postnatal period may contribute to psychological well-being.
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Affiliation(s)
- Shu-Shya Heh
- School of Nursing, Fu-Jen Catholic University, Hsin-Chuang City, Taipei Hsien, Taiwan.
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Dennis CL. The effect of peer support on postpartum depression: a pilot randomized controlled trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2003; 48:115-24. [PMID: 12655910 DOI: 10.1177/070674370304800209] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the effect of peer support (mother-to-mother) on depressive symptomatology among mothers identified as high-risk for postpartum depression (PPD). METHOD Forty-two mothers in British Columbia were identified as high-risk for PPD according to the Edinburgh Postnatal Depression Scale (EPDS) and randomly assigned to either a control group (that is, to standard community postpartum care) or an experimental group. The experimental group received standard care plus telephone-based peer support, initiated within 48 to 72 hours of randomization, from a mother who previously experienced PPD and attended a 4-hour training session. Research assistants blind to group allocation conducted follow-up assessments on diverse outcomes, including depressive symptomatology, at 4 and 8 weeks postrandomization. RESULTS Significant group differences were found in probable major depressive symptomatology (EPDS > 12) at the 4-week (chi 2 = 5.18, df = 1; P = 0.02) and 8-week (chi 2 = 6.37, df = 1; P = 0.01) assessments. Specifically, at the 4-week assessment 40.9% (n = 9) of mothers in the control group scored > 12 on the EPDS, compared with only 10% (n = 2) in the experimental group. Similar findings were found at the 8-week assessment, when 52.4% (n = 11) of mothers in the control group scored > 12 on the EPDS, compared with 15% (n = 3) of mothers in the experimental group. Of the 16 mothers in the experimental group who evaluated the intervention, 87.5% were satisfied with their peer-support experience. CONCLUSIONS Telephone-based peer support may effectively decrease depressive symptomatology among new mothers. The high maternal satisfaction with, and acceptance of, the intervention suggests that a larger trial is feasible.
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Watt S, Sword W, Krueger P, Sheehan D. A cross-sectional study of early identification of postpartum depression: implications for primary care providers from The Ontario Mother & Infant Survey. BMC FAMILY PRACTICE 2002; 3:5. [PMID: 11950393 PMCID: PMC107838 DOI: 10.1186/1471-2296-3-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2001] [Accepted: 04/11/2002] [Indexed: 11/21/2022]
Abstract
BACKGROUND This survey's objective was to provide planning information by examining utilization patterns, health outcomes and costs associated with existing practices in the management of postpartum women and their infants. In particular, this paper looks at a subgroup of women who score >or= 12 on the Edinburgh Postnatal Depression Survey (EPDS). METHODS The design is cross-sectional with follow-up at four weeks after postpartum hospital discharge. Five Ontario hospitals, chosen for their varied size, practice characteristics, and geographic location, provided the setting for the study. The subjects were 875 women who had uncomplicated vaginal deliveries of live singleton infants. The main outcome measures were the EPDS, the Duke UNC Functional Social Support Questionnaire and the Health and Social Services Utilization Questionnaire. RESULTS EPDS scores of >or= 12 were found in 4.3 to 15.2% of otherwise healthy women. None of these women were being treated for postpartum depression. Best predictors of an EPDS score of >or= 12 were lack: of confident support, lack of affective support, household income of <20,000 dollars, wanting to stay in hospital longer, identification of learning needs while in hospital, self-identified care needs for an emotional/mental health problem that have not been met and mother's rating of own and baby's health as fair or poor. CONCLUSIONS Primary care physicians, midwives, and public health nurses need to screen for depression at every opportunity early in the postpartum period. A mother's expression of undue concern about her own or her baby's health may be predictive of postpartum depression. Flexible, mother-focused support from community providers may decrease the prevalence of postpartum depression.
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Affiliation(s)
- Susan Watt
- School of Social Work, McMaster University, Hamilton, ON, Canada
- City of Hamilton, Social and Public Health Services Department, Public Health Research, Education and Development Program, Hamilton, ON, Canada
| | - Wendy Sword
- City of Hamilton, Social and Public Health Services Department, Public Health Research, Education and Development Program, Hamilton, ON, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Paul Krueger
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- St. Joseph's Health Care System Research Network, 97 Mount Pleasant St., Brantford, ON, Canada
| | - Debbie Sheehan
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- City of Hamilton, Social and Public Health Services Department, Environmental Health and Infectious Diseases Branch, Hamilton, ON, Canada
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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Gamble JA, Creedy DK, Webster J, Moyle W. A review of the literature on debriefing or non-directive counselling to prevent postpartum emotional distress. Midwifery 2002; 18:72-9. [PMID: 11945055 DOI: 10.1054/midw.2001.0287] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND childbirth generates powerful emotions and may lead to the development of symptoms of depression, anxiety, and trauma in some women. Debriefing and non-directive counselling have been used as early interventions to reduce the prevalence of depression and post-traumatic stress. METHODS a review of the literature was conducted to describe the current state of knowledge on the effectiveness of a single debriefing session or non-directive counselling session to reduce depression and trauma symptoms in women following birth. FINDINGS a total of three studies reported in four papers examined the use of debriefing or non-directive counselling to prevent or reduce psychological morbidity following birth. The two largest RCTs indicate that a single debriefing session with the woman whilst in the postnatal ward is of no statistically significant value in reducing psychological morbidity and may even be harmful. In contrast, women reported that an opportunity to talk with someone about the birth was helpful in facilitating recovery. CONCLUSION there is insufficient evidence to draw conclusions about the effectiveness of debriefing following childbirth, primarily because it is unclear if a standardised debriefing intervention was used. Future research should clearly describe the intervention and test alternative interventions; measure a broader range of outcomes including trauma symptoms; use inclusion criteria that acknowledge the complex contributing factors to depression and trauma; and examine the value of including the woman's partner (or significant other) in the debriefing or counselling session(s). Future studies should investigate the timing or place of the intervention, the provision of more than one opportunity to discuss the birth, and target the intervention to women who are more likely to develop trauma symptoms or post-traumatic stress disorder.
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Affiliation(s)
- Jenny A Gamble
- School of Nursing, Faculty of Nursing and Health, Griffith University, Nathan Campus, Kessels Road, Brisbane, Queensland 4111, Australia.
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49
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Abstract
BACKGROUND Current forms of analgesia often have significant side effects for women in labor. Bathing in warm water during labor has been reported to increase a woman's comfort level and cause a reduction in painful contractions. The objective of this trial was to compare immersion in warm water during labor with traditional pain management for a range of clinical and psychological outcomes. METHODS A prospective randomized controlled trial of 274 pregnant women, who were free from medical and obstetric complications and expecting a singleton pregnancy at term, was conducted at the Women's and Children's Hospital, a maternity tertiary referral center in Adelaide, South Australia. Women in labor were randomized to an experimental group who received immersion in a bath or to a nonbath group who received routine care. Pharmacological pain relief was the primary outcome that was measured, and secondary outcomes included maternal and neonatal clinical outcomes, factors relating to maternal and neonatal infectious morbidity, psychological outcomes, and satisfaction with care. RESULTS The use of pharmacological analgesia was similar for both the experimental and control groups; 85 and 77 percent, respectively, used major analgesia. No statistical differences were observed in the proportion of women requiring induction and augmentation of labor or in rates of perineal trauma, length of labor, mode of delivery, or frequency of cardiotocographic trace abnormalities. Neonatal outcomes (birthweight, Apgar score, nursery care, meconium-stained liquor, cord pH estimations) revealed no statistically significant differences. Infants of bath group women required significantly more resuscitation than routine group women. Routine group women rated their overall experience of childbirth more positively than bath group women. Psychological outcomes, such as satisfaction with care or postnatal distress, were the same for both groups. CONCLUSION Bathing in labor confers no clear benefits for the laboring woman but may contribute to adverse effects in the neonate.
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Affiliation(s)
- K Eckert
- Department of Obstetrics and Gynaecology, Women's and Children's Hospital, Adelaide, South Australia, Australia
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50
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Abstract
A recent paper by Barclay and Kent (1998) raised various issues with regards to motherhood and recent immigration. They expressed reservations with conceptualizing extreme misery in new mothers as depression, and with screening for postnatal distress in women from non-English-speaking backgrounds (NESB). They argued that a common self-report measure for postnatal distress screening, the Edinburgh Postnatal Depression Scale (EPDS), was flawed. They also argued that the concept of postnatal depression implies a medical aetiology and, thus, fails to recognise the socio-cultural aspects experienced by NESB women. We address these issues, by demonstrating that the EPDS is not flawed, and by arguing that screening for postpartum distress results in more NESB women being identified and, consequently, offered a service, than if such screening does not occur. We also disagree with the view that the term 'postnatal depression' necessarily implies any aetiology, and that work by our unit, as well as others around the world, indicates that the psychosocial and cultural aspects related to distress in new immigrant mothers is being recognised and acted upon.
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Affiliation(s)
- B E Barnett
- School of Psychiatry, University of New South Wales
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