Effectiveness of psychosocial support provided by midwives and family on preventing postpartum depression among first-time adolescent mothers at 3-month follow-up: A randomised controlled trial

Non-pharmacological interventions for perinatal depression and anxiety among adolescent mothers: A systematic review and meta-analysis

BACKGROUND

Perinatal depression and anxiety are the most common mental health disorders among pregnant and postpartum adolescents. Pharmacological and non-pharmacological interventions exist for perinatal depression and anxiety; however, there is limited evidence on the effectiveness of non-pharmacological interventions in adolescent mothers.

AIM

To identify, evaluate, and summarize the available evidence on the effectiveness of non-pharmacological interventions for the prevention and treatment of perinatal depression and anxiety in adolescent mothers.

METHODS

We followed the Cochrane guidelines in conducting the reviews and the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines in reporting the findings. Randomized clinical trials (RCTs), interventional studies, cohort studies, and case-control studies of non-pharmacological interventions that assessed depression and/or anxiety symptoms or diagnoses after intervention in adolescent mothers were eligible for inclusion. We searched PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO, as well as the reference lists of relevant studies and grey literature.

RESULTS

We identified eight clinical trials that were eligible for inclusion in the systematic review (n = 806); four of these studies were eligible for inclusion in a meta-analysis (n = 451). Non-pharmacological interventions (specifically Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT)) for depressive symptoms showed small to moderate effects (SMD: -0.57, 95 % CI: -0.77, -0.36; p-value<0.001) in the intervention groups compared to the control groups.

CONCLUSIONS

Non-pharmacological interventions, specifically CBT and IPT, may be effective in treating perinatal depression among adolescent mothers. These interventions could be successfully delivered by trained health care professionals in health care settings such as antenatal clinics.

Effectiveness of Smart Mama application on postpartum depression, anxiety, and maternal-infant bonding among women during the postnatal period: a randomized controlled trial

BACKGROUND

Postpartum depression and anxiety are significant public health concerns that have serious well documented negative effects on mothers and their families. However, they often remain under-recognized because of limited in-person interactions, time restrictions, lack of adequate support, and pervasive stigmatization. This study investigated the effectiveness of the Smart Mama application on postpartum depression, anxiety levels, and maternal-infant bonding at 12 weeks postpartum.

MATERIALS AND METHODS

This prospective parallel-group randomized controlled trial included 148 participants from March 1, 2023, to March 31, 2024. Those who agreed to participate were randomly assigned to receive the Smart Mama intervention (n = 74) or routine care (n = 74), using permuted stratified block randomization. The primary outcome was assessed using the Edinburgh Postnatal Depression Scale (EPDS). The secondary outcomes were evaluated using the State-Trait Anxiety Inventory (STAI) and Maternal-Infant Bonding Scale (MIBS) at baseline and the 12-week follow-up using validated standardized tools.

RESULTS

Compared with the control group, the Smart Mama intervention group showed a significant reduction in postpartum depressive symptoms (P for time × group interaction = 0.04), with a reduction in the EPDS mean score from 9.03 (standard deviation, 2.47) to 5.61 (3.3), whereas the control group showed a change from 9.01 (2.75) to 7.16 (3.1) at 12 weeks post-intervention. Similarly, the Smart Mama intervention led to a significantly greater decrease in both state and trait anxiety levels (both P for time × group interaction < 0.05) compared to the control group. No statistically significant effect on maternal-infant bonding was observed between the intervention and control group (P for time × group interaction = 0.25).

CONCLUSION AND IMPLICATIONS

The Smart Mama intervention significantly reduced postpartum depressive symptoms and anxiety. This study provides empirical evidence and novel insights into the effectiveness of mobile device applications. By integrating a holistic approach, Smart Mama represents a promising and innovative solution for enhancing maternal health outcomes, empowering self-care activities, and overcoming barriers to accessibility.

TRIAL REGISTRATION

The study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trial Registry (ID: (UMIN000050065) on January 19, 2023 ( https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000056562 ).

A network analysis of postpartum depression and mother-to-infant bonding shows common and unique symptom-level connections across three postpartum periods

Postpartum depression and mother-to-infant bonding difficulties (MIBD), two issues crucial to maternal and infant mental health, often coexist and affect each other. Our study aims to dissect their complex relationship through a graphical LASSO network analysis of individual symptoms in 5594 Japanese postpartum women, whose geographical distribution was nationally representative. We identified 'fear', 'enjoyment', 'overwhelm', and 'insomnia' as common bridge symptoms linking postpartum depression and MIBD across three distinct postpartum periods. Moreover, 'self-harm' emerged as a bridge symptom in the first 6 months and the 7-12 month period, while 'laugh' was a bridge symptom in the first 6 months and the 13-24 month period. Notably, 'self-blame' was identified as a unique bridge symptom specific to the 13-24 month period. Our analysis highlights the complexities of symptom connectivity across postpartum stages and underscores the critical need for interventions that address both common and stage-specific bridge symptoms to effectively support maternal mental health and strengthen mother-to-infant bonding.

Feasibility and acceptability of FOotpaths foR adolescent MAternal mental HeAlth (FOR MAMA): A co-designed intervention for pregnant adolescents in Malawi

This study aimed to assess feasibility, acceptability and potential for impact of FOotpaths foR Adolescent MAternal Mental HeAlth (FOR MAMA), a co-designed intervention for pregnant adolescents in Malawi. We used a mixed-methods interventional pre-post cohort design. We recruited pregnant adolescents from a rural health centre in Zomba district, Malawi, all of whom were offered a five-session psychosocial intervention delivered by community healthcare workers. Quantitative feasibility indicators related to participant enrolment, session attendance and intervention completion. Feasibility of intervention delivery was explored using in-depth semi-structured interviews with healthcare workers. Acceptability was investigated through in-depth semi-structured interviews with intervention participants and a service user satisfaction questionnaire. Intervention outcomes were assessed using standardised measures of common mental disorders, financial distress and poor mental health and perceived social support. 19 adolescents aged 15-19 years (mean=17.21, SD=1.18) started the intervention, with 18 (94.7%) completing the programme. Significant improvements (p<0.05) were reported across all outcome measures, with moderate to high pre-post effect sizes. Intervention participants reported high levels of service satisfaction, although healthcare workers (n = 6) reported that some feasibility challenges emerged during recruitment and delivery. The FOR MAMA intervention proved to be an acceptable and feasible psychosocial intervention for pregnant adolescents in Malawi.

Effectiveness of Psychosocial Interventions in Preventing Postpartum Depression Among Teenage Mothers-Systematic Review and Meta-analysis of Randomized Controlled Trials

Postpartum depression is a significant public health issue that occurs within the first 12 weeks after childbirth. It is more prevalent among teenage mothers compared to adults. However, the findings of the existing interventional studies cannot be readily applied to teenage mothers due to their unique psychosocial concerns. Furthermore, these findings have shown inconsistencies regarding the benefit of psychological and psychosocial interventions in reducing the incidence of postpartum depression. The current review is aimed at investigating the effectiveness of psychosocial interventions in preventing postpartum depression, specifically among teenage mothers. The preferred reporting items for systematic reviews and meta-analysis manuals were utilized to identify and select relevant articles for this review. The articles were retrieved using population, intervention, control, and outcome models. The quality of each article was assessed using the Cochrane risk of bias tool. Statistical analysis was conducted using STATA version 17. The effect size of the intervention was estimated using the standard mean difference in depression scores between the intervention and control groups. Heterogeneity among the studies was assessed using the I2 statistic and Q statistic, while publication bias was evaluated through funnel plot asymmetry and Egger's test. A total of nine eligible articles were included. While psychosocial interventions have been demonstrated to decrease the incidence of postpartum depression compared to usual maternal health care, it is worth noting that the mean difference in depression scores was significant in only three of the included studies. The meta-analysis revealed that psychosocial interventions were effective at preventing postpartum depression, with a pooled effect size of - 0.5 (95% CI: - 0.95, - 0.06) during the final postpartum depression assessment. The heterogeneity was substantial, with an I2 value of 82.3%. Although publication bias was not observed, small studies had a significant effect on the pooled effect size. The findings of this review suggest that psychosocial interventions can effectively prevent PPD, particularly within the first 3 months of the postpartum period. This review highlights the scarcity of interventional studies in low-income countries, indicating the need for further research in diverse communities.

Psychoeducation as an active ingredient for interventions for perinatal depression and anxiety in youth: a mixed-method systematic literature review and lived experience synthesis

BACKGROUND

Psychoeducation is a common element in psychological interventions for youth depression and anxiety, but evidence about its use with youth perinatally is limited.

AIMS

This review aims to understand outcomes and mechanisms of psychoeducation for the indicated prevention and treatment of perinatal depression and anxiety in youth.

METHOD

For this review, we synthesised published quantitative and qualitative evidence. Seven databases (ASSIA, Medline, PubMed, PsycINFO, PsycArticles, Scopus and Web of Science) were searched for studies published before 10 August 2021. We also had consultations with a youth advisory group (N = 12).

RESULTS

In total, 20 studies met the inclusion criteria. Seven quantitative studies examined multicomponent interventions that included psychoeducation, and one study evaluated psychoeducation as a standalone intervention for postnatal depression. Multicomponent interventions showed significant effects on postnatal depression in two out of six studies, as well as being effective at reducing prenatal anxiety in one study. Standalone psychoeducation for postnatal depression was also effective in one study. Evidence from 12 qualitative studies, corroborated by commentaries from the youth advisory group, suggested that psychoeducation could increase knowledge about symptoms, generate awareness of relevant services and enhance coping.

CONCLUSIONS

Psychoeducation may be an important foundational ingredient of interventions for perinatal depression and, potentially, anxiety in adolescents and young adults through stimulating help-seeking and self-care.

Postnatal depression and its social-cultural influences among adolescent mothers: A cross sectional study

In rural Malawi, adolescent mothers represent 31% of pregnancies. While some adolescent mothers experience motherhood as an exciting, positive, and affirming experience, for others, it may increase their risk of postnatal depression (PND). Social norms and culture contribute to adolescent mothers' experiences and may influence their mental health. However, there is limited research around the prevalence of PND and its cultural influences among adolescent mothers. A cross-sectional survey was administered from 7th September 2021 to 31st March 2022. Three hundred and ninety-five adolescent postnatal mothers aged ≤19 were conveniently recruited at Mitundu hospital in Lilongwe, Malawi. The Edinburgh Postnatal Depression Scale was used to assess depression. A cutoff point of ≥ 10 was employed to categorize probable PND. Binary logistic regression was used to determine the predictors of depression. The mean age of participants was 17 (SD 1.157). and 43.6% (n = 172) presented with PND (EPDS scores ≥10). When all factors were considered in a binary logistic model, adolescents who had ever experienced intimate partner violence (IPV) were 13.6 times more likely to report PND after controlling for age and other predictors compared to those without an experience of IPV (aOR 13.6, p = 0.01, 95% CI 2.10-88.9). Participants whose families did not decide for them (regarding their care) were 2.3 times more likely to present with PND than those whose families decided for them (aOR 2.3 p = 0.03, 95% CI 1.04-5.2). Adolescent mothers who had interacted with their health worker were less likely to report PND than those who had no interaction with the health worker (aOR 0.4 P0.02, CI 0.17-0.67). Social and cultural factors can impact mental health of adolescent mothers. It is recommended that targeted and integrated interventions are developed, implemented. and evaluated. There is a need to improve policy and practice to better support adolescent mothers postnatally.

Effectiveness of social support-based interventions in preventing depression in people without clinical depression: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The evidence available on the association between social support and prevention of depression has been basically obtained from observational studies.

AIM

We evaluated the effectiveness of social support-based interventions for the prevention of depression in people without clinical depression.

METHODS

Systematic review and meta-analysis (SR/MA) of randomized controlled trials (RCT), which were searched for in MEDLINE, EMBASE, CENTRAL, WOS, PsycINFO, OpenGrey and other sources from the inception dates to June 8, 2022. We selected RCTs that assessed the effectiveness of social support-based interventions as compared to controls, included subjects without baseline clinical depression, and measured as results a reduction in depressive symptoms and/or the incidence of new cases of depression. Pooled standardized mean differences (SMDs) were calculated from random effects models.

RESULTS

Nine RCTs involving 927 patients from North America, Asia and Europe were included. The pooled SMD was -0.43 [95% confidence interval (CI) -0.82 to -0.04; p = .031]. Sensitivity analyses confirmed the robustness of results. Heterogeneity was substantial [I² = 80% (95% CI: 64% to 89%)]. A meta-regression model that included usual care as comparator and the continent (Europe), explained 53% of heterogeneity. Eight RCTs had a moderate overall risk of bias and one had a high risk of bias. Follow-up was ⩾1 year in only three RCTs. There was no statistical evidence of publication bias. The quality of evidence, as measured on GRADE guidelines, was low.

CONCLUSION

Social support-based interventions had a small preventive effect on depression. Longer RCTs with a low risk of bias are necessary.

Psychological health status in postpartum women during COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis pooled the prevalence of psychological symptoms during the COVID-19 pandemic and examined the effects of the pandemic on psychological health in postpartum women.

METHODS

A systematic literature search and identification were performed in PubMed, EMBASE, Web of Science, and PsycINFO databases until June 16th, 2021. The fixed or random effect models to estimate the pooled prevalence of postpartum psychological symptoms during the COVID-19 pandemic and the odds ratio (OR) of COVID-19 for psychological symptoms.

RESULTS

A total of 29 articles including 20,225 postpartum women during the COVID-19 pandemic and 8312 before the COVID-19 pandemic were identified. During the COVID-19 pandemic, the prevalence of postpartum depressive, anxiety, stress, and post-traumatic stress disorder symptoms were 26.7 % (95 % CI: 22.0-31.9 %), 33.8 % (95 % CI: 21.1-49.4 %), 55.0 % (95%CI: 27.9-79.5 %), and 33.7 % (95%CI: 19.6-51.5 %), respectively. The ORs of COVID-19 pandemic for postpartum depressive and anxiety symptoms were 1.54 (95 % CI: 1.00-2.36) and 2.56 (95%CI: 1.62-4.04). Subgroup analyses revealed that women with >6 weeks after delivery, younger than 35 years old, low income, less education and without breastfeeding experienced a higher risk of depressive or anxiety symptoms after delivery.

LIMITATIONS

Only a few of prospective studies were included, and significant but inevitable heterogeneities were found in some analyses.

CONCLUSION

A significantly higher proportion of postpartum women were suffered from psychological symptoms during COVID-19 pandemic, particularly in those with >6 weeks after delivery, younger than 35 years old, low income, less education and formula feeding.

Effectiveness of Internet-based psychological interventions for treating perinatal depression: A systematic review and meta-analysis

BACKGROUND

Perinatal depression can result in short- and long-term adverse effects for women and their children if untreated. Psychological interventions, the preferred treatment for most women with perinatal depression, can also be provided online.

AIMS

This study aimed to provide a comprehensive and systematic review of Internet-based psychological interventions and to evaluate their effectiveness in the treatment of perinatal depression.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic literature search was conducted of six databases, including CINAHL, PubMed, Embase, Web of Science, the Cochrane Library and PsycINFO. Depression and anxiety, which were the primary and secondary results of this search, were presented as standardised mean differences (SMD) and 95% confidence intervals (CIs). This review was conducted according to the PRISMA checklist.

RESULTS

Thirteen studies involving 2158 perinatal women were included. Content, method, duration and frequency of Internet-based psychological interventions were varied. Participants indicated a high rate of satisfaction with these interventions; participants' dropout rates ranged from 2.6% to 60.8%. Meta-analysis demonstrated that Internet-based psychological interventions improved perinatal depression (SMD = -0.72, CI = [-1.02, -0.42], p < .01) and anxiety symptoms (SMD = -0.52, CI = [-0.73, -0.30], p < .01), with heterogeneity of 86% and 59%, respectively.

CONCLUSIONS

Internet-based psychological interventions are considered as convenient and effective alternative treatment for perinatal depression and anxiety. In the future, additional studies are needed to investigate the long-term effects of these interventions on the mental health of perinatal women and the effects on the growth and development of infants while controlling for the dropout rate.

RELEVANCE TO CLINICAL PRACTICE

Internet-based psychological interventions are innovative approaches to improving perinatal depressive symptoms that can leverage mental health resources and improve accessibility while promoting multidisciplinary integration. The approach, content, frequency and duration of intervention should be considered comprehensively to achieve the objectives of the intervention while maintaining compliance of women with perinatal depression.