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Annals of Family Medicine Sep 2016Postnatal depression affects 10% to 15% of new mothers, and approximately 90% of cases are managed in primary care. Antidepressants are effective, but adherence is poor;... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Postnatal depression affects 10% to 15% of new mothers, and approximately 90% of cases are managed in primary care. Antidepressants are effective, but adherence is poor; therefore, psychological interventions must be investigated. In this systematic review, we assessed the efficacy of psychological therapies for postnatal depression in primary care.
METHODS
We undertook a systematic search to identify articles published in English between 2000 and 2014 that reported studies meeting our eligibility criteria: (1) had a randomized controlled trial design; (2) assessed psychological interventions for postnatal depression against any other treatment or a wait-list control; (3) recruited patients in primary care; and (4) enrolled mothers with a diagnosed depressive episode or a score of at least 12 on the Edinburgh Postnatal Depression Scale or at least 10 on the Beck Depression Inventory at baseline who had a child younger than 12 months. Quality was assessed using an adapted Cochrane Collaboration Depression, Anxiety, and Neurosis (CCDAN) quality rating scale, and meta-analysis was carried out using RevMan 5.3 (The Cochrane Collaboration).
RESULTS
Screening of 5,919 articles identified 10 studies that met inclusion criteria. These studies reported on 14 psychological intervention arms: 7 using cognitive behavioral therapy, 2 using interpersonal therapy, 2 using counseling, and 3 using other interventions. Psychological interventions resulted in lower depressive symptomatology than control both immediately after treatment (standardized mean difference = -0.38; 95% CI, -0.49 to -0.27) and at 6 months of follow-up (standardized mean difference =-0.21; 95% CI, -0.37 to -0.05). We did not find any significant differences between the various types of therapy. Compared with control, the interventions also led to improvements in adjustment to parenthood, marital relationship, social support, stress, and anxiety.
CONCLUSIONS
Psychological interventions deliverable in the primary care setting are associated with a significant improvement in depressive symptomatology both immediately after completion and for up to 6 months of follow-up.
Topics: Depression, Postpartum; Female; Humans; Primary Health Care; Psychiatric Status Rating Scales; Psychotherapy; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 27621164
DOI: 10.1370/afm.1967 -
Journal of Assisted Reproduction and... Jun 2016The purpose of this study was to examine the effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples... (Review)
Review
The effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization: a systematic review.
PURPOSE
The purpose of this study was to examine the effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization (IVF), as determined through RCT studies.
METHODS
Using the electronic databases PubMed, EMBase, Cochrane Library, CINAHL, PsycInfo, and CAJ, a systematic literature search was conducted in July 2015. MeSH terms, key words, and free words such as "infertility," "fertilization in vitro," "psychotherapy," "intervention," "anxiety," "depression," and "marital satisfaction" were used to identify all potential studies. The quality of the studies that were included was assessed using the risk of bias assessment tool developed by the Cochrane Back Review Group. Descriptive analysis was adopted to synthesize the results.
RESULTS
A total of 20 randomized controlled trials were included in this review. There were reports of positive effects on the anxiety levels, pregnancy rates, or marital function of infertile couples in six studies that adopted different psychosocial approaches, including mind body intervention (Eastern body-mind-spirit, Integrative body-mind-spirit, and Mind/body intervention), cognitive behavioral therapy, group psychotherapy, and harp therapy. However, there were methodological or practical issues related to measurement points and attrition rates in these studies. None of these interventions were found to be efficacious in relieving the depression or stress of individuals or couples undergoing IVF treatment. None of the included studies tackled or measured the mental health status of the couples during the most stressful time of waiting for the pregnancy results of their treatment.
CONCLUSIONS
A complex intervention, based on sound evidence, should be developed targeting both females and males of infertile couples undergoing IVF treatment, particularly during the stressful period of waiting for the results of the pregnancy test result and after failed cycles.
Topics: Anxiety; Depression; Female; Fertilization in Vitro; Humans; Infertility; Male; Marriage; Mental Health; Pregnancy; Pregnancy Rate; Psychosocial Support Systems; Randomized Controlled Trials as Topic; Stress, Psychological
PubMed: 26979745
DOI: 10.1007/s10815-016-0690-8 -
Addiction & Health Jan 2018This comprehensive systematic review and meta-analysis were performed to assess the associated factors of maintenance in patients with methadone therapy in the world. (Review)
Review
BACKGROUND
This comprehensive systematic review and meta-analysis were performed to assess the associated factors of maintenance in patients with methadone therapy in the world.
METHODS
A systematic literature review was performed from several scientific databases; these include PubMed, Scopus, ISI Web of Science, and MEDLINE. We searched the following keywords: "Methadone", "Maintenance", "Retention", "Meta-analysis" and "Associated factors". Data were selected based on the inclusion and exclusion criteria. The purpose of this study was to assess the associated factors of maintenance in patients under treatment with methadone by an overall effect size, odds ratio (OR) [95% confidence interval (CI)] using meta-analysis.
FINDINGS
We selected 24 researches out of 94413 for our study based on the inclusion and exclusion criteria for systematic review and meta-analysis. The pooled recognized five significant positive associations of age, marital status, employment status, gender, and length of treatment with methadone usage (OR age = 3.566, 95% CI = 3.296-3.836, P < 0.001; OR marital status = 1.101, 95% CI = 1.028-1.175, P = 0.025; OR employment = 1.157, 95% CI = 1.060-1.254, P = 0.015; OR gender = 4.686, 95% CI = 4.434-4.939, P < 0.001; OR duration of treatment = 1.543, 95% CI = 1.443-1.647, P < 0.001; respectively). However, education and injection status showed a non-significant positive association with methadone usage (OR education level = 1.279, 95% CI = 0.976-1.583, P = 0.266; OR injection status = 1.205, 95% CI = 0.725-1.658, P = 0.442).
CONCLUSION
This systematic-review and meta-analysis study displayed that factors such as age, marital and employment status, gender, and duration of treatment are effective on maintenance in patients under treatment of methadone.
PubMed: 30627384
DOI: 10.22122/ahj.v10i1.488 -
Campbell Systematic Reviews Jun 2024Postpartum depression (PPD) is a condition that can affect any woman regardless of ethnicity, age, party, marital status, income, and type of delivery. This condition is... (Review)
Review
Effectiveness of interpersonal psychotherapy in comparison to other psychological and pharmacological interventions for reducing depressive symptoms in women diagnosed with postpartum depression in low- and middle-income countries: A systematic review.
BACKGROUND
Postpartum depression (PPD) is a condition that can affect any woman regardless of ethnicity, age, party, marital status, income, and type of delivery. This condition is highly prevalent worldwide. PPD, if not treated timely, can affect the maternal-child bond and can have a detrimental impact on the future cognitive, emotional, and behavioral development of the child. Interpersonal psychotherapy (IPT) has been reported as an effective treatment of PPD in previous studies as this focuses on relationship and social support issues. Previous reviews conducted in developed nations have reported the superior efficacy of IPT in comparison to other treatment options. There is no systematic review conducted in low to middle-income countries on the efficacy of IPT on PPD. Therefore it was necessary to undertake a systematic review to assess the effectiveness of IPT in reducing the depression among postpartum women in low and middle-income countries (LMICs).
OBJECTIVES
The main aim of this systematic review was to assess the effectiveness of IPT alone or in conjunction with pharmacological therapy and/or other psychological and psychosocial interventions, in reducing depressive symptoms among women diagnosed with PPD residing in LMICs.
SEARCH METHODS
The systematic search encompassed several prominent databases and grey literature. Furthermore, experts specializing in the field of IPT were consulted to identify any relevant studies conducted in LMICs that fulfilled the predetermined eligibility criteria. The most recent search update was performed in July 2022.
SELECTION CRITERIA
The PICOS criteria were meticulously defined for this review as described. Participants: Postpartum women diagnosed with PPD in LMICs were included. Intervention: IPT either as a standalone treatment or in conjunction with pharmacological therapy was included. Comparison: any form of psychological therapy or pharmacological therapy, whether administered individually or in combination, was considered for comparison. Study designs: experimental and quasi-experimental, factorial designs, and quantitative components (experimental, quasi-experimental, factorial designs) of mixed methods designs were eligible to be included. Studies with single-group study designs and qualitative studies were excluded from the review.
DATA COLLECTION AND ANALYSIS
Two reviewers from our team conducted a rigorous screening process to determine the eligibility of articles for inclusion. This involved an initial evaluation of titles and abstracts, followed by a comprehensive assessment of the full text of selected articles. In instances where discrepancies arose between the two reviewers, resolution was achieved through discussion or consultation with a third author to establish a consensus. Following the screening process, two team members independently extracted pertinent information and data from the studies that met the inclusion criteria. The treatment effect of the intervention, in comparison to the control group, was subsequently analyzed utilizing the fixed effects model taking into account the small number of studies.
MAIN RESULTS
A total of 17,588 studies were identified from various databases, and 6493 duplicate studies were removed. Subsequently, 9380 studies underwent independent title and abstract screening resulting in the exclusion of 9040 studies. 345 full texts were thoroughly assessed leading to the exclusion of 341 studies, finally including 4 studies for review. The four included trials were randomized trials and comprised a total sample size of 188 women diagnosed with PPD residing in LMICs. Among these studies, three compared IPT with usual treatment, while one study compared IPT with antidepressant medications (ADMs). In terms of the providers of IPT, in one study, IPT was administered by nurses, while psychologists delivered IPT in another study. In one study, community health workers were responsible for providing IPT. However, in one study, information regarding the specific providers of IPT was not available or reported. The primary outcome measure reported in all four studies was depression, assessed using the Edinburgh Postnatal Depression Scale (EPDS). The geographical distribution of the studies included; one conducted in Zambia, one in Kenya, one in Pakistan, and one in Iran. Out of the four studies, three were included in the meta-analysis, as missing data from one study could not be obtained. Based on the overall treatment effect, it was found that depression scores decreased significantly more in the IPT group compared to other interventions (usual treatment or ADMs) (standardized mean difference [SMD] -0.62, 95% confidence interval [CI] (-1.01, -0.23), = 3.13 ( = 0.002), = 49.49; df = 2; < 0.00001; = 96%; 3 studies, = 136). Out of the three studies, two studies compared the effectiveness of IPT in reducing depression scores specifically when compared to the usual treatment, and in both studies, depression scores were reduced significantly in the IPT group as compared to the usual treatment group. Only one study directly compared the effectiveness of IPT with ADM, reporting that IPT was more effective than ADM in reducing depression scores among postpartum women. Regarding adverse outcomes, only one study reported suicidal ideation with one participant in the IPT group and two in the ADM group (RR 0.50, 95% CI (0.05, 5.30), = 0.56, = 78). The same study reported seven participants in the ADM group had adverse drug reactions as compared to none in the IPT group (RR 15.0, 95% CI (0.89, 254), = 0.06, = 78).
AUTHORS' CONCLUSIONS
Our comprehensive search yielded a limited number of four studies conducted in such settings. Despite the scarcity of available evidence, the findings collectively suggest that IPT is indeed an effective treatment for reducing PPD when compared to usual treatment and pharmacological therapy. However given the low certainty of evidence, there is a need for further research in the form of well-designed randomized controlled trials with larger sample sizes and a reduced risk of bias. Such studies would greatly contribute to enhancing the strength and reliability of the evidence base regarding the effectiveness of IPT in the context of PPD in LMICs. The knowledge generated from future research endeavors would be highly valuable in guiding the development of more affordable and cost-effective treatment approaches for PPD in resource-limited settings.
PubMed: 38645302
DOI: 10.1002/cl2.1399 -
Transplantation Reviews (Orlando, Fla.) Jan 2018Although social support is used to determine transplant eligibility, the relationship between social support, medication adherence, and survival among transplant... (Meta-Analysis)
Meta-Analysis Review
Although social support is used to determine transplant eligibility, the relationship between social support, medication adherence, and survival among transplant recipients remains unclear. We estimated the relationship between social support and post-transplant medication adherence and outcomes using 10 electronic databases from inception to January 2016. Study quality was assessed and all review stages were conducted independently by 2 reviewers. Systematic review and meta-analysis were conducted. Thirty-two studies (9102 participants) met inclusion criteria: 21 assessed medication adherence (5197 participants), and 13 assessed clinical outcomes (3905 participants). Among high quality studies, neither social support nor marital status was predictive of medication adherence or post-transplant outcomes. Social support was not associated with medication adherence. It was associated with superior post-transplant outcomes, but the relationship was not significant among high quality studies. Compared to unmarried recipients, married recipients were more likely to adhere to medication post-transplant, but this relationship was not significant among high quality studies. Marital status was not significantly associated with transplant success. Social support is weakly and inconsistently associated with post-transplant adherence and outcomes. Larger prospective studies using consistent and validated measures are needed to justify the use of inadequate social support as a contraindication to transplantation.
Topics: Graft Rejection; Humans; Kidney Transplantation; Medication Adherence; Social Support; Transplant Recipients
PubMed: 28495070
DOI: 10.1016/j.trre.2017.04.001 -
Transactions of the Royal Society of... May 2016Foreign-born populations carry a significant TB burden in low-prevalence countries, composing over half of all cases in parts of Europe and North America. This study... (Review)
Review
BACKGROUND
Foreign-born populations carry a significant TB burden in low-prevalence countries, composing over half of all cases in parts of Europe and North America. This study systematically reviewed evidence of risk factors for nonadherence to TB drug therapy in this group.
METHODS
On 28 October 2013 MEDLINE, CINAHL, Embase, PsychINFO and ProQuest were systematically searched for studies examining adherence in foreign-born populations with TB. Grey literature and reference lists were hand-searched. Risk factor studies were selected for inclusion if they consisted of at least 95% foreign-born populations.
RESULTS
Of 1761 studies identified in the search, 20 were included in the risk factor review. Undocumented immigration status, older age, and social risk factors were consistently correlated with nonadherence; gender, ethnicity, immigration time, education level, adverse side effects, and HIV status were inconsistently correlated; and behavioural risk factors and marital status were consistently not correlated.
CONCLUSIONS
This review emphasizes documentation status as a risk factor candidate for further investigation.
Topics: Antitubercular Agents; Emigrants and Immigrants; Emigration and Immigration; Europe; Humans; Latent Tuberculosis; Medication Adherence; North America; Risk Factors; Tuberculosis, Pulmonary
PubMed: 27198210
DOI: 10.1093/trstmh/trw025 -
Psychology of Addictive Behaviors :... Dec 2021The aims of this systematic review and meta-analysis were to examine the overall prevalence of dropout from psychological treatments for problem gambling and gambling... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aims of this systematic review and meta-analysis were to examine the overall prevalence of dropout from psychological treatments for problem gambling and gambling disorder and to examine how study, client, and treatment variables influenced dropout rates.
METHOD
A systematic search was conducted to identify studies of cognitive and/or behavioral therapies and motivational interventions for problem gambling and gambling disorder. Meta-analysis was used to calculate an overall weighted dropout rate. Random effect meta-regressions were used to examine covariates of dropout rates. Mixed-effect subgroup analyses were used to examine moderators of dropout rates.
RESULTS
The systematic search identified 24 studies (31 dropout rates) comprising 2,791 participants. Using a random-effects model, the overall weighted dropout rate was 39.1%, 95% CI [33.0%, 45.6%]. Increases in the percentage of married participants were significantly associated with lower dropout rates. Dropout rates were significantly higher when dropout was defined as attending all sessions of a treatment protocol compared to when defined as attending a prespecified number of sessions different from the total in the protocol and when defined as study therapists judging participants to be dropouts. Insufficient reporting of some gambling-related variables and other psychological symptom variables prevented a thorough examination of covariates and moderators.
CONCLUSIONS
A large proportion of individuals drop out of treatment for problem gambling and gambling disorder. Future research should examine the reasons for dropout across marital statuses and should adopt dropout definitions that consider session-by-session symptom change. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Topics: Behavior Therapy; Gambling; Humans; Motivation; Prevalence
PubMed: 34881915
DOI: 10.1037/adb0000710 -
International Wound Journal Oct 2023The present systematic review was conducted to investigate the knowledge of health care workers (HCWs) regarding first aid in burns. A comprehensive, systematic search... (Review)
Review
The present systematic review was conducted to investigate the knowledge of health care workers (HCWs) regarding first aid in burns. A comprehensive, systematic search was performed in different international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Knowledge', 'First aid', 'Health personnel' and 'Burns' from the earliest to 1 February 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. A total of 3213 HCWs participated in seven cross-sectional studies. Of the HCWs, 44.50% were physicians. The studies included in this systematic review were conducted in Saudi Arabia, Australia, Turkey, the UK, Ukraine, and Vietnam. The knowledge rate of HCWs related to first aid for burns was 64.78 out of 100, which indicates their relatively desirable knowledge. The factors of first aid training experience, age, and experienced burn traumas had a significant positive effect on the knowledge of HCWs related to first aid for burns. Also, factors such as gender, nationality, marital status, and job position had a significant relationship with the knowledge of HCWs about first aid for burns. Therefore, it is suggested that health care managers and policymakers implement training programs and practical workshops related to first aid, especially first aid for burns.
Topics: Humans; Cross-Sectional Studies; Health Knowledge, Attitudes, Practice; Health Personnel; Physicians; Burns
PubMed: 36950866
DOI: 10.1111/iwj.14162 -
BMJ Open Jul 2015To identify variables that predict health service utilisation (HSU) by adults with mental disorders in the UK, and to determine the evidence level for these predictors. (Review)
Review
OBJECTIVES
To identify variables that predict health service utilisation (HSU) by adults with mental disorders in the UK, and to determine the evidence level for these predictors.
DESIGN
A narrative synthesis of peer-reviewed studies published after the year 2000. The search was conducted using four databases (ie, PsycINFO, CINAHL Plus with full text, MEDLINE and EMBASE) and completed on 25 March 2014.
SETTING
The majority of included studies were set in health services across primary, secondary, specialist and inpatient care. Some studies used data from household and postal surveys.
PARTICIPANTS
Included were UK-based studies that predicted HSU by adults with mental disorders. Participants had a range of mental disorders including psychotic disorders, personality disorders, depression, anxiety disorders, eating disorders and dementia.
PRIMARY OUTCOME
A wide range of HSU outcomes were examined, including general practitioner (GP) contacts, medication usage, psychiatrist contacts, psychotherapy attendances, inpatient days, accident and emergency admissions and 'total HSU'.
RESULTS
Taking into account study quality, 28 studies identified a range of variables with good preliminary evidence supporting their ability to predict HSU. Of these variables, comorbidity, personality disorder, age (heterogeneous age ranges), neurotic symptoms, female gender, a marital status of divorced, separated or widowed, non-white ethnicity, high previous HSU and activities of daily living, were associated with increased HSU. Moreover, good preliminary evidence was found for associations of accessing a primary care psychological treatment service and medication use with decreased HSU.
CONCLUSIONS
The findings can inform decisions about which variables might be used to derive mental health clusters in 'payment by results' systems in the UK. The findings also support the need to investigate whether combining broad diagnoses with care pathways is an effective method for mental health clustering, and the need for research to further examine the association between mental health clusters and HSU.
Topics: Activities of Daily Living; Age Factors; Anxiety Disorders; Comorbidity; Dementia; Depressive Disorder; Feeding and Eating Disorders; Female; Health Services; Hospitalization; Humans; Male; Marital Status; Mental Disorders; Mental Health Services; Personality Disorders; Primary Health Care; Psychotherapy; Psychotic Disorders; Risk Factors; Secondary Care; Sex Factors; Tertiary Healthcare; United Kingdom
PubMed: 26150142
DOI: 10.1136/bmjopen-2015-007575 -
PloS One 2021The fertility desire of people living with HIV (PLHIV) has been rising in the past decade. However, there are many studies among which the association remains... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The fertility desire of people living with HIV (PLHIV) has been rising in the past decade. However, there are many studies among which the association remains controversial between the fertility desire of HIV-infected persons and antiretroviral therapy (ART), sex, marital status, and educational level.
METHODS
We performed a literature search of these meta-analyses in PubMed, the Cochrane Library, Web of Science and ScienceDirect in November 2019. We also reviewed references of eligible studies to complement the search. We used pooled odds ratios (ORs) and 95% confidence intervals (CIs) with a random-effects model and a fixed-effects model to estimate the association between fertility desire among PLHIV and ART, sex, age, marital status, educational level, and number of children. Subgroups with I square values (I2) and sensitivity analyses were performed to assess the heterogeneity and the stability of the overall ORs, respectively. We evaluated publication bias using Egger's test and a visual inspection of the symmetry in funnel plots.
RESULTS
In these meta-analyses 50 articles were included with 22,367 subjects. The pooled prevalence of fertility desire among PLHIV was estimated to be 42.04%. The pooled analyses showed that the fertility desire of PLHIV is associated with ART (OR = 1.11, 95% CI:1.00-1.23, P = 0.043), sex (OR = 1.51, 95% CI:1.10-2.09), age (OR = 2.65, 95% CI:2.24-3.14), marital status (OR = 1.34, 95% CI:1.08-1.66), educational level (OR = 0.85, 95% CI:0.73-1.00, P = 0.047) and the number of children (OR = 3.99, 95% CI:3.06-5.20). PLHIV who are on ART, are male, are younger than 30, are married/cohabiting, have received a secondary education or above, and are childless have a higher prevalence of fertility desire. The two factors of age and the number of children, in particular demonstrated a strong significant association with fertility desire. We found moderate heterogeneity in the meta-analyses of age and educational level and high heterogeneity in the meta-analyses of sex, marital status and number of children. Publication bias was detected in the meta-analyses of the association of fertility with sex and educational level.
CONCLUSION
This study demonstrates that the prevalence of fertility desire among HIV-infected people is 42.04%, and the fertility desire among PLHIV is associated with ART experience, sex, age, marital status, the number of children, and educational level. Since a majority of PLHIV are of reproductive age, it is necessary to support PLHIV in terms of their needs regarding reproductive decision-making. Through counseling and reproductive health care, further measures to prevent the horizontal and vertical transmission of HIV should be taken.
Topics: Child; Female; Fertility; HIV Infections; Humans; Male; Prevalence; Publication Bias
PubMed: 33735265
DOI: 10.1371/journal.pone.0248872