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International Journal of Environmental... Dec 2022A large proportion of women experience depression during the postpartum period. Few studies have investigated the use of mobile technology to prevent postpartum... (Randomized Controlled Trial)
Randomized Controlled Trial
A large proportion of women experience depression during the postpartum period. Few studies have investigated the use of mobile technology to prevent postpartum depression in women. This study investigated the preliminary effectiveness of the CareMom program, a new app-based cognitive behavioral therapy program, on reducing the depressive symptoms of mothers during the very early postpartum period via a pilot randomized controlled study. The participants were recruited during birth hospitalization (within 3 days after giving birth) and randomized to the waiting-list control and CareMom groups. Over the four-week intervention period, the CareMom group was required to complete 28 daily challenges via CareMom. The depressive (via EPDS) and anxiety (via GAD-7) levels of participants were measured at baseline and every 7 days postbaseline for 4 weeks. A total of 112 eligible participants were randomly allocated to the two groups (CareMom: n = 57; control: n = 55). At week 4, the CareMom group achieved a significantly lower EPDS score than the control group at week 4 ( = 0.037). In addition, the EPDS ( < 0.001) scores of the CareMom group were significantly lower than the baseline values. However, the control group did not show any significant reduction in this measure. No significant reduction of GAD-7 scores was observed for CareMom and control groups at week 4. This study provides preliminary evidence of the effectiveness of CareMom in reducing depressive symptoms in the general postpartum population during the very early postpartum period.
Topics: Female; Pregnancy; Humans; Depression, Postpartum; Pilot Projects; Mobile Applications; Postpartum Period; Cognitive Behavioral Therapy; Depression
PubMed: 36554704
DOI: 10.3390/ijerph192416824 -
Medicina (Kaunas, Lithuania) Sep 2019During pregnancy and the postnatal period many changes occur in a woman's body, both in mental and physical spheres. The birth of a child and a new role-of a...
During pregnancy and the postnatal period many changes occur in a woman's body, both in mental and physical spheres. The birth of a child and a new role-of a mother-can sometimes be associated with numerous negative emotions, uncertainty, fear, anxiety, disgust, depression, or sadness. In the puerperium period, the development of baby blues or postpartum depression may occur. Postpartum depression develops within one month of childbirth and may last up to one year. Depressive disorders that may develop in a young mother affect both her and the newborn's health. That is why it is so important to try to search for factors that could significantly reduce the likelihood of developing depression in this period. The study aims at assessing the relationship between physical activity during pregnancy and puerperium or in the postpartum and the development of postnatal depression. A review of the literature was carried out in the Medline-PubMed database. The search terms were "pregnancy" AND "physical activity AND postpartum depression". The study included only English-language publications published in the period 2000-2018. A total of 216 references were found. After establishing the inclusion and exclusion criteria based on the analysis of titles and abstracts, 173 articles were excluded from the review. A total of 43 publications were read in full. Finally, 16 articles were included in the review. It was shown that regular physical activity during pregnancy, pregnancy, and puerperium, or in the postnatal period itself as compared to inactivity, reduces the risk of developing depression in pregnant women and after the birth of a child. Physical activity can be an essential factor in the prevention of depressive disorders of women in the postnatal period.
Topics: Depression, Postpartum; Exercise; Female; Humans; Postpartum Period; Pregnancy
PubMed: 31480778
DOI: 10.3390/medicina55090560 -
Jornal de Pediatria 2017To investigate the association between postpartum depression and the occurrence of exclusive breastfeeding.
OBJECTIVE
To investigate the association between postpartum depression and the occurrence of exclusive breastfeeding.
METHOD
This is a cross-sectional study conducted in the states of the Northeast region, during the vaccination campaign in 2010. The sample consisted of 2583 mother-child pairs, with children aged from 15 days to 3 months. The Edinburgh Postnatal Depression Scale was used to screen for postpartum depression. The outcome was lack of exclusive breastfeeding, defined as the occurrence of this practice in the 24h preceding the interview. Postpartum depression was the explanatory variable of interest and the covariates were: socioeconomic and demographic conditions; maternal health care; prenatal, delivery, and postnatal care; and the child's biological factors. Multivariate logistic regression analysis was conducted to control for possible confounding factors.
RESULTS
Exclusive breastfeeding was observed in 50.8% of the infants and 11.8% of women had symptoms of postpartum depression. In the multivariate logistic regression analysis, a higher chance of exclusive breastfeeding absence was found among mothers with symptoms of postpartum depression (OR=1.67; p<0.001), among younger subjects (OR=1.89; p<0.001), those who reported receiving benefits from the Bolsa Família Program (OR=1.25; p=0.016), and those started antenatal care later during pregnancy (OR=2.14; p=0.032).
CONCLUSIONS
Postpartum depression contributed to reducing the practice of exclusive breastfeeding. Therefore, this disorder should be included in the prenatal and early postpartum support guidelines for breastfeeding, especially in low socioeconomic status women.
Topics: Adult; Breast Feeding; Cross-Sectional Studies; Depression, Postpartum; Female; Humans; Infant; Infant, Newborn; Socioeconomic Factors; Young Adult
PubMed: 28034730
DOI: 10.1016/j.jped.2016.08.005 -
Journal of Advanced Nursing Oct 2019To determine if an electronic nursing intervention during the first 6 months postpartum was effective in improving mood and decreasing stress. (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To determine if an electronic nursing intervention during the first 6 months postpartum was effective in improving mood and decreasing stress.
BACKGROUND
Unmet needs postpartum can have a negative impact on mood and parenting stress. Technology-assisted nursing care may provide needed support and reduce risk.
DESIGN
Randomized controlled trial (RCT) with three conditions.
METHODS
Enrollment began on 11 May 2017. Participants were randomized into one of three groups after completion of the baseline survey. Intervention I participants received standardized electronic messages four times/week for 6 months postpartum. Intervention II participants additionally received the option for nurse contact. Depression and parenting stress as measured using the Edinburgh Postnatal Depression Scale (EPDS) and Parenting Stress Index-Short form (PSI-SF) was obtained at 3 weeks, 3 months and 6 months postpartum and results compared with a usual care group. Patient satisfaction and nursing factors were measured.
RESULTS
Significantly higher satisfaction scores were found in both intervention groups as compared with control, but there were no significant changes in EPDS or PSI-SF.
CONCLUSION
The interventions were perceived as helpful and not burdensome. Better nurse-sensitive outcome measures are needed to adequately assess effectiveness.
IMPACT
Postpartum women report unmet needs for support and education. The interventions were perceived as being helpful but did not significantly reduce depressive symptoms or parenting stress. Nurses can use this research to inform development of innovative approaches to support postpartum women.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov NCT02843022.
Topics: Adult; Depression, Postpartum; Female; Humans; Inventions; Mothers; Postnatal Care; Pregnancy
PubMed: 31222789
DOI: 10.1111/jan.14114 -
Acta Obstetricia Et Gynecologica... Mar 2020
Topics: Depression, Postpartum; Female; Humans; Narration; Pregnancy; Prenatal Care
PubMed: 32077102
DOI: 10.1111/aogs.13784 -
JAMA Psychiatry Oct 2022Current evidence on the association between family history of psychiatric disorders and postpartum depression is inconsistent; family studies have identified familial... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Current evidence on the association between family history of psychiatric disorders and postpartum depression is inconsistent; family studies have identified familial risk of postpartum depression, whereas systematic reviews and umbrella reviews, compiling all risk factors for postpartum depression, often have not.
OBJECTIVE
To investigate the association between family history of psychiatric disorders and risk of developing postpartum depression within 12 months post partum.
DATA SOURCES
Literature searches were conducted in PubMed, Embase, and PsycINFO in September 2021 and updated in March 2022, accompanied by citation and reference search.
STUDY SELECTION
Studies eligible for inclusion comprised peer-reviewed cohort and case-control studies reporting an odds ratio (OR) or sufficient data to calculate one for the association between family history of any psychiatric disorder and postpartum depression. Study selection was made by 2 independent reviewers: title and abstract screening followed by full-text screening.
DATA EXTRACTION AND SYNTHESIS
Reporting was performed using the MOOSE checklist. Two reviewers independently extracted predefined information and assessed included studies for risk of bias using the Newcastle-Ottawa Scale. Data were pooled in a meta-analysis using a random-effects model. Heterogeneity was investigated with meta-regression, subgroup, and sensitivity analyses. Publication bias was investigated using a funnel plot, and GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to evaluate the overall certainty of the findings.
MAIN OUTCOMES AND MEASURES
The primary outcome was the pooled association between family history of psychiatric disorders and postpartum depression.
RESULTS
A total of 26 studies were included, containing information on 100 877 women. Meta-analysis showed an increased OR of developing postpartum depression when mothers had a family history of psychiatric disorders (OR, 2.08; 95% CI, 1.67-2.59; I2 = 57.14%) corresponding to a risk ratio of 1.79 (95% CI, 1.52-2.09), assuming a 15% postpartum depression prevalence in the general population. Subgroup, sensitivity, and meta-regression analyses were in line with the primary analysis. The overall certainty of evidence was deemed as moderate according to GRADE.
CONCLUSIONS AND RELEVANCE
In this study, there was moderate certainty of evidence for an almost 2-fold higher risk of developing postpartum depression among mothers who have a family history of any psychiatric disorder compared with mothers without.
Topics: Case-Control Studies; Depression, Postpartum; Female; Humans; Mothers; Risk Factors
PubMed: 35976654
DOI: 10.1001/jamapsychiatry.2022.2400 -
JPMA. the Journal of the Pakistan... Jan 2022Depression and diabetes share a bidirectional causal association. Additionally, during the postpartum period women have an increased vulnerability for both depression...
Depression and diabetes share a bidirectional causal association. Additionally, during the postpartum period women have an increased vulnerability for both depression and impaired glucose tolerance. The impact of the comorbidity of diabetes and postpartum depression is also bidirectional with an impaired course and outcome of both these disorders. The clinic visits for pregnancy and/ or diabetes care offer important opportunity to screen for postpartum (as well as prepartum) depression. Screening tools that are shorter, that take less time and acceptable are recommended. While a limited number of guidelines on management of depression among persons with diabetes have commented on management of the postpartum depression, the emphasis is on timely intervention using pharmacological and psycho- social interventions. There is a need to develop a collaborative approach involving various stakeholders to effectively manage postpartum depression and diabetes.
Topics: Depression, Postpartum; Diabetes, Gestational; Female; Glucose Intolerance; Humans; Mass Screening; Postpartum Period; Pregnancy
PubMed: 35099464
DOI: 10.47391/JPMA.22-002 -
International Journal of Environmental... Nov 2022Targeting lifestyle behaviors during pregnancy is crucial to prevent the highly prevalent postpartum depression and its consequences. In these secondary analyses of an... (Clinical Trial)
Clinical Trial
Targeting lifestyle behaviors during pregnancy is crucial to prevent the highly prevalent postpartum depression and its consequences. In these secondary analyses of an intervention trial to investigate the effects of concurrent exercise training on postpartum depression, we aimed to investigate the potential role of Mediterranean diet (MD) adherence on the exercise effects. A total of 85 pregnant women met the per-protocol criteria (exercise n = 46, control n = 39). The exercise program was delivered in 60 min sessions, 3 days/week, from the 17th gestational week until birth. Women's dietary habits were assessed with a food frequency questionnaire. The Mediterranean Food Pattern (an MD index) was derived from it to assess MD adherence. We used the Edinburgh Postnatal Depression Scale to assess postpartum depression. The postpartum depression score was not statistically different between control and exercise groups ( > 0.05). A higher consumption of fruits (β = -0.242, = 0.022), lower intake of red meat and subproducts (β = 0.244, = 0.020), and a greater MD adherence (β = -0.236, = 0.027) were associated with lower levels of postpartum depression. Greater adherence to the MD during pregnancy was associated with fewer depressive symptoms and a lower risk of postpartum depression. Postnatal depression was not reduced by prenatal exercise. Promoting fruit consumption while controlling the intake of red meat during pregnancy might prevent postnatal depression.
Topics: Female; Humans; Pregnancy; Depression, Postpartum; Diet, Mediterranean; Exercise; Life Style; Postpartum Period; Pregnant Women
PubMed: 36361335
DOI: 10.3390/ijerph192114450 -
Journal of Medical Internet Research Dec 2021Previous research has confirmed that symptoms of postnatal depression (PND) can be ameliorated through internet-delivered psychological interventions. Advantages of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Previous research has confirmed that symptoms of postnatal depression (PND) can be ameliorated through internet-delivered psychological interventions. Advantages of internet-delivered treatment include anonymity, convenience, and catering to women who are unable to access face-to-face (FTF) treatments. To date, no research has examined the efficacy of such interventions compared directly with FTF treatments in women clinically diagnosed with PND.
OBJECTIVE
This study aims to compare the efficacy of one of the first web-based cognitive behavioral therapy (CBT) interventions (internet CBT+coach calls) for PND (MumMoodBooster [MMB]) with FTF-CBT in a randomized controlled trial (RCT).
METHODS
In this study, 116 postnatal women with a Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) diagnosis of major or minor depression were randomized to MMB (39/116, 33.6%), FTF-CBT (39/116, 33.6%), or a treatment-as-usual (TAU) control condition (38/116, 32.8%). Diagnostic status was determined at baseline and at 21-week follow-up using the Structured Clinical Interview for the DSM-IV. Severity of anxiety and depressive symptoms was evaluated using the Depression Anxiety Stress Scales and the revised Beck Depression Inventory at baseline, 12-week follow-up (after treatment), and 21-week follow-up.
RESULTS
Of the 116 participants, 107 (92.2%) had a diagnosis of major depression at baseline. Rates of remission from a major or minor depressive episode at 21 weeks in both the FTF-CBT and MMB groups were superior to that of the TAU group (56.6% and 47.7% less likely to be depressed, respectively) and they were not significantly different from each other. Although remission rates differed between TAU and FTF-CBT, growth models showed that, in terms of symptom reduction across time, the FTF-CBT treatment was not significantly better than TAU. By comparison, MMB was statistically superior to both TAU and FTF-CBT in reducing symptoms of depression, anxiety, and stress from baseline to the 21-week follow-up (large and moderate effect sizes). Thus, after 21 weeks, the average symptom scores for depression and anxiety of women receiving MMB were approximately half those of women in both the TAU and FTF-CBT groups.
CONCLUSIONS
In this RCT, MMB was at least as effective as FTF-CBT in achieving remission from a diagnosed PND episode. MMB was superior to TAU and FTF-CBT in encouraging and maintaining reduction of symptom severity over the 21-week follow-up for depressed postnatal women. These findings replicate results of prior studies on MMB that showed clinically significant improvements in depressive symptoms, and they provide direct empirical support that internet-delivered treatment for depressed postnatal women is a viable alternative to FTF treatment. The generalizability of the results needs to be examined in future research, as RCTs of internet-based versus FTF treatments necessarily involve a subset of people who are willing to undertake either modality of treatment.
TRIAL REGISTRATION
Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000881730; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364683&isReview=true.
Topics: Cognitive Behavioral Therapy; Depression, Postpartum; Female; Humans; Internet
PubMed: 34889742
DOI: 10.2196/17185 -
JAMA Network Open Mar 2024Postpartum depression (PPD) is one of the most common mental health conditions during the perinatal and postpartum periods, which can have adverse effects on both mother... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Postpartum depression (PPD) is one of the most common mental health conditions during the perinatal and postpartum periods, which can have adverse effects on both mother and infant.
OBJECTIVE
To investigate the efficacy of perioperative adjunctive esketamine administration after cesarean deliveries in the prevention of PPD.
DESIGN, SETTING, AND PARTICIPANTS
A single-center, double-blind, placebo-controlled, randomized clinical trial was conducted from January 1, 2022, to January 1, 2023, at Fujian Provincial Hospital among 298 women aged 18 to 40 years, with an American Society of Anesthesiologists grade I to III classification and singleton full-term pregnancies who were scheduled for elective cesarean deliveries. Primary analyses were performed on a modified intention-to-treat basis.
INTERVENTIONS
Patients were randomly assigned to the esketamine (n = 148) and control (n = 150) groups. Those in the esketamine group received a single intravenous injection of 0.25 mg/kg of esketamine immediately after fetal delivery, followed by 50 mg of esketamine as an adjuvant in patient-controlled intravenous analgesia for 48 hours after surgery. Saline was given to the control group of patients.
MAIN OUTCOMES AND MEASURES
The primary outcome was assessments of PPD symptoms by using the Edinburgh Postnatal Depression Scale (EPDS) at postpartum day 7. Positive screening for PPD was defined as a score of 10 or more points on the EPDS. In addition, the EPDS was analyzed as a continuous variable to evaluate depressive symptoms. Secondary outcomes included the Numeric Rating Scale (NRS) of postoperative pain, along with safety evaluations including adverse events and clinical assessments at postpartum days 14, 28, and 42.
RESULTS
A total of 298 pregnant women were included, with 150 in the control group (median age, 31.0 years [IQR, 29.0-34.0 years]) and 148 in the esketamine group (median age, 31.0 years [IQR, 28.0-34.0 years]). The prevalence of depression symptoms was significantly lower among patients given esketamine compared with controls (23.0% [34 of 148] vs 35.3% [53 of 150]; odds ratio, 0.55; 95% CI, 0.33-0.91; P = .02) on postpartum day 7. In addition, the esketamine group also showed a significantly lower change in EPDS scores (difference of least-squares means [SE], -1.17 [0.44]; 95% CI, -2.04 to -0.31; effect size, 0.74; P = .008). However, there were no differences between the groups in the incidence of positive screening results for PPD or in changes from the baseline EPDS scores at postpartum days 14, 28, and 42. There were no differences in NRS scores at rest and on movement except on movement at 72 hours postoperatively, when scores were significantly lower in the esketamine group (median, 3.0 [IQR, 2.0-3.0] vs 3.0 [IQR, 3.0-3.5]; median difference, 0 [95% CI, 0-0]; P = .03).
CONCLUSIONS AND RELEVANCE
These results suggest that intravenous administration of esketamine during the perioperative period of elective cesarean delivery can improve depression symptoms during the early postpartum period. However, this antidepression effect may not be universally applicable to patients with low EPDS scores.
TRIAL REGISTRATION
Chinese Clinical Trial Registry Identifier: ChiCTR2100054199.
Topics: Adult; Female; Humans; Pregnancy; Adjuvants, Immunologic; Cesarean Section; Depression, Postpartum; Ketamine; Adolescent; Young Adult
PubMed: 38446480
DOI: 10.1001/jamanetworkopen.2024.0953