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Frontiers in Psychiatry 2024The association of caesarean section (CS) for postpartum depression (PPD) remains controversial. This study aims to explore the relationship between CS and the risk of...
BACKGROUND
The association of caesarean section (CS) for postpartum depression (PPD) remains controversial. This study aims to explore the relationship between CS and the risk of PPD, in order to provide a basis for preventing PPD.
MATERIAL AND METHODS
We searched PubMed, Web of Science, Cochrane Library, and EMBASE databases for literature about the correlation between CS and PPD published as of February 2024. The combined odds ratios (ORs) and 95% confidence intervals (Cls) were obtained by flexible use of fixed-effects models or random-effects models.
RESULTS
A total of 18 publications were ultimately included in the analysis. Among these, 14 were cohort studies and 4 were case-control reports, encompassing 844,328 total cases. All of the included studies were deemed to be of moderate or higher quality. The meta-analysis indicated that the prevalence of PPD among parturients undergoing CS was 13.4% (95% CI: 6.5%-25.5%).The adjusted odds ratio (OR) for the association between CS and PPD was 1.12 (95% CI: 1.04-1.20) compared to the natural vaginal delivery (NVD) group. Specifically, the adjusted OR for the association between CS and PPD was 1.29 (95% CI: 1.18-1.40) during the first 1-6 months postpartum, and 1.23 (95% CI: 1.14-1.33) after 6 months postpartum. Furthermore, in comparison to the NVD group, the adjusted OR for elective caesarean section (ELCS) and emergency caesarean section (EMCS) were 0.96 (0.83, 1.10) and 1.20 (1.08, 1.34), respectively.
CONCLUSION
Our findings suggest that PPD risk may rise in the presence of CS. In particular, the risk was increased by 20% in the EMCS group, and the risk of PPD within one to six months postpartum after CS increases by 6% compared to that at six months postpartum. In the future, more rational designs and in-depth studies are needed to obtain more accurate information.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42023389265.
PubMed: 38606408
DOI: 10.3389/fpsyt.2024.1361604 -
Eating and Weight Disorders : EWD Aug 2023Pregorexia is a phenomenon posited to occur in the peripartum, characterized by an attempt to counter pregnancy's physiological changes in body shape through reduced... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Pregorexia is a phenomenon posited to occur in the peripartum, characterized by an attempt to counter pregnancy's physiological changes in body shape through reduced calorie intake or increased physical activity.
METHODS
In this pre-registered systematic review and meta-analysis, body image dissatisfaction and eating psychopathology in the peripartum according to gestational age were formally assessed. PubMed was searched up to May 2023. Selection criteria were represented by studies on body image concerns or eating psychopathology in the peripartum (up to 1 year after delivery). The population needed to include women from the general population or among patients with a history of (or current) eating disorder. For the meta-analysis, 17 studies were included: 10 for body image dissatisfaction (2625 individuals overall), 7 for eating behaviors (2551 individuals overall). The interplay between body image and the following themes was examined in depth: the adoption of breastfeeding, peripartum depression, sociocultural influences on body image, sexual disturbances, experiencing or reporting an altered food intake.
RESULTS
Progressive dissatisfaction with body image during pregnancy by gestational age was observed, stably elevated for at least 12 months postpartum. Eating psychopathology was observed as elevated only at 12 months in the postpartum, but not during pregnancy.
DISCUSSION
The current work offers normative values of body image satisfaction and eating psychopathology in the peripartum by gestational age. The relevance of current results was discussed, in order to inform both current clinical practice and future public policies.
LEVEL OF EVIDENCE
Level I-Evidence obtained from: systematic reviews and meta-analyses.
Topics: Female; Humans; Pregnancy; Body Dissatisfaction; Body Image; Feeding and Eating Disorders; Gestational Age; Peripartum Period
PubMed: 37526698
DOI: 10.1007/s40519-023-01595-8 -
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 -
Archives of Women's Mental Health Apr 2024This systematic review aimed to determine if digital screening for mental health in pregnancy and postpartum is acceptable, feasible and more effective than standard... (Review)
Review
PURPOSE
This systematic review aimed to determine if digital screening for mental health in pregnancy and postpartum is acceptable, feasible and more effective than standard care (paper-and pen-based screening or no screening). The second aim was to identify barriers and enablers to implementing digital screening in pregnancy and postpartum.
METHOD
OVID MEDLINE, PsycINFO, SCOPUS, CINAHL, Embase, Web of Science, Joanna Briggs Database and All EMB reviews incorporating Cochrane Database of Systematic Reviews (OVID) were systematically searched for articles that evaluated digital screening for mental health in pregnancy and postpartum between 2000 and 2021. Qualitative articles were deductively mapped to the Theoretical Domains Framework (TDF).
RESULTS
A total of 34 articles were included in the analysis, including qualitative, quantitative and mixed-methods studies. Digital screening was deemed acceptable, feasible and effective. TDF domains for common barriers included environmental context and resources, skills, social/professional role and identity and beliefs about consequences. TDF domains for common enablers included knowledge, social influences, emotion and behavioural regulation.
CONCLUSION
When planning to implement digital screening, consideration should be made to have adequate training, education and manageable workload for healthcare professionals (HCP's). Organisational resources and support are important, as well as the choice of the appropriate digital screening assessment and application setting for women. Theory-informed recommendations are provided for both healthcare professionals and women to inform future clinical practice.
PubMed: 38557913
DOI: 10.1007/s00737-024-01427-3 -
Psychiatry Research Aug 2023Peripartum depression is defined as the onset of depressive symptoms during pregnancy or within 12 months postpartum and affects 11.9% of women. Currently, its treatment... (Review)
Review
OBJECTIVE
Peripartum depression is defined as the onset of depressive symptoms during pregnancy or within 12 months postpartum and affects 11.9% of women. Currently, its treatment often involves psychotherapy and antidepressants, though only one medication has been specifically approved to treat it. In this context, novel, safe non-pharmacological treatment options have gained growing interest. The present review aims to assess current literature on possible side effects on the developing fetus/newborn of Transcranial Magnetic Stimulation (TMS) use in women with peripartum depression.
METHOD
A systematic search was performed using the PubMed, Scopus and Web of Science databases. PRISMA and PROSPERO guidelines were applied. The risk of bias assessment was performed using the Cochrane risk of bias tool version 2.0.
RESULTS
Twenty-three studies were included in our systematic review, two were randomized controlled trials. Eleven studies reported mothers experienced mild side effects; none of the included studies reported major side effects for newborns.
CONCLUSION
The present systematic review demonstrated that TMS use in women with peripartum depression is safe, feasible and well-tolerated by the developing fetus/newborn, with a good safety and tolerability profile even during breastfeeding.
Topics: Pregnancy; Humans; Female; Infant, Newborn; Transcranial Magnetic Stimulation; Depression; Peripartum Period; Antidepressive Agents; Psychotherapy
PubMed: 37270864
DOI: 10.1016/j.psychres.2023.115251 -
Early Intervention in Psychiatry Oct 2023Postpartum depression is prevalent worldwide and seriously endangers maternal and child health. Previous studies have demonstrated the effectiveness of psychological and... (Review)
Review
Identifying the common elements of psychological and psychosocial interventions for preventing postpartum depression: Application of the distillation and matching model to 37 winning protocols from 36 intervention studies.
AIM
Postpartum depression is prevalent worldwide and seriously endangers maternal and child health. Previous studies have demonstrated the effectiveness of psychological and psychosocial intervention programmes in preventing postpartum depression. However, the literature offers limited practice guidance. Therefore, this study aimed to deeply analyse prior findings to gather rich evidence-based information on this topic.
METHODS
Using the distillation and matching model, we conducted a systematic review of psychological and psychosocial interventions used to effectively prevent postpartum depression. Four researchers trained in coding system independently read eligible studies and identified reliable (Cohen's kappa >0.40) and frequently occurring (frequency ≥3 winning study groups) practice elements.
RESULTS
Our review included 36 studies containing 37 winning study groups. Fourteen practice elements were identified and subsequently divided into six categories: postpartum practical problems-related, social support-related, interpersonal psychotherapy-related, cognitive behavioural therapy-related, labour trauma-related and non-specific techniques. The most common practice elements were baby care skills and mother-infant bonding/interaction enhancement. Inter-rater reliability averaged 0.86, ranging from 0.48 to 1.
CONCLUSION
The practice elements identified in this study provide rich evidence-based information that can guide clinical practitioners in selecting or developing effective, realistically available intervention programmes.
Topics: Child; Female; Humans; Cognitive Behavioral Therapy; Depression, Postpartum; Distillation; Psychosocial Intervention; Psychotherapy; Reproducibility of Results
PubMed: 37680169
DOI: 10.1111/eip.13462 -
Archives of Women's Mental Health Jun 2024This systematic review aims to summarize the findings of empirical studies conducted in low- and middle-income countries (LMICs) examining the relationship between... (Review)
Review
AIMS
This systematic review aims to summarize the findings of empirical studies conducted in low- and middle-income countries (LMICs) examining the relationship between postpartum depression and anxiety, and child developmental outcomes measured at 24 months of child's age.
METHODS
The study was performed as per PRISMA guidelines for a systematic review. EBESCO, ProQuest, PubMed, Science Direct, Google Scholar, and BMJ databases were examined, along with a forward and backward examination of the citations published. The New Ottawa scales (NOS) was used to assess the quality of the studies. The findings of the studies were integrated using a narrative synthesis approach.
RESULTS
The systematic review revealed that there are 14 studies examining the impact of postpartum depression (n=14) and postpartum anxiety (n=2) across different domains of child development in LMICs. Studies varied regarding the severity and duration of maternal depression, the context and nature of evaluation, and motherinfant characteristics which are important to understand the association between postpartum depression and anxiety and infant development. Maternal depression is negatively associated with language development, socio-emotional and behavioural development while its association with motor and cognitive development is inconsistent. The impact of maternal anxiety on infant development was examined in two studies, and both have identified a negative association. However, the results of the current review need to be interpreted within the scope and limitations of the methodologies adopted by each study details of which are elaborated in the manuscript.
CONCLUSION
Postpartum depression and anxiety can have a wide range of effects on child development. Therefore, periodic infant developmental assessments should become part of routine psychiatric evaluation. There is a need for uniform guidelines for conducting studies and reporting data related to postpartum mental health and child development.
PubMed: 38896155
DOI: 10.1007/s00737-024-01485-7 -
Frontiers in Psychiatry 2023Interpersonal Psychotherapy (IPT) is an evidence-based therapy. There have been increasing demand and training opportunities of IPT in China. Reviewing current evidence... (Review)
Review
OBJECTIVE
Interpersonal Psychotherapy (IPT) is an evidence-based therapy. There have been increasing demand and training opportunities of IPT in China. Reviewing current evidence on its use in Chinese patients can help us understand the applicability of IPT in China and identify knowledge gaps to encourage and better future research in this field.
METHOD
We did a comprehensive search of three major electronic databases: PubMed (English), Chinese National Knowledge Infrastructure (CNKI) and WanFang Data (Chinese). We examined overall study design, outcome measures, data analyses and other parameters. We only selected articles of Randomized Clinical Trials (RCT) for this review. All study findings were grouped and summarized per psychiatric diagnoses. The meta-analysis and forest plots were performed whereas studies could be combined.
RESULTS
After a full text review of 132 articles, 40 were selected for the final review. Comparing with control groups, evidences supported the efficacy of IPT in Chinese patients with Major Depressive Disorder (MDD), Postpartum depression, Generalized Anxiety Disorder (GAD), Social Anxiety Disorder, Post Stress Traumatic Disorder (PTSD), and Post-psychotic Depression. It was also beneficial to college students and Chinese first-time mothers. Meta-analysis using a random-effects model consistently yielded significant score differences between the IPT and control groups ( < 0.0001) on MDD.
CONCLUSION
This systematic review has identified the current best evidence for IPT efficacy in Chinese population. The findings support IPT as an effective treatment in Chinese with certain psychiatric conditions, consistent with those from many other studies throughout the world.
PubMed: 37502817
DOI: 10.3389/fpsyt.2023.1160081 -
Journal of Affective Disorders Jun 2024Postpartum Depression (PPD) exerts a substantial negative effect on maternal well-being post-delivery, particularly among Cesarean Section (C/S) recipients. In this... (Review)
Review
BACKGROUND
Postpartum Depression (PPD) exerts a substantial negative effect on maternal well-being post-delivery, particularly among Cesarean Section (C/S) recipients. In this study, we aimed to review the efficacy of perioperative esketamine, the S-enantiomer of ketamine, in preventing PPD incidence and depressive symptoms as measured with the Edinburgh Postnatal Depression Scale (EPDS) after C/S.
METHODS
A systematic search for relevant articles was conducted in Scopus, PubMed, Web of Sciences, and PsycINFO until April 6, 2024. Meta-analyses were conducted using random-effect models to compare the PPD incidence and EPDS scores via log odds ratio and Hedge's g, respectively, during the first week post-C/S and at 42 days post-C/S in the esketamine and control group.
RESULTS
Fourteen studies, including 12 randomized controlled trials and 2 retrospective cohorts, were reviewed. Our meta-analyses found lower PPD incidence during the first week (log odds ratio: -0.956 [95 % confidence interval: -1.420, -0.491]) and at day 42 post-C/S (log odds ratio: -0.989 [95 % confidence interval: -1.707, -0.272]) among patients administered esketamine compared to controls. Additionally, EPDS scores for the esketamine group were significantly lower than controls during the first week (Hedge's g: -0.682 [95 % confidence interval: -1.088, -0.276]) and at day 42 post-C/S (Hedge's g: -0.614 [95 % confidence interval: -1.098, -0.129]).
LIMITATIONS
Presence of various concomitant medications and heterogeneous study designs.
CONCLUSION
Our review highlights the potential impact of esketamine in PPD prevention, as well as in alleviating depressive symptoms post-C/S, regardless of PPD occurrence, therefore suggesting the benefits of adding esketamine to peri-C/S analgesic regimen.
PubMed: 38925307
DOI: 10.1016/j.jad.2024.06.080 -
Obstetrics and Gynecology Mar 2024To identify the social-structural determinants of health risk factors associated with maternal morbidity and mortality in the United States during the prenatal and...
OBJECTIVE
To identify the social-structural determinants of health risk factors associated with maternal morbidity and mortality in the United States during the prenatal and postpartum periods.
DATA SOURCES
We searched MEDLINE, CINAHL, and Social Sciences Citation Index through November 2022 for eligible studies that examined exposures related to social and structural determinants of health and at least one health or health care-related outcome for pregnant and birthing people.
METHODS OF STUDY SELECTION
After screening 8,378 unique references, 118 studies met inclusion criteria.
TABULATION, INTEGRATION, AND RESULTS
We grouped studies by social and structural determinants of health domains and maternal outcomes. We used alluvial graphs to summarize results and provide additional descriptions of direction of association between potential risk exposures and outcomes. Studies broadly covered risk factors including identity and discrimination, socioeconomic, violence, trauma, psychological stress, structural or institutional, rural or urban, environment, comorbidities, hospital, and health care use. However, these risk factors represent only a subset of potential social and structural determinants of interest. We found an unexpectedly large volume of research on violence and trauma relative to other potential exposures of interest. Outcome domains included maternal mortality, severe maternal morbidity, hypertensive disorders, gestational diabetes, cardiac and metabolic disorders, weathering depression, other mental health or substance use disorders, and cost per health care use outcomes. Patterns between risk factors and outcomes were highly mixed. Depression and other mental health outcomes represented a large proportion of medical outcomes. Risk of bias was high, and rarely did studies report the excess risk attributable to a specific exposure.
CONCLUSION
Limited depth and quality of available research within each risk factor hindered our ability to understand underlying pathways, including risk factor interdependence. Although recently published literature showed a definite trend toward improved rigor, future research should emphasize techniques that improve the ability to estimate causal effects. In the longer term, the field could advance through data sets designed to fully ascertain data required to robustly examine racism and other social and structural determinants of health, their intersections, and feedback loops with other biological and medical risk factors.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42022300617.
Topics: Pregnancy; Female; Humans; Diabetes, Gestational; Mental Health; Postpartum Period; Maternal Mortality; Violence
PubMed: 38128105
DOI: 10.1097/AOG.0000000000005489