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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 -
Der Nervenarzt Sep 2020Psychiatric research and care increasingly explore the connection between mental health and migration; however, it is striking that only a small number of analyses... (Review)
Review
Psychiatric research and care increasingly explore the connection between mental health and migration; however, it is striking that only a small number of analyses exist on the effect of migration on mental ailments specific to women. For example, even though postpartum depression regularly occurs among women with a migration background, in Germany and internationally there is a lack of knowledge on the epidemiology, particularly with respect to factors causing or contributing to postpartum depression among women with a migration background. Prospectively, culturally specific treatment options for women with a migration background are necessary to prevent chronification and subsequent harm to the mother and other family members. With this aim in mind, psychologists, psychiatrists and gynecologists should be aware of the specific factors contributing to the development of postpartum depression among women with a migration background. This overview article focuses on key aspects of postpartum depression, such as epidemiology, symptoms, risk factors and treatment concepts, while contextualizing them with respect to women's experience of migration.
Topics: Depression; Depression, Postpartum; Female; Germany; Humans; Mental Health; Mothers; Postpartum Period; Risk Factors
PubMed: 31720700
DOI: 10.1007/s00115-019-00828-5 -
EBioMedicine Dec 2023
Topics: Female; Humans; Depression; Depression, Postpartum; Postpartum Period
PubMed: 38099513
DOI: 10.1016/j.ebiom.2023.104925 -
Journal of Affective Disorders Oct 2023Postpartum depression (PPD) is a prevalent public health issue. Although ketamine has prophylactic effects on PPD in women undergoing cesarean section, the effects of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Postpartum depression (PPD) is a prevalent public health issue. Although ketamine has prophylactic effects on PPD in women undergoing cesarean section, the effects of esketamine on PPD remain unclear. This trial aimed to evaluate the efficacy of perioperative esketamine infusion on PPD risk by assessing Edinburgh Postnatal Depression Scale (EPDS) scores and blood biomarkers.
METHODS
A total of 150 participants undergoing elective cesarean section were randomly allocated to receive either esketamine or normal saline. Since 27 participants were excluded due to consent withdrawal or loss to follow-up, 123 patients were included. The primary outcome was the prevalence of PPD risk. Secondary outcomes included the prevalence of postpartum anxiety (PPA) risk, levels of biomarkers, postoperative pain intensity, and cumulative sufentanil consumption.
RESULTS
The prevalence of PPD and PPA risk at 3 days, 42 days, 3 months, and 6 months postpartum did not differ between the two groups. Furthermore, EPDS scores, pain intensity at rest, and during coughing on postoperative days (POD) 1 and 2 did not differ between the two groups. Sufentanil consumption during 0-12 h, 12-24 h, 0-24 h, and 0-48 h postoperatively were significantly lower in the esketamine group compared to the control group. Blood biomarkers did not differ between the two groups on POD 3.
LIMITATIONS
The sample size was small. PPD risk was simply screened, not diagnosed.
CONCLUSIONS
Perioperative administration of esketamine did not decrease the incidence of PPD risk in women after elective cesarean section. However, esketamine reduced opioid consumption.
Topics: Humans; Female; Pregnancy; Cesarean Section; Ketamine; Depression, Postpartum; Sufentanil; Biomarkers
PubMed: 37482224
DOI: 10.1016/j.jad.2023.07.103 -
Annals of Medicine 2023Depression during pregnancy or postpartum carries the same risks as general depression as well as additional risks specific to pregnancy, infant health and maternal...
BACKGROUND/OBJECTIVES/INTRODUCTION
Depression during pregnancy or postpartum carries the same risks as general depression as well as additional risks specific to pregnancy, infant health and maternal well-being. The purpose of this study is to document the prevalence of depression symptoms and diagnosis during pregnancy and in the first 3 months postpartum among a cohort of women receiving prenatal care in a large health system. Secondarily, we examine variability in screening results and diagnosis by race, ethnicity, language, economic status and other maternal characteristics during pregnancy and postpartum.
PATIENTS/MATERIALS AND METHODS
A retrospective study with two cohorts of patients screened for depression during pregnancy and postpartum. Out of 7807 patients with at least three prenatal care visits and a delivery in 2016, 6725 were screened for depression (87%) at least once during pregnancy or postpartum. Another 259 were excluded because of missing race data. The final sample consisted of 6523 prenatal care patients who were screened for depression; 4914 were screened for depression in pregnancy, 4619 were screened postpartum (0-3 months). There were 3010 screened during both periods who are present in both the pregnancy and postpartum cohorts. Depression screening results are from the Patient Health Questionnaire (PHQ-9) and diagnosis of depression was measured using ICD codes. For patients screened more than once during either time period, the highest score is used for analysis.
RESULTS
Approximately, 11% of women had a positive depression screen as indicated by an elevated PHQ-9 score (>10) during pregnancy (11.3%) or postpartum (10.7%). Prevalence of depression diagnosis was similar in the two periods: 12.6% during pregnancy and 13.0% postpartum. A diagnosis of depression during pregnancy was most prevalent among women who were age 24 and younger (19.7%), single (20.5%), publicly insured (17.8%), multiracial (24.1%) or Native American (23.8%), and among women with a history of depression in the past year (58.9%). Among women with a positive depression screen, Black women were less than half as likely as White women to receive a diagnosis in adjusted models (AOR 0.40, CI: 0.23-0.71, = .002). This difference was not present postpartum.
CONCLUSIONS
Depression symptoms and diagnoses differ by maternal characteristics during pregnancy with some groups at substantially higher risk. Efforts to examine disparities in screening and diagnosis are needed to identify reasons for variability in prenatal depression diagnosis between Black and White women.Key messagesWomen who were young, single, have public insurance, and women who identify as multiracial or non-Hispanic (NH) Native American were most likely to have a positive depression screen or a diagnosis for depression.After adjustment for confounders, NH Black women with a positive depression screen were about half as likely to have a diagnosis of depression during pregnancy as NH White women.Awareness of the differing prevalence of depression risk screening results, diagnoses and potential for variation in diagnosis may identify opportunities to improve equity in the delivery of essential mental health care to all patients.
Topics: Pregnancy; Female; Humans; Young Adult; Adult; Depression, Postpartum; Retrospective Studies; Prevalence; Ethnicity; Racial Groups; Postpartum Period
PubMed: 37963220
DOI: 10.1080/07853890.2023.2281507 -
Journal of Correctional Health Care :... Apr 2024This viewpoint was developed to revisit the burden and risks associated with postpartum depression (PPD) among incarcerated women based on a thematic review of the... (Review)
Review
This viewpoint was developed to revisit the burden and risks associated with postpartum depression (PPD) among incarcerated women based on a thematic review of the literature. Around one third of incarcerated pregnant women have symptoms of moderate to severe depression perinatally. In particular, PPD negatively impacts the well-being of parents and their children. Mitigating the consequences of PPD through screening, promotion of protective factors, and early identification coupled with treatment may have a substantial impact on the overall well-being of the affected children and postpartum individuals. Important risk factors for PPD in correctional populations include previous mental illness diagnosis, a lack of social support, poor pre- and perinatal care, inability to breastfeed, a lack of skin-to-skin contact, and partner violence. We recommend that correctional facilities promote the development of on-site mother-baby units and streamline the visitation process for newborns to visit parents. Improved access to pre- and postnatal care, education, and doula support is highly recommended, as well as consideration of community-based alternatives to incarceration, particularly in correctional settings with underserved mental health care needs. Future studies are needed to estimate the burden of PPD in correctional settings, identify system-related risk factors, and implement evidence-based guidelines for PPD and associated psychosocial sequelae.
Topics: Infant, Newborn; Child; Pregnancy; Female; Humans; Depression, Postpartum; Mothers; Risk Factors; Violence; Risk Assessment
PubMed: 38466964
DOI: 10.1089/jchc.23.08.0071 -
Journal of Obstetric, Gynecologic, and... Nov 2023In August 2023, the U.S. Food and Drug Administration approved Zurzuvae (zuranolone) as the first oral medication to treat postpartum depression. Despite recommendations... (Review)
Review
In August 2023, the U.S. Food and Drug Administration approved Zurzuvae (zuranolone) as the first oral medication to treat postpartum depression. Despite recommendations to screen and treat depression during pregnancy and after birth, perinatal depression is still considered under-detected and under-treated. In this column, I review screening recommendations and the new pharmacological treatment for postpartum depression, research findings on gaps in the cascade of mental health care, integrative care models, and recommendations from professional organizations on screening and treating postpartum depression within broader systems of mental health care.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Depression; Depression, Postpartum; Mass Screening; Perinatal Care; Postpartum Period
PubMed: 37806320
DOI: 10.1016/j.jogn.2023.09.007 -
Journal of the American Psychiatric... 2022The reported incidence of postpartum depression in healthy women without a history of depression was 12%, and the prevalence was 17%. A silent health crisis in America...
BACKGROUND
The reported incidence of postpartum depression in healthy women without a history of depression was 12%, and the prevalence was 17%. A silent health crisis in America is the undiagnosed and untreated mental health of women related to childbirth. Unfamiliar with medical terminology, persons may communicate more effectively by means of metaphors to describe what they are experiencing.
AIMS
To examine the language women used to describe their experiences of postpartum depression with metaphors that can provide a valuable source of insight for psychiatric nurses and other clinicians.
METHODS
Secondary qualitative data analysis of three primary datasets of postpartum depression was conducted. Metaphor identification procedure was the approach used to analyze the texts for metaphorical expressions.
RESULTS
Eleven metaphors were identified that women used to help explain their postpartum depression: , and
CONCLUSIONS
These 11 metaphors provide a new voice for women's experiences of postpartum depression. As a result, they provide rich insights for psychiatric nurses and other clinicians to help identify women struggling with postpartum depression.
Topics: Depression, Postpartum; Female; Health Status; Humans; Mental Health; Metaphor; Parturition; Postpartum Period; Pregnancy
PubMed: 32959705
DOI: 10.1177/1078390320959448 -
Neurobiology of Disease Apr 2022Postpartum depression (PPD) is the most common psychiatric complication associated with pregnancy and childbirth with debilitating symptoms that negatively impact the... (Review)
Review
Postpartum depression (PPD) is the most common psychiatric complication associated with pregnancy and childbirth with debilitating symptoms that negatively impact the quality of life of the mother as well as inflict potentially long-lasting developmental impairments to the child. Much of the theoretical pathophysiology put forth to explain the emergence of PPD overlaps with that of major depressive disorder (MDD) and, although not conventionally described in such terms, can be seen as neurodegenerative in nature. Framing the disorder from the perspective of the well-established inflammatory theory of depression, symptoms are thought to be driven by dysregulation, and subsequent hyperactivation of the body's immune response to stress. Compounded by physiological stressors such as drastic fluctuations in hormone signaling, physical and psychosocial stressors placed upon new mothers lay bare a number of significant vulnerabilities, or points of potential failure, in systems critical for maintaining healthy brain function. The inability to compensate or properly adapt to meet the changing demands placed upon these systems has the potential to damage neurons, hinder neuronal growth and repair, and disrupt neuronal circuit integrity such that essential functional outputs like mood and cognition are altered. The impact of this deterioration in brain function, which includes depressive symptoms, extends to the child who relies on the mother for critical life-sustaining care as well as important cognitive stimulation, accentuating the need for further research.
Topics: Child; Depression; Depression, Postpartum; Depressive Disorder, Major; Female; Humans; Pregnancy; Quality of Life; Risk Factors
PubMed: 35104645
DOI: 10.1016/j.nbd.2022.105646 -
Applied Clinical Informatics Jan 2022Postpartum depression (PPD) remains an understudied research area despite its high prevalence. The goal of this study is to develop an ontology to aid in the...
OBJECTIVE
Postpartum depression (PPD) remains an understudied research area despite its high prevalence. The goal of this study is to develop an ontology to aid in the identification of patients with PPD and to enable future analyses with electronic health record (EHR) data.
METHODS
We used Protégé-OWL to construct a postpartum depression ontology (PDO) of relevant comorbidities, symptoms, treatments, and other items pertinent to the study and treatment of PPD.
RESULTS
The PDO identifies and visualizes the risk factor status of variables for PPD, including comorbidities, confounders, symptoms, and treatments. The PDO includes 734 classes, 13 object properties, and 4,844 individuals. We also linked known and potential risk factors to their respective codes in the International Classification of Diseases versions 9 and 10 that would be useful in structured EHR data analyses. The representation and usefulness of the PDO was assessed using a task-based patient case study approach, involving 10 PPD case studies. Final evaluation of the ontology yielded 86.4% coverage of PPD symptoms, treatments, and risk factors. This demonstrates strong coverage of the PDO for the PPD domain.
CONCLUSION
The PDO will enable future researchers to study PPD using EHR data as it contains important information with regard to structured (e.g., billing codes) and unstructured data (e.g., synonyms of symptoms not coded in EHRs). The PDO is publicly available through the National Center for Biomedical Ontology (NCBO) BioPortal ( https://bioportal.bioontology.org/ontologies/PARTUMDO ) which will enable other informaticists to utilize the PDO to study PPD in other populations.
Topics: Biological Ontologies; Depression, Postpartum; Electronic Health Records; Female; Humans; Prevalence; Risk Factors
PubMed: 35263799
DOI: 10.1055/s-0042-1743240