Computer- or web-based interventions for perinatal mental health: A systematic review.

http://www.ncbi.nlm.nih.gov/pubmed/26991368?dopt=Abstract

Computer- or web-based interventions for perinatal mental health: A systematic review.

J Affect Disord. 2016 Mar 9;197:134-146

Authors: Ashford MT, Olander EK, Ayers S

Abstract
BACKGROUND: Treating prenatal mental health issues is of great importance, but access to treatment is often poor. One way of accessing treatment is through computer- or web-based interventions. Reviews have shown that these interventions can be effective for a variety of mental health disorder across different populations. However, their effectiveness for women in the perinatal period has not been reviewed. This review therefore aimed to provide a first overview of computer- or web-based interventions for women's perinatal mental health issues by systematically identifying and reviewing their characteristics and efficacy.
METHODS: Twelve electronic databases were searched for published and unpublished literature using keywords, supplemented by hand searches. Data were extracted for characteristics of the intervention and the study, study findings and the methodological quality was assessed.
RESULTS: The majority of the eleven eligible studies were randomized controlled trials. Interventions were targeted at depression, stress, and complicated grief during the antenatal or postpartum period or the time after pregnancy loss. Findings suggest that computer- or web-based interventions targeted at improving mental health, especially depression and complicated grief, may be effective.
LIMITATIONS: Findings and their generalizability is limited by the heterogeneity of reviewed interventions and study designs, as well as methodological limitations.
CONCLUSIONS: This systematic review constitutes the first synthesis of research on computer- or web-based interventions for perinatal mental health issues and provides preliminary support that this could be a promising form of treatment during this period. However, there are significant gaps in the current evidence-base so further research is needed.

PMID: 26991368 [PubMed - as supplied by publisher]

Immediate postpartum evaluation of clinical markers for depression symptoms by means of the Edinburg

http://www.ncbi.nlm.nih.gov/pubmed/26990101?dopt=Abstract

Immediate postpartum evaluation of clinical markers for depression symptoms by means of the Edinburgh Postnatal Depression Scale.

Minerva Ginecol. 2016 Feb;68(1):92-95

Authors: Garcia-Flores JR, Peregalli S, Garrido S, Garcia-Diaz S, Espada M, Sainz DE LA Cuesta R

PMID: 26990101 [PubMed - as supplied by publisher]

Managing antidepressant treatment in pregnancy and puerperium. Careful with that axe, Eugene.

http://www.ncbi.nlm.nih.gov/pubmed/25882518?dopt=Abstract

Related Articles

Managing antidepressant treatment in pregnancy and puerperium. Careful with that axe, Eugene.

Expert Opin Drug Saf. 2015 Jul;14(7):1011-4

Authors: Gentile S

Abstract
Until 2005, selective serotonin reuptake inhibitors (SSRIs), the class of antidepressants most frequently used in clinical practice, had been deemed devoid of any teratogenic effects. However, in recent years several concerns have been raised about their reproductive safety, including: disturbed fetal development, increased rates of congenital anomalies, increased risks of neonatal complications, neuro-motor delay and even autism. Specific concerns are also arising about the safety of SSRIs for infants breastfed by mothers who take such medications in puerperium. Such considerations have led to the 'bad reproductive reputation' of SSRIs, whose utilization during pregnancy and breastfeeding is deemed incautious. Specific reproductive problems also involve tricyclic antidepressants, especially clomipramine. Thus, any conclusion about what antidepressant should be considered the safest during pregnancy must be stated and read with great caution. However, the risks associated with pharmacological treatment must be balanced with the effects of untreated antenatal maternal depression on the mother-fetus dyad, which are likely to be devastating. During puerperium, it is mandatory to weigh the risks to the infant of antidepressant exposure through breast milk against the disadvantage of not receiving mother's milk and being exposed to a relapse of maternal mood symptoms (which may also have tragic consequences for the patient).

PMID: 25882518 [PubMed - indexed for MEDLINE]

The Neurobiological Impact of Postpartum Maternal Depression: Prevention and Intervention Approaches

http://www.ncbi.nlm.nih.gov/pubmed/26980123?dopt=Abstract

Related Articles

The Neurobiological Impact of Postpartum Maternal Depression: Prevention and Intervention Approaches.

Child Adolesc Psychiatr Clin N Am. 2016 Apr;25(2):179-200

Authors: Drury SS, Scaramella L, Zeanah CH

Abstract
The lasting negative impact of postpartum depression (PPD) on offspring is well established. PPD seems to have an impact on neurobiological pathways linked to socioemotional regulation, cognitive and executive function, and physiologic stress response systems. This review focus on examining the current state of research defining the effect of universal, selected, and indicated interventions for PPD on infant neurodevelopment. Given the established lasting, and potentially intergenerational, negative implications of maternal depression, enhanced efforts targeting increased identification and early intervention approaches for PPD that have an impact on health outcomes in both infants and mothers represent a critical public health concern.

PMID: 26980123 [PubMed - in process]

The Feasibility of Recruiting and Retaining Perinatal Latinas in a Biomedical Study Exploring Neuroe

http://www.ncbi.nlm.nih.gov/pubmed/26976007?dopt=Abstract

The Feasibility of Recruiting and Retaining Perinatal Latinas in a Biomedical Study Exploring Neuroendocrine Function and Postpartum Depression.

J Immigr Minor Health. 2016 Mar 14;

Authors: Lara-Cinisomo S, Plott J, Grewen K, Meltzer-Brody S

Abstract
This study evaluates the feasibility of enrolling and retaining perinatal immigrant and U.S.-born Latinas in a laboratory-based study that includes the collection of biomarkers implicated in the development of postpartum depression. This prospective study followed Latinas from third trimester of pregnancy to 12 weeks postpartum. Women were enrolled during pregnancy and interviewed at 4, 8 and 12 weeks postpartum. Demographic information, depression status and breastfeeding practices were ascertained using validated Spanish- and English-measures. Blood samples were collected at the 8-week postpartum laboratory visit during infant feeding and pain testing. Feasibility was demonstrated with 85 % retention of the original 34 prenatal women enrolled in the study. The majority (88 %) of women enrolled attended the 8-week laboratory visit regardless of depression status. This is the first study to demonstrate feasibility of enrolling and retaining depressed and nondepressed perinatal immigrant and U.S.-born Latinas in biomedical research.

PMID: 26976007 [PubMed - as supplied by publisher]

Maternal depression is not just a problem early on.

http://www.ncbi.nlm.nih.gov/pubmed/26972518?dopt=Abstract

Maternal depression is not just a problem early on.

Public Health. 2016 Mar 10;

Authors: Kothari C, Wiley J, Moe A, Liepman MR, Tareen RS, Curtis A

Abstract
INTRODUCTION: Little is known about the onset of depression beyond the first postpartum year. This study examines the onset and course of depression over an 18 month period among a socio-economically diverse, community-wide sample of women.
MATERIALS & METHODS: A prospective longitudinal telephone survey of 249 women was conducted at two weeks, two months, six months and 18 months after delivery. Depression was measured using the Edinburgh Postnatal Depression Scale (EPDS), and onset was defined as the first EPDS score of 12+ on the 30-point scale. Temporal trends were assessed using generalized estimating equation (GEE) regression.
RESULTS: There was a significant temporal trend for EPDS scores decreasing until six months and then rebounding at 18 months; mean EPDS 5.5, 4.3, 4.2, and 4.9 at two weeks, two months, six months and 18 months respectively, GEE, P < .001. Depression onset followed a similar trend and was found to be 6.8%, 2.6%, 2.7% and 6.0% at two weeks, two months, six months and 18 months respectively, GEE, P = .068. The high scores of the early-onset group (mean 14.4 at two weeks) contributed to the early depression spike, while the high scores of the late-onset group (mean 13.9 at 18 months) contributed to the late spike.
CONCLUSIONS: Two peaks of depression were identified, one early and one late. They appear to be the result of two processes: (1) elevated depression symptoms at two-weeks and again at 18 months postpartum experienced by the full sample and, thus, they may be a normal trend, and (2) onset of major depression by two sub-groups of women, one at each time period. Therefore, continued screening after one-year post delivery is indicated.

PMID: 26972518 [PubMed - as supplied by publisher]

Predicting adolescent postpartum caregiving from trajectories of depression and anxiety prior to chi

http://www.ncbi.nlm.nih.gov/pubmed/26971266?dopt=Abstract

Predicting adolescent postpartum caregiving from trajectories of depression and anxiety prior to childbirth: a 5-year prospective study.

Arch Womens Ment Health. 2016 Mar 12;

Authors: Hipwell AE, Stepp SD, Moses-Kolko EL, Xiong S, Paul E, Merrick N, McClelland S, Verble D, Keenan K

Abstract
Symptoms of depression and anxiety in pregnancy have been linked to later impaired caregiving. However, mood symptoms are often elevated in pregnancy and may reflect motherhood-specific concerns. In contrast, little is known about the effects of prepregnancy depression and anxiety on postpartum caregiving. Understanding these developmental risk factors is especially important when childbearing also occurs during adolescence. The sample comprised 188 adolescent mothers (ages 12-19 years) who had participated in a longitudinal study since childhood. Mothers were observed in face-to-face interaction with the infant at 4 months postpartum, and caregiving behaviors (sensitivity, hostile-intrusive behavior, and mental state talk) were coded independently. Data on self-reported depression and anxiety gathered in the 5 years prior to childbirth were drawn from the large-scale longitudinal study. Parallel process latent growth curve models revealed unique effects of distal anxiety and slow decline in anxiety over time on lower levels of maternal mental state talk after accounting for the overlap with depression development. Depressive symptoms showed significant stability from distal measurement to the postpartum period, but only concurrent postpartum mood was associated with poorer quality of maternal speech. The results highlight specific targets for well-timed preventive interventions with vulnerable dyads.

PMID: 26971266 [PubMed - as supplied by publisher]

Telephone-Administered Interpersonal Psychotherapy by Nurse-Midwives for Postpartum Depression.

http://www.ncbi.nlm.nih.gov/pubmed/26970401?dopt=Abstract

Telephone-Administered Interpersonal Psychotherapy by Nurse-Midwives for Postpartum Depression.

J Midwifery Womens Health. 2016 Mar 10;

Authors: Posmontier B, Neugebauer R, Stuart S, Chittams J, Shaughnessy R

Abstract
INTRODUCTION: Postpartum depression (PPD) affects 7% to 13% of childbearing women. Access to care may be limited by maternal time constraints and fears of being judged, labeled as mentally ill, and having their infants taken away. The study's objective was to test the feasibility, effectiveness, and acceptability of certified nurse-midwife telephone-administered interpersonal psychotherapy (CNM-IPT) as a treatment for PPD.
METHODS: A prospective cohort study was conducted from 2010 to 2014. A sample of women meeting Diagnostic and Statistical Manual of Mental Disorders, Version 4, Text Revision (DSM-IV-TR) criteria for depression was recruited from 8 obstetric practices employing CNMs in the United States. Forty-one women in the treatment group received up to eight 50-minute CNM-IPT sessions, and 20 in the control group were referred to mental health professionals. The main outcome measure was the Hamilton Rating Scale for Depression. Secondary outcomes included maternal and marital functioning, mother-infant bonding, social support, and client satisfaction.
RESULTS: The Hamilton Rating Scale for Depression at 8 and 12 weeks was significantly lower among women in the treatment group compared to the control group (Week 8, P = .047; Week 12, P = .029). Client satisfaction was high in both groups. While only 5 out of 8 CNM-IPT counselors continued the intervention until the study's conclusion, CNM-IPT counselor protocol adherence was high.
DISCUSSION: CNM-IPT is effective and acceptable as a method of reducing the severity of PPD symptoms. Careful assessment of CNM availability is critical to intervention feasibility. Future research is needed to evaluate translation of this intervention into practice.

PMID: 26970401 [PubMed - as supplied by publisher]

The birth of new neurons in the maternal brain: hormonal regulation and functional implications.

http://www.ncbi.nlm.nih.gov/pubmed/26969795?dopt=Abstract

The birth of new neurons in the maternal brain: hormonal regulation and functional implications.

Front Neuroendocrinol. 2016 Mar 9;

Authors: Leuner B, Sabihi S

Abstract
The maternal brain is remarkably plastic and exhibits multifaceted neural modifications. Neurogenesis has emerged as one of the mechanisms by which the maternal brain exhibits plasticity. This review highlights what is currently known about peripartum-associated changes in adult neurogenesis and the underlying hormonal mechanisms. We also consider the functional consequences of neurogenesis in the peripartum brain and extent to which this process may play a role in maternal care, cognitive function and postpartum mood. Finally, while most work investigating the effects of parenting on adult neurogenesis has focused on mothers, a few studies have examined fathers and these results are also discussed.

PMID: 26969795 [PubMed - as supplied by publisher]

Determinants of postnatal depression in Sudanese women at 3 months postpartum: a cross-sectional stu

http://www.ncbi.nlm.nih.gov/pubmed/26966055?dopt=Abstract

Determinants of postnatal depression in Sudanese women at 3 months postpartum: a cross-sectional study.

BMJ Open. 2016;6(3):e009443

Authors: Khalifa DS, Glavin K, Bjertness E, Lien L

Abstract
OBJECTIVES: Maternal mental health is a neglected issue in Sudanese healthcare. The aim of this study was to explore the factors associated with postnatal depression (PND) at 3 months postpartum in a sample of Sudanese women in Khartoum state.
SETTING: Recruitment was from two major public antenatal care (ANC) clinics in two maternity teaching hospitals in Khartoum state. The study participants were recruited during their pregnancy and were followed up and screened for PND at 3 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS).
PARTICIPANTS: A sample of 300 pregnant Sudanese women in their second or third trimester was included in the study. The inclusion criteria were Sudanese nationality, pregnancy in the second or third trimester and satisfactory contact information.
OUTCOME MEASURES: PND was assessed using the EPDS at a cut-off score of ≥12. Maternal and sociodemographic factors of interest were illustrated in a directed acyclic graph (DAG) to identify which variables to adjust for in multivariate analyses and to show their type of effect on PND. A forward logistic regression model was built to assess the factors that are independently associated with PND.
RESULTS: History of violence increased the odds of PND sevenfold, OR=7.4 (95% CI 1.9 to 27.6). Older age of mothers decreased the odds of PND by almost 20%, OR=0.82 (95% CI 0.73 to 0.92). Exclusive breast feeding and regular prenatal vitamins during pregnancy are associated with an 80% decrease in odds of PND, OR=0.2 (95% CI 0.06 to 0.70) and 0.17 (95% CI 0.06 to 0.5), respectively.
CONCLUSIONS: Factors associated with PND in this study are comparable to factors from other developing countries, although findings should be judged with caution owing to the high number of women who refused recruitment into the study.

PMID: 26966055 [PubMed - in process]