Management Of Postnatal Depression Research Articles

The Malaysian Women's Experience of Care and Management of Postnatal Depression.

Objectives:Early detection and intervention for Maternal Postnatal Depression (PND) are imperative to prevent devastating consequences for mothers, babies, and families. However, there are no guidelines that explicitly focus on the management of PND in Malaysia. Consequently, it is unclear whether women with PND are receiving proper care and treatment. Therefore, this study aimed to explore Malaysian Women's experience in managing PND symptoms.Methods:A qualitative study was conducted among 33 women attending Maternal and Child Health (MCH) clinics in Kuala Lumpur. Data were obtained through a face-to-face semi-structured interview and analysed using framework analysis.Results:The women considered PND as a personal and temporary issue. Therefore, professional care was deemed unnecessary for them. Additionally, all Malay women considered religious approach as their primary coping strategy for PND. However, this was not the case for most Indian and Chinese women.Conclusion:The findings of this study indicated that women did not acknowledge the roles of Healthcare Practitioners (HCPs) in alleviating their emotional distress.Also, they perceived PND as a personal problem and less serious emotional condition. It is due to this perception that the women adopted self-help care as their primary coping strategy for PND. However, the coping strategy varied between different cultures. These findings underscore the importance of HCPs’ proactive action to detect and alleviate PND symptoms as their attitude towards PND may influence Women's help-seeking behaviour.

Antidepressant treatment for postnatal depression.

Depression is one of the most common morbidities of the postnatal period. It has been associated with adverse outcomes for women, children, the wider family and society as a whole. Treatment is with psychosocial interventions or antidepressant medication, or both. The aim of this review is to evaluate the effectiveness of different antidepressants and to compare their effectiveness with placebo, treatment as usual or other forms of treatment. Thisis an update of a review last published in 2014. To assess the effectiveness and safety of antidepressant drugs in comparison with any other treatment (psychological, psychosocial, or pharmacological), placebo, or treatment as usual for postnatal depression. We searched Cochrane Common Mental Disorders's Specialized Register, CENTRAL, MEDLINE, Embase and PsycINFO in May 2020. We also searched international trials registries and contacted experts in the field. We included randomised controlled trials (RCTs) of women with depression during the first 12 months postpartum that compared antidepressant treatment (alone or in combination with another treatment) with any other treatment, placebo or treatment as usual. Two review authors independently extracted data from the study reports. We requested missing information from study authors wherever possible. We sought data to allow an intention-to-treat analysis. Where we identified sufficient comparable studies we pooled data and conducted random-effects meta-analyses. We identified 11 RCTs (1016 women), the majority of which were from English-speaking, high-income countries; two were from middle-income countries. Women were recruited from a mix of community-based, primary care, maternity and outpatient settings. Most studies used selective serotonin reuptake inhibitors (SSRIs), with treatment duration ranging from 4 to 12 weeks. Meta-analysis showed that there may be a benefit of SSRIs over placebo in response (55% versus 43%; pooled risk ratio (RR) 1.27, 95% confidence interval (CI) 0.97 to 1.66); remission (42% versus 27%; RR 1.54, 95% CI 0.99 to 2.41); and reduced depressive symptoms (standardised mean difference (SMD) -0.30, 95% CI -0.55 to -0.05; 4 studies, 251 women), at 5 to 12 weeks' follow-up. We were unable to conduct meta-analysis for adverse events due to variation in the reporting of thisbetween studies. There was no evidence of a difference between acceptability of SSRI and placebo (27% versus 27%; RR 1.10, 95% CI 0.74 to 1.64; 4 studies; 233 women). The certainty of all the evidence for SSRIs was low or very low due to the small number of included studies and a number of potential sources of bias, includinghigh rates of attrition. There was insufficient evidence to assess the efficacy of SSRIs compared with other classes of antidepressants and of antidepressants compared with other pharmacological interventions, complementary medicines, psychological and psychosocial interventions or treatment as usual. A substantial proportion of women experienced adverse effects but there was no evidence of differences in the number of adverse effects between treatment groups in any of the studies. Data on effects on children, including breastfed infants, parenting, and the wider family were limited, although no adverse effects were noted. There remains limited evidence regarding the effectiveness and safety of antidepressants in the management of postnatal depression, particularly for those with more severe depression. We found low-certainty evidence that SSRI antidepressants may be more effective in treating postnatal depression than placebo as measured by response and remission rates. However, the low certainty of the evidence suggests that further research is very likely to have an important impact on our effect estimate. There is a continued imperative to better understandwhether, and for whom, antidepressants or other treatments are more effective for postnatal depression, and whether some antidepressants are more effective or better tolerated than others. In clinical practice, the findings of this review need to be contextualised by the extensive broader literature on antidepressants in the general population and perinatal clinical guidance, to inform an individualised risk-benefit clinical decision. Future RCTs shouldfocus on larger samples, longer follow-up, comparisons with alternative treatment modalities and inclusion of child and parenting outcomes.

Healthcare Practitioners’ Views of Postnatal Depression: A Qualitative Synthesis

The World Health Organisation recommends healthcare practitioners to equip themselves with appropriate skills to assess the psychological distress in women attending the antenatal and postnatal healthcare. Nevertheless, little is known about the healthcare practitioners’ perceptions of postnatal depression and its management. The aims of this review were: (i) to explore the experiences of healthcare practitioners in caring for women with postnatal depression in different countries and (ii) to identify any qualitative study conducted in Malaysia regarding the healthcare practitioners’ perceptions of postnatal depression. To achieve these objectives, a qualitative synthesis of studies reporting the healthcare practitioners’ experience of managing women with postnatal depression was conducted. A search in CINAHL, PubMed, MEDLINE, PsycINFO, and ASSIA databases was performed using specific keywords and published peer-reviewed articles from 2006 to 2016 were screened for inclusion criteria. A total of 15 relevant studies were identified and reviewed. The studies included were conducted in eight different countries: America, Australia, United Kingdom, Brazil, Canada, Greek, Mexico, and Slovenia. No study conducted in Malaysia was found. T his review suggested that the experiences of managing women with postnatal depression were relatively similar among the healthcare professionals in different countries . The main limitations reported by the healthcare practitioners were the lack of resources on maternal mental health and the absence of policy regarding the management of postnatal depression . Further research should investigate how Malaysian healthcare practitioners perceive postnatal depression and their roles in its management to provide more insights into the current clinical practice in Malaysia for postnatal depression. DOI : http://dx.doi.org/10.17576/JSKM-2019-1701-10

The effectiveness of psychosocial assessment in the detection and management of postpartum depression: a systematic review

Perinatal mental disorders remain a public health concern. A psychosocial assessment gives a comprehensive understanding of a woman's circumstances by identifying risk factors that affect the overall mental state and function of the woman. The aim was to evaluate the current international evidence regarding the effectiveness of psychosocial assessments in the detection and management of postpartum depression. Six health related databases were systematically searched from January 2000 to June 2016. Full papers reporting the effectiveness of psychosocial assessment on the detection and management of postpartum depression were included. A data extraction form was designed and piloted on two studies. Data were extracted on study design, population, study context, intervention/s and outcome/s. The methods of all the studies selected were critically appraised using the Quality Assessment Tool for Quantitative Studies. A total of 692 citations were found. Four randomized control trials (RCTs) met full inclusion criteria and qualified for full paper review and data extraction. Due to the heterogeneity of the data retrieved a narrative synthesis was carried out. Overall, when compared to routine care, psychosocial assessments were found to be sensitive to detect risk factors associated with postnatal depression. Results from two of the included studies reported no statistically significant difference in outcomes amongst those who screened positive and received the intervention compared to those who screened positive and were given standard care. Presently there is a paucity of published data on the effectiveness of psychosocial assessment in the detection and management of postnatal depression and results show conflicting evidence. Further RCTs are recommended to further elucidate the effectiveness of psychosocial assessments.

Basic body awareness in postnatal depression: A case study

Currently, there is limited evidence that a physiotherapy intervention may reduce depressive symptoms as well as the conventional interventions of medications and psychotherapy. We describe the effect of basic body awareness, a form of physiotherapy intervention, on the physical and psychological well-being of a 32 year old mother with postnatal depression. After six weeks of basic body awareness intervention, there was considerable reduction in her depressive symptoms, thus enhancing physical and psychological well-being. Hence, we propose that basic body awareness may be considered as an adjunct to the management of postnatal depression.

Trajectories of long-term outcomes for postnatally depressed mothers treated with group interpersonal psychotherapy

There is evidence that psychological treatments for postnatal depression are effective in the short-term; however, whether the effects are enduring over time remains an important empirical question. The aim of this study was to investigate the depressive symptoms and interpersonal functioning of participants in a randomised controlled trial (RCT) of group interpersonal psychotherapy (IPT-G) at 2 years posttreatment. The study also examined long-term trajectories, such as whether participants maintained their recovery status, achieved later recovery, recurrence or persistent symptoms. Approximately 2 years posttreatment, all women in the original RCT (N = 50) were invited to participate in a mailed follow-up. A repeated measures analysis of variance assessed differences between the treatment and control conditions on depression and interpersonal scores across five measurement occasions: baseline, mid-treatment, end of treatment and 3-month and 2-year follow-up. Chi-square tests were used to analyse the percentage of participants in the four recovery categories. Mothers who received IPT-G improved more rapidly in the short-term and were less likely to develop persistent depressive symptoms in the long-term. Fifty seven percent of IPT-G mothers maintained their recovery over the follow-up period. Overall, IPT-G participants were significantly less likely to require follow-up treatment. Limitations include the use of self-report questionnaires to classify recovery. The positive finding that fewer women in the group condition experienced a persistent course of depression highlights its possible enduring effects after treatment discontinuation. Further research is needed to improve our long-term management of postnatal depression for individuals who are vulnerable to a recurrent or chronic trajectory.

Management of postnatal depression in primary care: a window of opportunity

The postnatal period is a particularly distressing time to experience mental health problems. Detection and appropriate treatment of psychiatric symptoms at this critical time in family life is perhaps more important than at any other time. Postnatal depression (PND) affects more than one in 10 women;1,2 it significantly impacts on partners;3 is associated with an impaired mother–infant bond;4 and has been linked to poor cognitive and emotional development in the infant,5 thus contributing to the inter-generational transmission of poor health. Suicide is a leading cause of maternal death in the UK; the largest proportion due to PND and puerperal psychosis,6 and completed suicides are thought to be the tip of the iceberg in terms of ‘near miss’ events. However, many women are reluctant to disclose PND symptoms to healthcare professionals.7 Strategies for identifying PND and supporting women and their families are therefore very important and must be timely, holistic, and appropriate to new mothers. The perinatal period provides many opportunistic occasions within which to identify and manage mild, moderate, and severe mental illness. This is due to the increased level of health professional contact through routine antenatal and postnatal contact, which does not occur in the non-postpartum population. Although GPs are often the first port of call for women8 or their families seeking help during pregnancy and postnatally, all healthcare professionals in contact with pregnant or postpartum women should be alert to possible symptoms, either those of new onset or of a more chronic nature. Given the evidence for the effectiveness of both pharmacological and psychological interventions in improving health outcomes when PND is identified, there is much to be gained from early identification and management in primary care. …

Maintaining vigilance for postnatal depression

All practitioners have a role in the management of postnatal depression, be it with treatment or ongoing support.

The effectiveness of exercise in the management of postnatal depression: Systematic review and meta analysis

s identified. Full articles of any possibly relevant reports were retrieved for more detailed evaluation and two authors (AD and KJ) independently performed a final selection of trials to be included in the review using a standardized eligibility form. If the study fulfilled the inclusion criteria, data concerning type of publication, participant characteristics, study design, number of cases, recruitment procedures, nature and length of the intervention, type of comparator group, outcome assessments, intervention adherence, potential sources of bias and relevant confounders were extracted by two reviewers (AD and KJ) using a standard extraction form. Reviewers were not blinded to names of authors, institutions or journal of publication. Study authors were contacted if additional information was required to adequately complete the data extraction form.

Postpartum Mental Illness: Perspectives from an Arabian Gulf Population

There is growing awareness of the importance of mental health issues in the perinatal period in Western societies, but very little information is available from Muslim and Arab countries. Qualitative information gathered using focus group discussions of women of childbearing age is presented along with additional information obtained from key informant interviews with grandmothers, husbands, and health care professionals in the United Arab Emirates. The participants were women attending a public sector clinic in Al Ain, Abu Dhabi, and a private clinic in Dubai on a particular day. There were 19 women in the age range 17 to 46 years (M age = 29 yr.). The majority of the women who took part in the study did not recognize postnatal depression as a psychological issue but considered the problems a result of "evil eye" or "Jinn." The present findings suggest the need for initiating awareness programs among women and training of health professionals on the detection and management of postnatal depression.

The effectiveness of exercise in the management of post-natal depression: systematic review and meta-analysis

Post-natal depression (PND) is a serious mental health problem that may be reduced by exercise. National Institute for Health and Clinical Excellence in England have recommended that health professions should consider exercise as a treatment for PND. To evaluate the effectiveness of exercise in the management of PND. Systematic review and meta-analysis of randomized controlled trials (RCTs). Data sources involved in the study are Cochrane Library (CENTRAL), MEDLINE, EMBASE, PsycINFO, Science Citation Index and Social Science Citation Index, CINAHL and SPORTDiscus. Review methods. Selection criteria are RCTs and quasi-RCTs that compared any type of exercise intervention with other treatments or no treatment in women with PND. Database searches and abstracts were reviewed independently by two authors. The Delphi criteria were used to assess the quality of included studies. Data were abstracted by two reviewers. Data synthesis is meta-analysis. Main outcome measure is post-natal depression. Five studies fulfilled our inclusion criteria. When compared with no exercise, exercise reduced symptoms of PND {SMD = -0.81 [95% confidence interval (CI): -1.53 to -0.10]}. The overall WMD in Edinburgh Post-natal Depression Scale score was -4.00 points (95% CI: -7.64 to -0.35). However, significant heterogeneity was found. The effect size was reduced considerably (non-significant) when the trial that included exercise as a co-intervention with social support was excluded [SMD = -0.42 (95% CI: -0.90 to 0.05)] and heterogeneity was no longer present. Due to heterogeneity, it is uncertain whether exercise reduces symptoms of PND. Caution is also required when interpreting findings from the main analysis as only five small trials were included and CIs were wide. Further research is evidently required.

Disclosure of symptoms of postnatal depression, the perspectives of health professionals and women: a qualitative study

BackgroundIn the UK, 8–15% of women suffer from postnatal depression with long term consequences for maternal mood and child development. Current guidelines state that health visitors and GPs should continue to have a major role in the detection and management of postnatal depression. Previous literature suggests that women are reluctant to disclose symptoms of postnatal depression. This study aimed to explore general practitioners' (GPs), health visitors' and women's views on the disclosure of symptoms which may indicate postnatal depression in primary care.MethodsIn-depth interviews with GPs, health visitors and women who were participating in a randomised controlled trial of anti-depressants versus health visitor delivered non-directive counselling for the treatment of postnatal depression. Interviews were audio-taped and fully transcribed. Thematic analysis with an iterative approach was used, allowing the views of practitioners and patients to be explored and then compared.ResultsNineteen GPs, 14 health visitors and 28 women were interviewed. A number of common themes were identified across all three data sets: understanding and negotiating the diagnosis of postnatal depression, hindering and facilitating disclosure, and the system of care. Both women and health professionals described postnatal depression in psychosocial terms: an adjustment reaction to change in life circumstances and the reality of motherhood not meeting personal expectations. Women described making a conscious decision about whether or not to disclose their feelings to their GP or health visitor. Health professionals described strategies used to hinder disclosure and described a reluctance to make a diagnosis of postnatal depression, as they had few personal resources to manage women with postnatal depression themselves, and no services to which to refer women for further treatment.ConclusionTo improve disclosure of symptoms in primary care, there should be a move away from questioning why health professionals do not make the diagnosis of depression and in response suggesting that education and training will improve skills and thus improve detection of depression. Improving the detection and management of postnatal depression in primary care requires recognition of the context in which women consult, and system changes that ensure health professionals work in an environment that can facilitate disclosure and that the necessary resources for management are available.Trail RegistrationISRCTN 16479417

Policy and practice in the management of postnatal depression in Scotland

To investigate current policy and practice in postnatal depression in Scotland and to consider how effectively guidelines were addressed. A questionnaire survey of all National Health Service Boards in Scotland between September 2003 and February 2004 to determine what written policies for postnatal depression were in place as at September 2003. This was followed by a questionnaire survey of a representative sample of general practices in Scotland to determine the routine procedures in use for managing postnatal depression in general practice primary care teams. NHS Boards and general practices in Scotland, UK. Forty-seven per cent of policies and 68% of General Practices had implemented the majority of the Scottish Intercollegiate Guidelines Network 60 evidence based recommendations. Practices were more likely than NHS Boards to have addressed a higher percentage of the recommendations (p < 0.05). Practices were more likely to implement antenatal screening for a history of puerperal psychosis if they were within NHS Boards that recommend this as routine practice. Practices within NHS Boards that had in-patient facilities for mother and baby admissions were more likely to identify these services as a treatment option than in the areas where the NHS Boards indicated the facilities were unavailable. Board guidance did not relate significantly to the likelihood of practices following the other evidence-based recommendations. Minimum standards represented by the SIGN 60 evidence-based recommendations were mostly followed in both policy and practice. If Board policy followed guidelines, the guidelines were more likely to be implemented at primary care level.

GPs' and health visitors' views on the diagnosis and management of postnatal depression: a qualitative study

In the UK, 8-15% of women suffer from postnatal depression, with long-term consequences for maternal mood and child development. Previous literature suggests that health visitors struggle with their conflicting roles with respect to mother and infant. Current policy is redirecting the emphasis and organisation of health visitor work, but guidelines state that health visitors and GPs should continue to have a major role in the detection and management of postnatal depression. To explore the views of GPs and health visitors on the diagnosis and management of postnatal depression. A qualitative study nested within a multicentre randomised controlled trial. Nine primary care trusts in Bristol, Manchester, and London. In-depth interviews with GPs and health visitors from primary care trusts participating in a randomised controlled trial of antidepressants versus health visitor-delivered non-directive counselling. Interviews were audiotaped and fully transcribed. Thematic analysis with an iterative approach was used to develop conceptual categories from the transcripts. Nineteen GPs and 14 health visitors were interviewed. GPs and health visitors described their work in making and negotiating the diagnosis of postnatal depression, the value of a long-term relationship with the woman, and how labelling affects management of women with postnatal depression. Responders described how they viewed others' roles in the management of postnatal depression, and how national policy and local organisational changes had an impact on patient care, so that no one health professional was assuming overall responsibility for the care of women with postnatal depression. Ongoing organisational changes within primary care, such as the implementation of corporate working by health visitors, affect care provided to women after birth, which in turn has an impact on the diagnosis and management of postnatal depression.

Postnatal depression and the original mother–child relationship: A prospective cohort study

BackgroundPrevious studies assessing the role of early mother–child relationship as a risk factor for postnatal depression have been cross-sectional and/or retrospective in nature. AimsTo examine associations between early mother–child relationship (assessed prospectively and retrospectively) and later risk of postnatal depression. MethodsDataset from national 1946 birth cohort study; 1137 women at age 51, completed a modified version of the Bromley Postnatal Depression Scale. ResultsCompared with women who did not experience maternal separation or recalled moderate to best level of care, women who experienced maternal separation for 3.5 days or more in early childhood and who felt they received a low level of maternal care were at higher risk of postnatal depression (odds ratio (95% CI): 2.4 (1.51–3.79), p=0.001); this relationship was robust to adjustment for current psychological status. Regular enuresis at age of 6 years (2.2 (1.01–4.90), p=0.05), and lack of emotional closeness in current maternal relationship (1.6 (1.01–2.46), p=0.04) were also associated with increased postnatal depression risk. Insufficient evidence was found for a link between other indicators of early behaviour and temperament (anxious, antisocial, or neurotic behaviour) and reported postnatal depression. LimitationsPostnatal depression was assessed retrospectively using self-report, introducing potential bias in recall. ConclusionWomen who experienced early maternal separation and recalled the lowest level of maternal care had a particularly high risk of postnatal depression. In the treatment and management of postnatal depression, the results support health professionals in their consideration of the woman's past and current relationship with her mother; both actual events and the woman's perceptions of them.

Are Slovenian midwives and nurses ready to take on a greater role in caring for women with postnatal depression?

to answer the question of whether Slovenian midwives and nurses feel prepared to take over the responsibility for the care of women with postnatal depression. questionnaire survey using a tool designed with data from previously conducted focus groups and a literature review. the central maternity hospital and six community centres in the Slovenian capital city of Ljubljana. 134 participants completed the questionnaire, out of 175 distributed. The sample consisted of 86 participants from the maternity hospital, who were almost evenly divided into midwives and nurses, and 48 participants from the community services, where nurses prevailed over midwives. participants lacked knowledge of postnatal mental health, and 99% of them expressed the need for more information. They considered the woman's partner to be the most appropriate person to detect postnatal depression, and doctors to be the key people involved in the treatment. In order to take over the role of prevention, detection and management of postnatal depression, midwives and nurses felt that they would need more knowledge and more continuous contact with women. most participants did not know the main characteristics of postnatal depression, and were not confident in their knowledge. They felt that they lacked continuity in the care they could provide, and this affected their ability to establish a trusting relationship with women. information on postnatal mental health should be provided during undergraduate study of midwifery and nursing, and with continuous education through seminars and workshops in Slovenia. In order to enable continuity of carer, the role of the midwife should be expanded in pregnancy, and more visits in the puerperium should be planned.

Impact of postnatal depression on breastfeeding duration.

Postnatal depression can cause adverse effects on both mother and infant, but its impact on breastfeeding duration is poorly understood. The aim of this study was to investigate the relationship between maternal postnatal depression and breastfeeding duration. A cohort of 1745 women was recruited on the postnatal wards of two large Australian obstetric hospitals. Self-report questionnaires were completed at recruitment, and at 2, 6, and 12 months postpartum. Breastfeeding status was determined at each follow-up, and the Edinburgh Postnatal Depression Scale was used to screen for symptoms of depression. Diagnostic psychological interviews were conducted on a subsample of women at each interval. Breastfeeding was initiated by 96 percent of the participants; at 2 months 79 percent were still breastfeeding, 57 percent at 6 months, and 22 percent at 12 months. Of the 18 percent of participants diagnosed with postnatal depression, the onset occurred before 2 months in 63 percent of cases. Median duration of breastfeeding was 26 weeks for women with early-onset depression, 28 weeks for women with late-onset depression, and 39 weeks for women without depression. After adjustment for confounding factors, early cessation of breastfeeding was found to be significantly associated with postnatal depression (adjusted hazard ratio 1.25, 95% CI 1.03-1.52). Onset of postnatal depression occurred before cessation of breastfeeding in most cases. Postnatal depression has a significant negative impact on breastfeeding duration. Assistance with breastfeeding issues should be included in the management of postnatal depression.

Management of postnatal depression reviewed

Management of postnatal depression reviewed

Training health visitors to reduce levels of depression after childbirth: An evaluation

Postnatal depression has become a popular topic for intervention research. However, few studies have assessed implementation in the real world of primary care practice. This paper uses an AB design to assess health visitor training in the management of postnatal depression, replicated in eleven sectors in Stoke-on-Trent and Lewisham. Nearly 90% of health visitors volunteered for training. Only 64 of the 151 participating health visitors completed both pre and post training questionnaires but these did demonstrate highly significant improvement in self-ratings of knowledge and skills. Future studies should undertake direct assessments of all health visitors' practice. More important, however, is the significant reduction in levels of depressive symptomatology among their patients as rated on the Edinburgh Postnatal Depression Scale (EPDS). Six month postnatal EPDS scores were reduced in ten of the eleven sectors, nine significantly. Improvements to the research design are proposed to increase confidence in the effectiveness of training.

Screening an Australian community sample for risk of postnatal depression

This exploratory study on the transition to motherhood focused on screening a community sample of Australian women to identify those mothers at risk of having postnatal depression. Seventy-one first-time mothers completed the Edinburgh Postnatal Depression Scale approximately 6 weeks after childbirth. The results indicated that 35.2% of the first-time mothers in the sample required further investigation. That is, approximately 35% of the community sample reported experiencing significant difficulties in their transition to motherhood. A total of 25.4% of these women were identified as being at risk of experiencing depression, and between 9.9% and 15.7% were identified as being at risk of experiencing severe depressive symptomol-ogy. The study therefore identified a significant proportion of first-time mothers, within a community sample, experiencing difficulties in the early postpartum period of a severity which warranted further clinical assessment for postnatal depression. These findings have significant implications for the prevention and management of postnatal depression in the community. The study underscores the need for more community-based research into the challenges and difficulties that women endure at this critical developmental stage.