Prevention Of Postpartum Depression Research Articles

Effect of intraoperative and/or postoperative esketamine administration on preventing postpartum depression: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate the impact of intraoperative and/or postoperative esketamine application on the prevention of postpartum depression (PPD). PubMed, Embase, and Web of Science were thoroughly searched for eligible randomized controlled trials (RCTs) regarding the application of esketamine for postnatal depression prevention. Nine RCTs including 1277 participants were involved in the final analysis. It was found that intraoperative and/or postoperative administration of esketamine significantly reduced the PPD incidence and the Edinburgh Postnatal Depression Scores in the early postoperative period. Meanwhile, esketamine lowered the occurrence of postoperative nausea and vomiting with no influence on other psychiatric symptoms.

Factors Influencing the Effectiveness of Midwife Led Debriefing on Prevention of Postpartum Depression in Western, Kenya

Childbirth is a stressful event in women’s lives and could influence emotions which may lead to mental ill health like depression in the postnatal period if not resolved. Depression is a common mental disorder with serious consequences especially during the postpartum period. The prevalence of postpartum depression varies globally, and can be as low as 0.5% or as high as 60.8% in the first year after childbirth. Due to its detrimental impacts, postpartum depression is a serious public health problem. Debriefing is a type of interpersonal therapy, utilized to treat and prevent serious depressive disorders in both pregnant women and the general adult population. Although debriefing has been shown to be useful in both preventing and treating postpartum depression, its effectiveness has not been fully evaluated. The purpose of the study was to assess factors influencing the effectiveness of midwife-led debriefing on prevention of Postpartum Depression in Western region, of Kenya. The study used a quasi-experimental design with pre and post-test assessments. Systematic random sampling was used to identify and allocate participants. The target population was women of childbearing age and study participants were women who gave birth during the study period, of which a sample of 212 participated. Data were collected using standard questionnaire including Edinburg postpartum depression scale (EPDS) score and an interview schedule. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 26. Chi-square was used to test association between variables. Logistic regression model was used to assess the influence of time-based outcome, based on social cultural and demographic characteristics of women on prevention of postpartum depression. Study results indicated that parity, Age, living together with spouse and social support (p=0.004; p=0.003; p=0.002) were significant factors. Additionally, it showed that social support significantly reduced the symptoms of postpartum depression. In conclusion, at the 5% significance level, the key factor was social support (p=0.001) <0.05 which showed that participants postpartum depression symptoms decreased greatly. Midwife led debriefing is recommended as a routine care during perinatal period. Further studies to be done to explore how social support influences midwife led debriefing on prevention of Postpartum depression.

Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery

Postpartum depression (PPD) is one of the most common mental health conditions during the perinatal and postpartum periods, which can have adverse effects on both mother and infant. To investigate the efficacy of perioperative adjunctive esketamine administration after cesarean deliveries in the prevention of PPD. A single-center, double-blind, placebo-controlled, randomized clinical trial was conducted from January 1, 2022, to January 1, 2023, at Fujian Provincial Hospital among 298 women aged 18 to 40 years, with an American Society of Anesthesiologists grade I to III classification and singleton full-term pregnancies who were scheduled for elective cesarean deliveries. Primary analyses were performed on a modified intention-to-treat basis. Patients were randomly assigned to the esketamine (n = 148) and control (n = 150) groups. Those in the esketamine group received a single intravenous injection of 0.25 mg/kg of esketamine immediately after fetal delivery, followed by 50 mg of esketamine as an adjuvant in patient-controlled intravenous analgesia for 48 hours after surgery. Saline was given to the control group of patients. The primary outcome was assessments of PPD symptoms by using the Edinburgh Postnatal Depression Scale (EPDS) at postpartum day 7. Positive screening for PPD was defined as a score of 10 or more points on the EPDS. In addition, the EPDS was analyzed as a continuous variable to evaluate depressive symptoms. Secondary outcomes included the Numeric Rating Scale (NRS) of postoperative pain, along with safety evaluations including adverse events and clinical assessments at postpartum days 14, 28, and 42. A total of 298 pregnant women were included, with 150 in the control group (median age, 31.0 years [IQR, 29.0-34.0 years]) and 148 in the esketamine group (median age, 31.0 years [IQR, 28.0-34.0 years]). The prevalence of depression symptoms was significantly lower among patients given esketamine compared with controls (23.0% [34 of 148] vs 35.3% [53 of 150]; odds ratio, 0.55; 95% CI, 0.33-0.91; P = .02) on postpartum day 7. In addition, the esketamine group also showed a significantly lower change in EPDS scores (difference of least-squares means [SE], -1.17 [0.44]; 95% CI, -2.04 to -0.31; effect size, 0.74; P = .008). However, there were no differences between the groups in the incidence of positive screening results for PPD or in changes from the baseline EPDS scores at postpartum days 14, 28, and 42. There were no differences in NRS scores at rest and on movement except on movement at 72 hours postoperatively, when scores were significantly lower in the esketamine group (median, 3.0 [IQR, 2.0-3.0] vs 3.0 [IQR, 3.0-3.5]; median difference, 0 [95% CI, 0-0]; P = .03). These results suggest that intravenous administration of esketamine during the perioperative period of elective cesarean delivery can improve depression symptoms during the early postpartum period. However, this antidepression effect may not be universally applicable to patients with low EPDS scores. Chinese Clinical Trial Registry Identifier: ChiCTR2100054199.

Usability Study of the Mommy-Be App: Exploring the Experience of Breastfeeding Mothers in Eastern Indonesia

Objective: The rise of mobile health (mHealth) apps has brought attention to their potential in supporting breastfeeding mothers and preventing postpartum depression (PPD). This study aims to evaluate the usability of Mommy-Be, a mobile phone app designed to support breastfeeding women and help them to acknowledge of their mental health and breastfeeding efficacy during lactation period. Theoretical Framework: This study uses Usability theory to analyze the use of mHealth applications that proposed by Nielsen model. Method: This study combines quantitative and qualitative methods, that asses Mommy-Be app's usability among breastfeeding mothers using the Mobile Application Usability Questionnaire (MAUQ) and conducted in-depth interviews with a subset of participants. The study included 50 breastfeeding mothers in Makassar, Indonesia, who were primarily between the ages of 19 and 42 and had diverse educational and employment backgrounds. Four weeks after using the Mommy-Be app, revealed a generally positive impression of the application. Result: Based on MAUQ three dimensions, ease of use, interface satisfaction, usefulness, this study has been determined that the utilization of a Mommy-Be application is both acceptable and feasible as a mobile health (mHealth) solution for breastfeeding mothers. The mothers experience revealed diverse user impressions of the Mommy-Be application. Participants generally found it easy to use, with a favorable interface preference. Participants expressed various benefits of using Mommy-Be, including increased awareness of breastfeeding activities, assistance in meeting nutritional needs, and early detection of postpartum depressive disorders. Recommendations: To enhance the application's utility, participants suggested improvements, such as data export capabilities, better module integration, consideration of the target audience's resources regarding internet access and the inclusion of educational content, such as the provision of interconnection with multiple lactation counsellors.

Validation and psychometric testing of the Chinese version of the prenatal body image questionnaire

BackgroundThe body image during pregnancy potentially affects both short- and long-term maternal and child health outcomes, including pregnancy mood, postpartum weight recovery, and the quality of mother–child interactions. However, research on the impact of body changes during pregnancy in the Chinese population is scarce. A comprehensive, practical, and reliable tool for assessing pregnant women is needed to detect, intervene in, and implement the reduction of physical dissatisfaction risk. This study translated the Prenatal Body Image Questionnaire (PBIQ) into the Chinese version (PBIQ-C) to assess the body image of pregnant women and evaluated its reliability and validity.MethodsAn improved Brislin translation model was used for the translation. A panel of experts determined the content validity. A convenience sample of 429 pregnant women was chosen from three third-class hospitals in different regions of Fujian Province, China. Factor analysis, Pearson’s correlation, retest reliability, and Cronbach’s alpha were employed to evaluate structural validity and reliability.ResultsThe final PBIQ-C had five dimensions with 21 items. Exploratory factor analysis obtained a five-factor solution, which accounted for a total of 60.34%. Confirmatory factor analysis showed that the model fit of the five-factor model also reached a satisfactory model fit after modifying: The Comparative Fit Index was 0.93, and the Tucker-Lewis Index was 0.92; the Root Mean Square Error of Approximation was 0.079. The content validity index of the scale ranged from 0.63 ~ 1.00. The Cronbach’s alpha coefficient was 0.95 for the total scale, and the test–retest reliability was 0.80.ConclusionsThe findings indicated that the PBIQ-C is a valid and reliable instrument for assessing women’s body image during pregnancy, which helps in the early identification of body dissatisfaction during pregnancy and enables the early prevention of postpartum depression.

Effect of Dexmedetomidine on Postpartum Depression in Women With Prenatal Depression

Postpartum depression (PPD) is emerging as a major public health problem worldwide. Although the particular period and context in which PPD occurs provides an opportunity for preventive interventions, there is still a lack of pharmacologic prevention strategies for PPD. To assess the efficacy and safety of dexmedetomidine for prevention of PPD among women with prenatal depression undergoing cesarean delivery. This randomized clinical trial enrolled 338 women who screened positive for prenatal depression at 2 hospitals in Hunan, China from March 28, 2022, to April 16, 2023. Women with an Edinburgh Postnatal Depression Scale score of more than 9 who were 18 years of age or older and were scheduled for elective cesarean delivery were eligible. Eligible participants were randomly assigned in a 1:1 ratio to either the dexmedetomidine group or the control group via centrally computer-generated group randomization. Dexmedetomidine, 0.5 μg/kg and 0.9% saline were intravenously infused for 10 minutes after delivery in the dexmedetomidine and control groups, respectively. After infusion, sufentanil or dexmedetomidine plus sufentanil was administered via patient-controlled intravenous analgesia for 48 hours in the control group and dexmedetomidine group, respectively. The primary outcome was positive PPD screening results at 7 and 42 days post partum, defined as a postpartum Edinburgh Postnatal Depression Scale score of more than 9. Analysis was on an intention-to-treat basis. All 338 participants were female, with a mean (SD) age of 31.5 (4.1) years. Positive PPD screening incidence at 7 and 42 days post partum in the dexmedetomidine group vs the control group was significantly decreased (day 7, 21 of 167 [12.6%] vs 53 of 165 [32.1%]; risk ratio, 0.39 [95% CI, 0.25-0.62]; P < .001; day 42, 19 of 167 [11.4%] vs 50 of 165 [30.3%]; risk ratio, 0.38 [95% CI, 0.23-0.61]; P < .001). The dexmedetomidine group showed no significant difference in adverse events vs the control group (46 of 169 [27.2%] vs 33 of 169 [19.5%]; P = .10), but the incidence of hypotension increased (31 of 169 [18.3%] vs 16 of 169 [9.5%]; risk ratio, 2.15 [95% CI, 1.13-4.10]; P = .02). Dexmedetomidine administration in the early postpartum period significantly reduced the incidence of a positive PPD screening and maintained a favorable safety profile. Chinese Clinical Trial Registry Identifier: ChiCTR2200057213.

The risk of anxiety disorders in women in the first year postpartum - the results from the postpartum depression prevention program ‟Next Stop: MUM".

The purpose of the study was to examine the severity of anxiety symptoms and the co-occurrence of anxiety disorders and mood disorders in a group of women in the first year after childbirth participating in the program for the prevention of postpartum depression. The study included 1,514 women who were screened by midwives during a patronage visit and were followed up, and 10,454 women who took part in an online screening conducted on the project website. The Edinburgh Postpartum Depression Scale was used for screening, including factor analysis to assess the anxiety subscale, and the GAD-2 questionnaire was used too. The risk of anxiety disorders was observed in 9.5% of women during the patronage visit and, depending on the survey method, 21.2% (ESDP 3 A) or 13.2% (GAD-2) in the follow-up study up to 9 months postpartum. In the online study, 62.8% of women obtained results indicating a high risk of anxiety disorders. For comparison, the result of 12 points and more indicating the risk of depression was obtained by 6.3% in the first month after childbirth and 14.3% in the follow-up study. The results show that anxiety disorders and mood disorders are significantly related (r = 0.631; p < 0.01). The risk of having anxiety disorders after childbirth is higher or similar to that of mood disorders. It is warranted to extend screening to anxiety disorders and to develop a rapid pathway of early psychological/psychiatric intervention for women in need.

EMPOWERING THE INDEPENDENCE OF PARTWORLD WOMEN IN THE USE OF THE DPP SOLUTION APPLICATION AS A PREVENTIVE MEASURE FOR POST PARTUM BLUES

Postpartum blues is a mild postpartum stress syndrome experienced by mothers within 3-10 days. Postpartum blues has symptoms such as excessive sadness, sudden crying, irritability, difficulty sleeping, headaches, and a tendency to blame yourself. Postpartum blues causes mothers to become passive and ignore their babies as well as hormonal imbalances due to anxiety and stress. Mothers experiencing excessive stress have an impact on decreasing interest and interest in babies and the ability to care for their babies properly, not being enthusiastic about breastfeeding so that the health and development of the baby is not optimal. The novelty of this community service activity can provide education regarding the prevention of postpartum depression by using an application. This service activity was attended by posyandu cadres, couples of childbearing age (PUS), pregnant women and postpartum mothers. The purpose of this service activity is to increase public understanding of the prevention of postpartum depression, to be skilled at self-detection and its citizens about postpartum depression. The target of this activity is 30 people. The activity method is carried out twice by giving a pre test, lecture and followed by a post test by filling out a questionnaire. The evaluation was carried out with cadres by conducting interviews on their understanding of prevention of postpartum depression. The results achieved in this activity are that the community gains knowledge about postpartum depression.

A prospective cohort study to assess the prevalence and risk factors of antepartum depression and its effect on maternal and fetal outcome

Antepartum depression (APD) is a public health issue has negative repercussions on the health of the mother, child, and family. Early screening for APD will help in early detection and further prevention of postpartum depression and adverse maternal and fetal outcomes. This study was designed to determine i) the prevalence rate of APD in the Indian population and its associated risk factors, ii) the impact of APD on maternal and fetal outcomes. A retrospective cohort study was conducted among antenatal women in the third trimester and screened for antepartum depression between October 2021 and March 2022 by adopting the Edinburgh Postnatal Depression Scale (EPDS). In the study population, 36.6 % had mild to moderate level of depressive symptoms (EPDS score of 8–12) and 28 % had high levels of depressive symptoms (EPDS score of ≥13). An unplanned pregnancy, a history of abortion, and a history of any pregnancy complications were the likely maternal risk factors for developing antepartum depression. The APD risk was also likely to be increased by sociodemographic and personal factors such as insufficient family support, a history of domestic violence, marital dissatisfaction, and a partner with a poor level of education (P < 0.05). Women screened with antepartum depression had 58.34 times the likelihood of developing postpartum depression and a threefold greater risk of having premature delivery. These findings may help to improve pregnancy outcomes by early identification, referral for early treatment of antepartum depression, also inform maternal mental health service development and utilization for boosting women's mental wellbeing.

Effectiveness of aerobic exercise in the prevention and treatment of postpartum depression: Meta-analysis and network meta-analysis.

Aerobic exercise is widely recognized for improving mental health and reducing negative emotions, including anxiety. However, research on its role in preventing and treating postpartum depression (PPD) has yielded inconsistent results. Some studies show positive effects on PPD symptoms, while others find limited impact, suggesting various factors at play, such as exercise type, intensity, and individual differences. To address this gap, our study aims to comprehensively gather evidence on the preventive and therapeutic effects of aerobic exercise for PPD. We'll focus on differences in exercise program design and implementation, exploring how these factors impact intervention outcomes. By identifying effective exercise approaches, we aim to provide more comprehensive exercise prescription recommendations for this vulnerable population. We conducted a quantitative systematic review of the study in 5 representative databases for the effect of aerobic exercise on PPD. Meta-analysis and network meta-analysis were performed with Review-Manager.5.4 and Stata.16.0 software, respectively. This study has been registered on the official Prospero website, and the registration code is CRD42023398221. Twenty-six studies with 2,867 participants were eventually included and the efficacy of aerobic exercise in preventing and treating postpartum depression is significant compared to standard care. (MD = -1.90; 95%CL: -2.58 to -1.21; I2 = 86%). Subgroup analysis suggests that the intervention objective (prevention vs. treatment) of exercise could potentially be a source of heterogeneity in this study, as the "Test for subgroup difference" revealed the presence of significant distinctions (p = 0.02<0.05). The "Test for subgroup difference" yielded non-significant results for both the supervised vs. unsupervised subgroup comparison (p = 0.55 > 0.05) and the individual vs. team subgroup comparison (p = 0.78 > 0.05). Nonetheless, when assessing their effect sizes [Subtotal (95%CL)], the supervised exercise group [-1.66 (-2.48, -0.85)] exhibited a slightly better performance than the unsupervised exercise group [-1.37 (-1.86, -0.88)], while the team exercise group [-1.43 (-1.94, -0.93)] slightly outperformed the individual exercise group [-1.28 (-2.23, -0.33)]. Network meta-analysis indicated that moderate intensity (35~45 min) group demonstrated a more pronounced intervention effect compared to low intensity (50~60 min) group [-2.63 (-4.05, -1.21)] and high intensity (20~30 min) group [-2.96 (-4.51, -1.41)], while the 3~4 times/week group had a more significant intervention effect compared to 1~2 times/week groups [-2.91 (-3.99, -1.83)] and 5~6 times/week groups [-3.28 (-4.75, -1.81)]. No significant differences were observed in pairwise comparisons of intervention effects among the five common types of aerobic exercises. (95%CL including 0). The Surface Under the Cumulative Ranking curve (SUCRA) results align with the findings mentioned above and will not be reiterated here. The efficacy of aerobic exercise in preventing and treating postpartum depression is significant compared to standard care, with a greater emphasis on prevention. The optimal prescribed exercise volume for intervention comprises a frequency of 3~4 exercise sessions per week, moderate intensity (35~45 minutes). Currently, several uncharted internal factors influence the optimal intervention effect of aerobic exercise, such as the potential enhancement brought by team-based and supervised exercise. Given the absence of significant differences in certain results and the limitations of the study, it is essential to exercise caution when interpreting the outcomes. Further research is needed in the future to provide a more comprehensive understanding.

Using an Electronic Mindfulness-based Intervention (eMBI) to improve maternal mental health during pregnancy: Results from a randomized controlled trial

Prevalence rates of peripartum depression and anxiety are high and correlate with adverse maternal and neonatal outcomes. Mindfulness-based interventions (MBI) have been shown to reduce mental distress during pregnancy.A multicenter, randomized controlled study was conducted after screening for depressive symptoms. The intervention group (IG) was given access to an 8-week supervised eMBI between weeks 29 and 36 of pregnancy and followed up to 5 months postpartum. Psychometric data were collected using the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI), the Pregnancy-Related Anxiety Questionnaire (PRAQ-R), the Freiburg Mindfulness Inventory (FMI-14) as well as the Patient Health Questionnaire (PHQ).Out of 5299 pregnant women, 1153 scored >9 on the EPDS and N = 460 were included in the RCT. No significant interaction effects for depressive symptoms and anxiety were found. Pregnancy- and birth-related anxiety decreased significantly in the IG and 6 weeks after birth, the rate of women at risk for adverse mental outcome was significantly lower compared to the CG. Mindfulness scores improved significantly in the IG.The eMBI program did not show effective regarding general depressive or anxiety symptoms, however, positive results were demonstrated regarding pregnancy and birth-related anxiety and the prevention of postpartum depression.

The Effect Of Meridian Acupoint Massage On Fatigue, And Prevention Of Post Partum Depression During The Public Period

Postpartum fatigue is a feeling of tiredness experienced by around 65-80% of mothers after giving birth. Fatigue can trigger post partum depression during the postpartum period. In Indonesia, the incidence of post partum blues is 50% -70%. One of the method is meridian accupoints massage intervention to reduce fatigue and prevent post partum depression. This study aims to analyze the effects of meridian accupoint massage on fatigue and prevention post partum depression in the post partum period.&#x0D; A quasi experimental design with pretest posttest nonequivalent control group was utilized. The study group consisted of 28 postpartum women on the 5th day at the Nining Lubuk Pakam Clinic. The instrument used to measure fatigue is th. e Postpartum Fatique Scale, prevention of post partum depression is measured by the Edinburgh Postnatal Depression Scale (EPDS). Data analysis uses independent and dependent t-tests.&#x0D; The experimental group demonstrated a significantly larger decrease compared with the control groupin measures of fatique and prevention post partum depressive. There was a significant difference in maternal fatigue and prevention of post partum depression after meridian accupoint massage between the intervention group and the control group with a value of p=0.003; p=0.002. The average reduction in fatigue after meridian accupoint massage was 27.11%, while the reduction in stress as an assessment for preventing post partum depression was 43.41%.&#x0D; Meridian Accupoint Massage has been proven to have an influence on reducing fatigue and preventing post partum depression during the postpartum period. For midwives to be able to learn and apply this method to normal postpartum mothers in order to improve the quality of life of postpartum mothers. Meridian accupoint massage intervention can be used as learning material in complementary therapy during the postpartum period.

A Mixed Methods Evaluation of Virtually Delivered Group-based Mothers and Babies for Latina Immigrant Mothers.

Immigrant Latinas are at higher risk for postpartum depression (PPD) than the general perinatal population, yet face numerous barriers to accessing mental health services. The goal of this study was to pilot an enhanced, virtual group delivery of a PPD prevention program, Mothers and Babies (MB), among immigrant Latinas engaged in early childhood programming. Forty-nine Spanish-speaking mothers participated in one of four MB virtual groups, facilitated by trained bilingual staff at affiliated early learning centers. MB was enhanced to also target social determinants of health. A mixed-methods design was used to evaluate MB using participant interviews and pre-post surveys measuring depressive symptoms, parenting distress, and self-efficacy to manage emotions. On average, participants attended 69% of MB virtual sessions and rated group cohesiveness at a 4.6 on a 5-point scale. Paired-samples t tests showed significant reductions in depressive symptoms (Cohen's d=0.29; p=.03) and parenting distress (Cohen's d=0.31; p=.02), and improved self-efficacy to manage emotions (Cohen's d=-0.58; p<.001). Participants reported both benefits and drawbacks of the virtual format and provided largely favorable feedback on program enhancements. Results provide initial evidence for the acceptability, feasibility, and effectiveness of an enhanced virtual group PPD prevention program for immigrant Latinas, delivered in partnership with local early learning centers. These findings have important implications for extending the reach of preventive interventions among a population that faces many structural and linguistic barriers to traditional forms of mental health service delivery.

Mindfulness-Based Interventions During Pregnancy and Long-Term Effects on Postpartum Depression and Maternal Mental Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objectives: Preventing postpartum depression (PPD) is a public health goal. The scientific literature has demonstrated the short-term efficacy of Mindfulness-Based Interventions (MBIs) delivered during pregnancy on PPD. Nevertheless, the long-term outcomes of MBIs are still unclear. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Four databases were searched to identify RCTs focused on describing the efficacy of MBIs on PPD and published in English up to February 2022. Settings/Location: The study was conducted globally. Subjects: Pregnant women who received MBIs. Interventions: MBIs were delivered during pregnancy in the included RCTs. Outcome Measures: Data collection and analysis effect size were combined using a random-effects model. The reporting in this study was consistent with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results: Six studies were included. The overall effect size significantly reduced PPD symptoms severity in the MBI group versus the control group in the first 3 months after childbirth (standardized mean difference = -0.26; 95% confidence interval = -0.51 to -0.01; I2 = 30.65%). The effects of MBIs were significant in women who started MBIs with a low risk of developing PPD. Conclusions: MBIs delivered during pregnancy have long-term benefits for PPD. Implications for Practice: Further studies focused on testing MBIs starting during pregnancy and lasting over the postpartum and modulating the intensity of delivering MBIs based on the risk for developing PPD are needed to inform the practice with solid evidence.

Development of Practice Guidelines for Peripartum Depression in Primary Healthcare

Abstract Background Antenatal and postpartum major depressive episode (MDE) according to Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) is defined as either daily sustained sad mood or lack of enjoyment or desire for a minimum two weeks plus four associated manifestations (only three if the two major symptoms are present): 1) Unintentional notable slimming up or down; 2) Sleepiness or sleeplessness; 3)Tiredness sensation; 4) Guilty or futility sensation; 5) Declined concentration capacity; 6) Frequent suicidal thoughts or 7) Psychomotor excitation or delay, that start throughout pregnancy or during the first 4 weeks postpartum respectively. Objective To develop Egyptian practice guidelines for peripartum depression in Primary Healthcare (PHC). Methods The current study was conducted thorough Delphi technique by participation of Thirteen experts at psychiatry and family medicine specialties from different governmental universities, Ministry of Health and Population (MOHP), World Health Organization (WHO) and World Organization of Family Doctors (WONCA) via email thorough three consecutive phases of Delphi technique. Results The current study recommended health education programs, provision of awareness about physical exercise’s importance for prevention of antenatal and postnatal depression, adding telephone- based peer support for the preventive measures of the antenatal depression and family therapy for the postpartum depression prevention. Screening for all the pregnant women every trimester by patient health questionnaire II and screening for all the new mothers every well child clinic visit in the first year after delivery by Edinburg Postpartum Depression Scale (EPDS). Diagnosis by beck depression inventory II questionnaire and Postpartum Depression Screening Scale (PDSS) for antenatal and postnatal depression respectively with post diagnosis evaluation for: 1) Comorbid anxiety; 2) Bipolar disorder; 3) Thoughts of harming intrauterine fetus or newborns; 4) Suicidal thoughts and 5) Psychotic features. Cognitive Behavioral Therapy (CBT) for treatment of mild cases and CBT with half dose sertraline for moderate cases of antenatal depression. Cognitive Behavioral Therapy (CBT) for mild cases, CBT and the usual dose sertraline for moderate cases with no hormonal therapy for any patient. Referral for patients with: 1) severe depression; 2) comorbid anxiety; 3) bipolar disorder; 4) thoughts of harming intrauterine fetus or newborns; 5) suicidal thoughts; 6) psychotic features; 7) substance abuse. Conclusion development of Egyptian practice guidelines for peripartum depression in PHC. Wide dissemination of the practice guidelines to all the Egyptian PHC facilities via a suitable method and training programs for the family physicians on practicing these guidelines must be ensured.

Study protocol for the ROSE Scale-Up Study: Informing a decision about ROSE as universal postpartum depression prevention

PurposeTo examine the effectiveness, cost-outcome, equity, scalability, and mechanisms of the Reach Out, Stay strong, Essentials for mothers of newborns (ROSE) postpartum depression prevention (PPD) program as universal versus selective or indicated prevention. BackgroundThe United States Preventive Services Task Force (USPSTF) currently recommends PPD prevention for pregnant people at risk of PPD (i.e., selective/indicated prevention). However, universal prevention may be more scalable, equitable, and cost-beneficial. DesignEffectiveness of ROSE for preventing PPD among people at risk is known. To assess ROSE as universal prevention, we need to determine the effectiveness of ROSE among all pregnant people, including those screening negative for PPD risk. We will enroll 2320 pregnant people, assess them with commonly available PPD risk prediction tools, randomize everyone to ROSE or enhanced care as usual, and assess ROSE as universal, selective, and indicated prevention in terms of: (1) effectiveness (PPD prevention and functioning), (2) cost-benefit, (3) equity (PPD cases prevented by universal prevention that would not be prevented under selective/indicated for minority vs. non-Hispanic white people), (4) quantitative and qualitative measures of scalability (from 98 agencies previously implementing ROSE), (5) ROSE mechanisms across risk levels. We will integrate results to outline pros and cons of the three prevention approaches (i.e., universal, selective, indicated). ConclusionThis will be the first trial to assess universal vs. selective/indicated PPD prevention. Trial design illustrates a novel, efficient way to make these comparisons. This trial, the largest PPD prevention trial to date, will examine scalability, an understudied area of implementation science.

Predicting efficacy of sub-anesthetic ketamine/esketamine i.v. dose during course of cesarean section for PPD prevention, utilizing traditional logistic regression and machine learning models

ObjectiveIncreasing researches supported that intravenous ketamine/esketamine during the perioperative period of cesarean section could prevent postpartum depression(PPD). With the effective rate ranging from 87.2 % to 95.5 % in PPD, ketamine/esketamine's responsiveness was individualized. To optimize ketamine dose/form based on puerpera prenatal characteristics, reducing adverse events and improving the total efficacy rate, prediction models were developed to predict ketamine/esketamine's efficacy. MethodBased on two randomized controlled trials, 12 prenatal features of 507 women administered the ketamine/esketamine intervention were collected. Traditional logistics regression, SVM, random forest, KNN and XGBoost prediction models were established with prenatal features and dosage regimen as predictors. ResultsAccording to the logistic regression model (ain = 0.10, aout = 0.15, area under the receiver operating characteristic curve, AUC = 0.728), prenatal Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10, thoughts of self-injury and bad mood during pregnancy were associated with poorer ketamine efficacy in PPD prevention, whilst a high dose of esketamine (0.25 mg/kg loading dose+2 mg/kg PCIA) was the most effective dosage regimen and esketamine was more recommended rather than ketamine in PPD. The AUCvalidation set of KNN and XGBoost model were 0.815 and 0.651, respectively. ConclusionLogistic regression and machine learning algorithm, especially the KNN model, could predict the effectiveness of ketamine/esketamine iv. during the course of cesarean section for PPD prevention. An individualized preventative strategy could be developed after entering puerpera clinical features into the model, possessing great clinical practice value in reducing PPD incidence.

App-based interventions for the prevention of postpartum depression: a systematic review and meta-analysis

BackgroundThis study explored whether psychosocial intervention applications (apps) are effective in preventing postpartum depression.MethodsWe conducted an initial article search on 26 March 2020, and the updated search on 17 March 2023 on the electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, Scopus, PsycINFO, CINAHL, and ProQuest Dissertations & Theses A&I. Furthermore, we searched the International Clinical Trials Platform Search Portal (ICTRP), and Clinical Trials.ResultsWe identified 2515 references, and sixteen studies were ultimately included in this review. We conducted a meta-analysis of two studies on the onset of postpartum depression. There were no significant differences between the intervention and control groups (RR 0.80; 95% CI 0.62 to 1.04; P = 0.570). We performed a meta-analysis of the Edinburgh Postnatal Depression Scale (EPDS). The intervention group had significantly lower EPDS scores than the control group (mean difference -0.96; 95% CI -1.44 to -0.48; P < 0.001, I2 = 82%, Chi2 = 62.75, P < 0.001; high heterogeneity).ConclusionThis study presents the results of current RCTs on interventions with apps, including an app with an automated psychosocial component for preventing postpartum depression that has been conducted. These apps improved the EPDS score; furthermore, they may prevent postpartum depression.

EDUKASI MANAJEMEN KOPING PENCEGAHAN DAN TATALAKSANA DEPRESI POST PARTUM

Postpartum depression is a serious condition, especially for mothers who are giving birth for the first time or mothers with sibling conditions who have not been prepared. The impact that occurs on the mother and baby should be prevented with good management. The purpose of this community service is to provide education on coping management about the prevention and management of postpartum depression, for postpartum mothers in collaboration with the Punggul-Mojokerto Village Polindes Midwife. Implementation of activities in January 2023, starting from the preparation stage to the evaluation stage. The output of the activity is an increase in the understanding of postpartum mothers, the readiness of mothers to undergo childbirth, and new roles. In efforts to improve maternal and child health, modules and booklets are available related to postpartum and newborn care, with the hope that reproductive mothers will increase their knowledge about maternal issues

A INFLUÊNCIA DO PRÉ-NATAL PSICOLÓGICO SOBRE A MANIFESTAÇÃO DE TRANSTORNOS NO PUERPÉRIO: uma revisão narrativa

This article aims to identify, in the scientific literature, how psychological prenatal care helps during pregnancy and postpartum, verifying the benefits it proposes, aiming at reducing postpartum depression in postpartum mothers. This is a narrative-type literature review that included articles from the PEPSIC database. From the methods, 05 (five) articles. In view of the analysis of the chosen texts, it was observed that psychological prenatal care is an important tool for the prevention of postpartum depression, and that it does not nullify the risk factors for the development of mental disorders, however, it is a great ally, together with protective factors, to reduce possible negative symptoms during pregnancy and the puerperium.