Festschrift in honor of Professor Ian F. Brockington.
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History, 20th Century↗
Biomedical subjects
M W O'Hara
Publications and source records attributed to M W O'Hara.
Patient choice of treatment for postpartum depression: a pilot study.
OBJECTIVE: The lack of systematic efficacy research makes the selection of optimal treatment for postpartum depression (PPD) difficult. Moreover, the treatment decisions for women with PPD who are breastfeeding are heavily influenced by their concerns about infant exposure to antidepressant medication. The objective of this pilot trial was to examine the clinical characteristics of women with PPD associated with treatment selection. METHOD: This open pilot trial offered 23 women with PPD one of 3 treatment options: sertraline, interpersonal psychotherapy (IPT), or their combination administered in an outpatient mental health setting over 12 weeks. Baseline and treatment outcome measures included the Hamilton Rating Scale for Depression (HRSD), the Beck Depression Inventory (BDI) and the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: Completers across all 3 treatment groups (n = 18) experienced significant clinical improvement with each of the 3 treatment modalities on the HRSD (p < 0.001), BDI (p < 0.001) and EPDS (p < 0.001). There were trends for women with a prior depression to more frequently choose sertraline as a treatment (alone or with IPT, p = 0.07), and for women who were breastfeeding to choose sertraline (alone or with IPT, p = 0.10) less frequently. CONCLUSION: In this small sample of women with PPD, most women chose IPT with or without sertraline. A larger randomized study could further confirm the suggested predictors of treatment selection identified in this study: previous depression and breastfeeding status.
Adult↗
A partner-rating scale of postpartum depression: the Edinburgh Postnatal Depression Scale - Partner (EPDS-P).
Partners could be useful as informants of postpartum women's depressive symptoms; however, currently no partner-ratings exist. The Edinburgh Postnatal Depression Scale - Partner (EPDS-P) is a 10-item measure adapted from the Edinburgh Postnatal Depression Scale (EPDS). The EPDS-P is expected to converge with the EPDS and other measures of depressive symptoms and to demonstrate incremental validity in the prediction of depressive symptoms. 101 women and their partners completed multiple measures of depressive symptoms during the first six weeks postpartum. Initial results suggest adequate reliability and validity for the EPDS-P. The EPDS-P showed moderate convergent correlations with other depression measures. Longitudinal correlations showed a link between the two-week EPDS-P and the six-week EPDS. The EPDS-P demonstrated incremental validity over and above the EPDS. Results supported the use of the EPDS-P as a valid partner-rating scale. The findings confirm that partners of postpartum women are valuable resources when assessing depressive symptoms.
Adult↗
Adaptation of the structured clinical interview for DSM-IV disorders for assessing depression in women during pregnancy and post-partum across countries and cultures.
BACKGROUND: To date, no study has used standardised diagnostic assessment procedures to determine whether rates of perinatal depression vary across cultures. AIMS: To adapt the Structured Clinical Interview for DSM-IV Disorders (SCID) for assessing depression and other non-psychotic psychiatric illness perinatally and to pilot the instrument in different centres and cultures. METHOD: Assessments using the adapted SCID and the Edinburgh Postnatal Depression Scale were conducted during the third trimester of pregnancy and at 6 months postpartum with 296 women from ten sites in eight countries. Point prevalence rates during pregnancy and the postnatal period and adjusted 6-month period prevalence rates were computed for caseness, depression and major depression. RESULTS: The third trimester and 6-month point prevalence rates for perinatal depression were 6.9% and 8.0%, respectively. Postnatal 6-month period prevalence rates for perinatal depression ranged from 2.1% to 31.6% across centres and there were significant differences in these rates between centres. CONCLUSIONS: Study findings suggest that the SCID was successfully adapted for this context. Further research on determinants of differences in prevalence of depression across cultures is needed.
Adult↗
The prevention and psychotherapeutic treatment of postpartum depression.
The efficacy of psychotherapeutic interventions for the acute treatment of postpartum depression is strongly supported by empirical data, which suggest that counseling is of benefit as a stand-alone treatment for postpartum depression. Given the paucity of treatment trials using medication for postpartum depression, and the fact that psychotherapeutic interventions do not confer any "exposure" risks to breastfeeding infants, the data also suggest that psychotherapy should be considered a first-line treatment, rather than as an adjunct to medication treatment. There is also some data supporting the use of psychotherapy as a means of preventing postpartum depression, though research is still needed regarding the type of interventions to be used and the types of patients towards whom the interventions should be directed.
Adult↗
Efficacy of interpersonal psychotherapy for postpartum depression.
BACKGROUND: Postpartum depression causes women great suffering and has negative consequences for their social relationships and for the development of their infants. Research is needed to evaluate the efficacy of psychotherapy for postpartum depression. METHODS: A total of 120 postpartum women meeting DSM-IV criteria for major depression were recruited from the community and randomly assigned to 12 weeks of interpersonal psychotherapy (IPT) or to a waiting list condition (WLC) control group. Subjects completed interview and self-report assessments of depressive symptoms and social adjustment every 4 weeks. RESULTS: Ninety-nine of the 120 patients completed the protocol. Hamilton Rating Scale for Depression (HRSD) scores of women receiving IPT declined from 19.4 to 8.3, a significantly greater decrease than occurred in the WLC group (19.8 to 16.8). The Beck Depression Inventory (BDI) scores of women who received IPT declined from 23.6 to 10.6 over 12 weeks, a significantly greater decrease than occurred in the WLC group (23.0 to 19.2). A significantly greater proportion of women who received IPT recovered from their depressive episode based on HRSD scores of 6 or lower (37. 5%) and BDI scores of 9 or lower (43.8%) compared with women in the WLC group (13.7% and 13.7%, respectively). Women receiving IPT also had significant improvement on the Postpartum Adjustment Questionnaire and the Social Adjustment Scale-Self-Report relative to women in the WLC group. CONCLUSIONS: These findings suggest that IPT is an efficacious treatment for postpartum depression. Interpersonal psychotherapy reduced depressive symptoms and improved social adjustment, and represents an alternative to pharmacotherapy, particularly for women who are breastfeeding.
Depression, Postpartum↗
Postpartum anxiety and depression: onset and comorbidity in a community sample.
A community-based sample of 107 women completed the Beck Anxiety Inventory, Beck Depression Inventory, State-Trait Anxiety Inventory, and Edinburgh Postnatal Depression Scale at 14 weeks postpartum and at 30 weeks postpartum. The point prevalence of anxiety was 8.7% at 14 weeks and 16.8% at 30 weeks postpartum. The point prevalence of depression was 23.3% at 14 weeks and 18.7% at 30 weeks postpartum. The incidence of anxiety during this time period was 10.28%, and the incidence of depression was 7.48%, indicating high incidences of both postpartum anxiety and depression later in the postpartum period. The Edinburgh Postnatal Depression Scale was found to have a strong correlation with the State Anxiety Scale of the State-Trait Anxiety Inventory (r = .73 at 14 weeks, r = .82 at 30 weeks), suggesting that the Edinburgh Postnatal Depression Scale may be a good screening instrument for anxiety as well as depression.
Adult↗
Mental disorders associated with childbearing: report of the Biennial Meeting of the Marcé Society.
This article presents highlights from an international conference focused on mental disorders in association with childbearing. Findings from related research on diagnosis, classification, epidemiology, child outcome, prevention, and treatment are summarized. A need is seen for more research on prevention of childbearing disorders, on the effectiveness of interventions in reducing maternal and child morbidity, on the development of new psychosocial interventions, and on the assessment of the efficacy and safety of somatic treatments in pregnant and lactating women. Mental disorders associated with childbearing are a significant public health problem. Antenatal and postpartum mental disorders are not only associated with morbidity and mortality in affected women, but also with increased morbidity in their children. Despite their prevalence, they are often not recognized by primary care providers, and are hence undertreated. Moreover, physicians are reluctant to treat women with medication during pregnancy and the postpartum for fear of adverse effects on the fetus and the breastfeeding newborn. Little information is available to inform clinicians about the relative risks and benefits of pharmacological treatments. Psychosocial interventions for mental disorders associated with childbearing have not been widely investigated, leaving few options for treatment. The Biennial Meeting of the Marcé Society was convened in Iowa City, Iowa, from June 24 to June 28, 1998. The meeting was jointly sponsored by the University of Iowa Department of Psychology, the Colleges of Medicine and Nursing, Postpartum Support International, and by the National Institute of Mental Health, Division of Mental Disorders, Behavioral Research, and AIDS. The Marcé Society is a multi-disciplinary organization that aims to improve the understanding, prevention, and treatment of mental illnesses related to childbearing. International and U.S. participants met to present new research on the epidemiology, identification, and treatments for childbearing women with mental disorders. Highlights of the meeting are summarized below.
Depression, Postpartum↗
A prospective study of sleep, mood, and cognitive function in postpartum and nonpostpartum women.
OBJECTIVE: To compare the sleep patterns, mood states, and cognitive functioning of primiparous mothers during the first 3 weeks postpartum with those of a control group of nonpostpartum women and to assess the relationships among these variables. METHODS: For the first 3 weeks postpartum, 30 primiparous women and 28 nonpostpartum mothers completed daily assessments of mood and recorded multiple aspects of sleep including time of retiring, occurrence and duration of sleep interruption, time of awakening, and morning alertness. Objective measures of memory, attention/concentration, and psychomotor performance were obtained on three occasions. RESULTS: Postpartum women reported more evening awakenings, more time awake after retiring, and more naps than controls, but overall sleep time was similar. New mothers experienced a higher level of dysphoric mood during the first week than nonpostpartum controls; however, controlling for the effect for "time awake" at night eliminated the significant effect for dysphoric mood. Few differences were observed on the multiple assessments of cognitive function; however, performances of new mothers on memory and psychomotor tasks were likely to be influenced by sleep loss. CONCLUSION: Women must make important adjustments in their sleep patterns during the postpartum period. In the study group, these adjustments were largely successful, particularly after the first week postpartum, in avoiding the negative consequences of sleep disturbances such as dysphoric mood and impaired cognitive function. Nevertheless, the significant associations between sleep indices and mood and objective measures of cognitive function point to the importance of encouraging appropriate amounts of sleep for recently delivered women.
Adult↗
Description and evaluation of the Iowa Depression Awareness, Recognition, and Treatment Program.
OBJECTIVE: The National Institute of Mental Health developed the Depression Awareness, Recognition, and Treatment Program to provide up-to-date information and training to health, mental health, and social service professionals regarding the identification and treatment of depression. This study was undertaken to evaluate a series of these programs for professionals who provide services to rural residents in the Midwest. METHOD: The 18 2-day training programs were attended by a total of 1,221 participants, physicians, psychologists, social workers, and nurses. Participants' knowledge regarding depression was assessed both before and after each program. Practice characteristics and perceived ability to assess and treat depression were assessed. Finally, 6-month follow-up evaluations of the usefulness of the training to the participants were undertaken. RESULTS: Following the programs, participants evidenced significant increases in levels of knowledge of depression and a high degree of satisfaction with most elements of the program. Six-month follow-up evaluations indicated a continued positive evaluation of the program. CONCLUSIONS: These outcomes suggest that the goals of the Depression Awareness, Recognition, and Treatment Program were met and provide support for the wider dissemination of these training programs.
Adult↗
Treatment of postpartum depression with interpersonal psychotherapy.
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Adult↗
Abuse history and chronic pain in women: I. Prevalences of sexual abuse and physical abuse.
OBJECTIVE: To compare the prevalences of childhood and adult physical and sexual abuse in women with chronic pelvic pain to those in women with chronic nonpelvic pain (headache) and pain-free women. METHODS: Using a structured interview, we assessed the prevalence rates of both sexual abuse and physical abuse in 64 women with chronic pelvic pain, 42 women with chronic headache, and 46 pain-free women. Abuse histories were stratified by age at occurrence and severity. Demographic characteristics of the three groups were also assessed. RESULTS: Women with chronic pelvic pain were found to have a higher lifetime prevalence of sexual abuse, involving penetration or other contact with the unclothed genitals or anus (ie, major sexual abuse), than either comparison group. Further, more women in the chronic pelvic pain group had experienced major sexual abuse in both childhood and adulthood than women in the headache group, but there was no difference with the pain-free group. With respect to physical abuse, women in the chronic pelvic pain group had a higher lifetime prevalence than pain-free women, but not compared to those with chronic headache. In addition, more women with chronic pelvic pain reported physical abuse in both childhood and adulthood and both major sexual abuse and physical abuse at some time in their lives than did either comparison group. CONCLUSIONS: These results support a specific association between major sexual abuse and chronic pelvic pain and a more general association between physical abuse and chronic pain. Moreover, the global nature of the abuse histories of the women in the chronic pelvic pain group suggests that more rigorous studies of the relation between abuse history and chronic pelvic pain are needed.
Adolescent↗
Abuse history and chronic pain in women: II. A multivariate analysis of abuse and psychological morbidity.
OBJECTIVE: To assess the potential role of childhood and adulthood physical and sexual abuse and complaints of chronic pain in accounting for psychiatric symptomatology in adult women. METHODS: We assessed sexual abuse, physical abuse, depression, anxiety, and somatization in 64 women with chronic pelvic pain, 42 women with chronic headache, and 46 women without chronic pain complaints. Using multiple regression analyses, we tested a model comprising sociodemographic, chronic pain, childhood sexual abuse and physical abuse, and adulthood sexual abuse and physical abuse variables in the prediction of depression, anxiety and somatization. RESULTS: This model significantly predicted all three outcomes. However, childhood sexual abuse was not significant in the prediction of any of the outcome variables, whereas childhood physical abuse was significant in the prediction of all three. Further, the adulthood abuse variable set contributed significantly to the prediction of somatization, and the individual variable of adulthood sexual abuse was predictive of anxiety. CONCLUSIONS: The relation observed between childhood sexual abuse and the outcomes of depression, anxiety, and somatization in women may be a function of its association with other forms of abuse, particularly childhood physical abuse. Further investigation is clearly needed of the nature of the relations between the various categories of abuse and psychological morbidity.
Adolescent↗
Self-discrepancies in clinically anxious and depressed university students.
Self-discrepancy theory proposes that anxiety and depression are the result of different types of conflicting self-beliefs. This study examined self-discrepancies in four groups of university students who completed a questionnaire assessing levels of self-discrepancy and were characterized by the following disorders: (a) depression, (b) anxiety, (c) both anxiety and depression, or (d) no psychiatric disorder. As predicted, subjects with anxiety or depressive disorders had higher levels of self-discrepancy than normal subjects. Depressive subjects had higher levels of actual:ideal discrepancies than nondepressive subjects. Anxious subjects (with or without depressive disorders) had higher levels of actual:ought discrepancies than nonanxious subjects (normals and depressed-only subjects). Results provided general support for self-discrepancy theory in accounting for depressive and anxiety disorders.
Adult↗
Increases in depressive symptomatology in the rural elderly: results from a cross-sectional and longitudinal study.
Depressive symptomatology was examined in a large sample of noninstitutionalized older adults using the Center for Epidemiological Studies-Depression scale (CES-D). Both cross-sectional and longitudinal data showed age-related increases in mean CES-D scores and increases in the percentage of respondents scoring at or above the cutoff score of 16. Variables collected at baseline in the longitudinal study from 2,032 participants 65 years of age and older were significant predictors of depressive symptomatology 3 and 6 years later. Baseline CES-D scores accounted for the largest proportion of the variance.
Activities of Daily Living↗
Prospective study of postpartum blues. Biologic and psychosocial factors.
Potential biologic and psychosocial causative factors for the postpartum blues were tested in a prospective study of 182 women followed up from the second trimester of pregnancy until postpartum week 9. Personal and family history of depression, depressive symptoms, stressful life events, and social adjustment were all assessed during the second trimester. Levels of progesterone, prolactin, estradiol, free and total estriol, and free and total cortisol were measured on several occasions during late pregnancy and early puerperium. Obstetric and child-care stressors and the postpartum blues were assessed after delivery. Predictors of the postpartum blues were personal and family history of depression, social adjustment, stressful life events, and levels of free and total estriol. Our results support the hypothesis that the postpartum blues is within the spectrum of affective disorders.
Adult↗
Controlled prospective study of postpartum mood disorders: psychological, environmental, and hormonal variables.
Demographic, psychiatric, social, cognitive, and life stress variables were used to determine the etiology of depression in childbearing (CB; n = 182) and nonchildbearing (NCB; n = 179) women. Hormonal variables in postpartum depression were also evaluated. In the CB group predictors of depression diagnosis were previous depression, depression during pregnancy, and a Vulnerability (V) x Life Stress (LS) interaction; predictors of depressive symptomatology were previous depression, depressive symptoms during pregnancy, life events, and V x LS. Only estradiol was associated with postpartum depression diagnosis. In the NCB group V X LS was the only predictor of depression diagnosis; depressive symptoms during pregnancy and life events were predictors of depressive symptomatology. Previous findings about depression vulnerability were replicated. The significant V x LS interactions support the vulnerability-stress model of postpartum depression.
Adult↗
Prospective study of postpartum depression: 4 1/2-year follow-up of women and children.
The consequences of maternal postpartum depression for mothers and children were investigated in a 4 1/2-year follow-up study, which included 70 of 99 women who had participated in an earlier study of postpartum depression. Information about maternal adjustment and depression during the follow-up period and child adjustment at age 4 1/2 years was obtained. Women who had experienced a postpartum depression were predicted to be at increased risk for subsequent depression and poor adjustment of their child. Postpartum depression was directly related to subsequent depression but not child problems. Later depression was related to child problems at 4 1/2 years. We concluded that postpartum depression may increase risk for later maternal depression and in turn increases risk for child behavior problems. Intervening with women who have experienced a postpartum depression may reduce likelihood of future depressions and child behavior problems.
Adaptation, Psychological↗