Implementing the USPSTF Recommendations on Prevention of Perinatal Depression—Opportunities and Challenges

Felder, Jennifer N.

doi:10.1001/jamainternmed.2018.7729

Cited by 16 publications

(11 citation statements)

References 18 publications

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“…Highlighting the need for such studies is the recent recommendation by the United States Preventive Services Task Force to refer all women at increased risk of perinatal depression to counseling services. Implementing this recommendation will place a tremendous burden on the health care system, which already has a shortage of mental health care providers [69][70][71][72][73][74]. Thus, the findings from this study support the need for pragmatic trials, which will provide evidence on the effectiveness of implementing low-cost, technology-based programs for women with moderate to moderately severe PPD symptoms, which are necessary for improving the health of families.…”

Section: Discussionmentioning

confidence: 56%

A Mobile Health Mindfulness Intervention for Women With Moderate to Moderately Severe Postpartum Depressive Symptoms: Feasibility Study

Avalos¹,

Aghaee²,

Kurtovich³

et al. 2020

JMIR Ment Health

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Background Approximately 20% of women suffer from postpartum depression (PPD). Due to barriers such as limited access to care, half of the women with PPD do not receive treatment. Therefore, it is critical to identify effective and scalable interventions. Traditional mindfulness programs have been effective in reducing depressive symptoms, however access remains a barrier. A self-paced mobile health (mHealth) mindfulness program may fit the lifestyle of busy mothers who are unable to attend in-person classes. However, little is known regarding the feasibility or efficacy of mHealth mindfulness interventions in postpartum women with depressive symptoms. Objective This study aims to assess the feasibility, acceptability, and preliminary efficacy of an mHealth mindfulness intervention for postpartum women with moderate to moderately severe depressive symptoms. Methods We conducted a single-arm feasibility trial of an mHealth mindfulness intervention within Kaiser Permanente Northern California (KPNC), a large integrated health care system. Participants were identified through clinician referral and electronic health records via KPNC's universal perinatal depression screening program and recruited by the study team. Inclusion criteria included the following: English-speaking, up to 6 months postpartum with a Patient Health Questionnaire (PHQ-8) score of 10 to 19, and no regular mindfulness/meditation practice. Participants were asked to use a mindfulness app, Headspace, 10 to 20 min/day for 6 weeks. Baseline and postintervention surveys captured data on patient-reported outcomes (depression and stress symptoms, sleep quality, and mindfulness). Semistructured interviews captured acceptability. Retention and adherence were used to assess feasibility. Results Of the 115 women who were contacted and met the eligibility criteria or declined participation before eligibility assessment, 27 (23%) were enrolled. In addition, 70% (19/27) completed the study. The mean age of participants was 31 years (SD 5.2), 30% (8/27) were non-Hispanic White, and, on average, participants were 12.3 weeks postpartum (SD 5.7). Of the women who completed the study, 100% (19/19) used the Headspace app at least once, and nearly half (9/19, 47%) used the app on ≥50% of the days during the 6-week intervention period. Of the 16 participants who completed the postintervention interview, 69% (11/16) reported that they were very or extremely satisfied with the app. Interviews indicated that women appreciated the variety of meditations and felt that the program led to reduced anxiety and improved sleep. Significant improvements in pre- and postintervention scores were observed for depressive symptoms (PHQ-8: −3.8, P=.004), perceived stress (10-item Perceived Stress Scale: −6.0, P=.005), and sleep quality (Pittsburgh Sleep Quality Index: −2.1, P=.02, indicating less sleep disturbance). Improvements in mindfulness were also significant (Five Facet Mindfulness Questionnaire-Short Form: 10.9, P=.01). Conclusions An mHealth mindfulness intervention for postpartum women with moderate to moderately severe depressive symptoms is feasible and acceptable. An efficacy trial is warranted.

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Section: Discussionmentioning

confidence: 56%

A Mobile Health Mindfulness Intervention for Women With Moderate to Moderately Severe Postpartum Depressive Symptoms: Feasibility Study

Avalos¹,

Aghaee²,

Kurtovich³

et al. 2020

JMIR Ment Health

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“…48 Interventions such as interpersonal therapy, cognitive behavioural therapy, non-directive counselling, and peer and partner support aim to build social support and lead to behavioural changes that enhance coping and reduce distress. 49,50 Ideally, prophylactic measures in terms of prospective support for all pregnant and newly delivered mothers should be offered, and would most likely result in reducing disease severity and burden for women and families. However, large-scale population-based interventions often confer a substantial load on the healthcare system.…”

Section: Resultsmentioning

confidence: 99%

Severe obstetric lacerations associated with postpartum depression among women with low resilience – a Swedish birth cohort study

Asif

Mulic‐Lutvica

Axfors

et al. 2020

BJOG

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Objective Women's levels of resilience and attitudes towards perineal lacerations vary greatly. Some women see them as part of the birthing process, while others react with anger, depressed mood or even thoughts of self‐harm. A previous study has reported increased risk of postpartum depressive (PPD) symptoms in women with severe perineal lacerations. The aim of this study was to assess the association between severe obstetric perineal lacerations and PPD. A secondary objective was to assess this association among women with low resilience. Design Nested cohort study. Setting Uppsala, Sweden. Sample Vaginally delivered women with singleton pregnancies (n = 2990). Methods The main exposure was obstetric perineal lacerations. Resilience was assessed in gestational week 32 using the Swedish version of the Sense of Coherence Scale. A digital acyclic graph was used to identify possible confounders and mediators. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). A sub‐analysis was run after excluding women with normal or high resilience. Main outcome measures Postpartum depression, assessed with the Depression Self‐Reporting Scale, completed at 6 weeks postpartum. Results There was no significant association between severe obstetric perineal lacerations and PPD at 6 weeks postpartum. However, a significant association was found between severe lacerations and PPD in women with low resilience (OR = 4.8, 95% CI 1.2–20), persisting even after adjusting for confounding factors. Conclusion Healthcare professionals might need to identify women with low resilience, as they are at increased risk for PPD after a severe perineal laceration. Tweetable abstract Severe perineal lacerations associated with postpartum depression in women with low resilience in a Swedish cohort.

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“…Though PPD screening is recommended by American College of Obstetricians and Gynecologists (2018) and the United States Preventive Services Task Force (Felder, 2019), few participants felt that PPD had been addressed well during pre- and postnatal visits. Although early prenatal care can help mitigate some of the effects of substance use during pregnancy, studies have found that women in rural areas face multiple challenges to receiving care such as transportation concerns and fear of judgment by health care providers (Benoit et al, 2015; Kramlich et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Challenges in Accessing Mental Health Care during Pregnancy and Postpartum in Rural Montana

Hanson

Reese

Newcomer

2023

McN: The American Journal of Maternal/Child Nursing

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Purpose: Postpartum depression is a well-known maternal health care concern. For women using substances or experiencing underlying mental health conditions, incidence of postpartum depression is higher than that of the general population. The purpose of this study was to identify barriers and facilitators associated with seeking mental health care among women with substance use disorder or mental health concerns. Study Design and Methods: Qualitative methods using interviews were conducted via the narrative inquiry approach. Women receiving care at a clinic in rural Montana and reporting substance use or mental health concerns were referred to the research team by the care manager. Participants were at least 18 years of age, English speaking, and pregnant or within 12 months postpartum at time of referral. Results: Twenty-five women met inclusion criteria and were referred for potential study participation. Seven women were interviewed. Four themes on family history, stigmatization, lack of postpartum depression awareness, and isolation were identified. Clinical Implications: Our findings provide a better understanding of barriers and facilitators to seeking mental health care during pregnancy and postpartum among women living in rural areas with mental health concerns or perinatal substance use. An environment where opportunities for women to receive mental health care in a location that is free of stigma and judgment, while understanding the effects of familial trauma and limited or inconsistent social support, is essential to promote optimal outcomes.

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Implementing the USPSTF Recommendations on Prevention of Perinatal Depression—Opportunities and Challenges

Cited by 16 publications

References 18 publications

A Mobile Health Mindfulness Intervention for Women With Moderate to Moderately Severe Postpartum Depressive Symptoms: Feasibility Study

A Mobile Health Mindfulness Intervention for Women With Moderate to Moderately Severe Postpartum Depressive Symptoms: Feasibility Study

Severe obstetric lacerations associated with postpartum depression among women with low resilience – a Swedish birth cohort study

Challenges in Accessing Mental Health Care during Pregnancy and Postpartum in Rural Montana

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