Postpartum Depression Prevention for Reservation-Based American Indians: Results from a Pilot Randomized Controlled Trial

Background  

Postpartum depression is a devastating condition that affects a significant number of women and their offspring. Few preventive interventions have targeted high risk youth, such as American Indians (AIs).     

Postpartum Contraception and Interpregnancy Intervals Among Adolescent Mothers Accessing Public Services in California

Objective To determine the association of age at index birth with postpartum contraceptive use and optimal interpregnancy interval (IPI, defined as delivery to next pregnancy >18 months), controlling for provider type and client demographics among adolescent mothers who have repeat pregnancies. Methods California’s 2008 birth records were linked to California’s Medi-Cal and Family PACT claims data to identify 26,393 women with repeat births between 2002 and 2008, whose index birth occurred as an adolescent, and who received publicly-funded services within 18 months after the index birth. Multivariable regression analyses were conducted to examine the relationship between timing of contraception provision and interpregnancy intervals, adjusting for socio-demographic factors. Results Seventy-eight percent of adolescent women did not receive contraception at their first postpartum visit, and twenty-eight percent of adolescent women never received contraception from a Family PACT or Medi-Cal provider. Adolescents who were older at their index birth had lower rates of optimal IPIs. Native American, Asian-Pacific Islander and Latina women had lower rates of optimal IPIs compared to white women. Compared to those using only barrier methods, adolescent women receiving highly effective contraceptive methods had a 4.25 times higher odds of having an optimal IPI than those receiving hormonal methods (OR 2.10), or using no method (OR 0.70). Conclusion Effective postpartum contraceptive use and being a Family PACT provider were associated with optimal birth spacing among adolescent mothers, yet racial and ethnic disparities persisted. A missed opportunity was the provision of contraception at the first postpartum visit. Providers should aim to remove barriers to initiation of contraception at this visit.     

The #Tamojunto Drug Prevention Program in Brazilian Schools: a Randomized Controlled Trial

A randomized controlled trial was conducted in 2014 with 7th and 8th grade students from 72 public schools in 6 Brazilian cities. This trial aimed to evaluate the effects of an adapted European school-based drug prevention program Unplugged, called #Tamojunto in Brazil, which was implemented by the Ministry of Health as part of public policy. The experimental group (n = 3340) attended 12 classes in the #Tamojunto program, and the control group (n = 3318) did not receive a school prevention program. Baseline data were collected prior to program implementation, and follow-up data were collected 9 months later, allowing a matching of 4213 adolescents in both waves. The substances examined were alcohol, tobacco, marijuana, inhalants, cocaine, and crack. Multilevel analyses were used to evaluate the changes in consumption of each drug between time points and between groups. The intervention and control groups had similar baseline characteristics. The mean age of the adolescents was 12.5 ± 0.7 years, and 51.3% were female. The program seemed to increase alcohol use initiation (first alcohol use); students in the experimental group had a 30% increased risk of initiating alcohol use during the 9-month follow-up (aRR = 1.30, 95% confidence interval (95%CI) 1.13–1.49, p < 0.001) compared to the control group. The opposite was found for the first inhalant use: the risk of using inhalants for the first time after baseline was lower in the experimental group (aRR = 0.78, 95%CI 0.63–0.96, p = 0.021) than the control group. The results of the #Tamojunto program suggest that the content and lessons regarding alcohol may enhance curiosity about its use among adolescents. We suggest a re-evaluation of the expansion of the #Tamojunto program in schools while analyzing why the program’s effects were inconsistent with those of previous European studies.     

Postpartum Depression in Adolescent and Adult Mothers: Comparing Prenatal Risk Factors and Predictive Models

Our objective was to assess whether postpartum depression risk factors differ between adolescent and adult mothers and to evaluate the need for adolescent specific screening instruments. We performed a retrospective cohort study using data from the Rhode Island Pregnancy Risk Assessment Monitoring System, 2004–2008. We identified maternal age specific risk factors using weighted logistic regression and developed predictive models using a forward selected weighted logistic regression. Notable differences in odds ratios were observed for risk factors such as maternal race (OR Hispanic vs. White: 0.99, 95 % CI 0.49–1.99 among adolescents; 3.32, 95 % CI 2.01–5.49 among adults), pre-pregnancy alcohol use (OR use vs. non-use: 2.04, 95 % CI 1.08–3.86 among adolescents; 0.49, 95 % CI 0.33–0.73 among adults), and pregnancy intention (OR unintended vs. intended: 1.05, 95 % CI 0.37–2.97 among adolescents; 2.67, 95 % CI 1.51–4.74 among adults). In predictive models, adolescent postpartum depressive symptoms were most influenced by prior depression and social support while adult postpartum depressive symptoms were associated with risk factors including maternal race, pregnancy intention, SES, prior depression, mental health during pregnancy, stressors, and social support. We were able to identify similarities and dissimilarities in risk factors for postpartum depressive symptoms among adolescents and adults. Predictive models developed in the general population of pregnant women performed poorly among adolescents relative to age specific predictive models, suggesting that current screening tools may not adequately identify high risk adolescents.     

Using Technology to Promote Postpartum Weight Loss in Urban,Low-Income Mothers: A Pilot Randomized Controlled Trial

ObjectiveTo examine the feasibility, acceptability, and initial efficacy of a technology-based weight loss intervention for urban, low-income mothers.MethodsEighteen obese, ethnic minority, socioeconomically disadvantaged mothers in the first year after childbirth were randomly assigned to either: 1) technology-based intervention, which included empirically supported behavior-change strategies, daily skills, and self-monitoring text messages with personalized feedback, biweekly counseling calls from a health coach, and access to a Facebook support group, or 2) usual-care control.ResultsAfter 14 weeks of treatment, the technology-based intervention participants had significantly greater weight loss (−2.9 ± 3.6 kg) than usual care (0.5 ± 2.3 kg; adjusted mean difference: −3.2 kg, 95% confidence interval −6.2 to −0.1 kg, P = .04). One-third of intervention participants (3 of 9) and no control participants lost > 5% of their initial body weight at follow up.Conclusions and ImplicationsResults suggest the potential for using technology to deliver a postpartum weight loss intervention among low-income racial/ethnic minorities.     

Relationship Between Postpartum Depression and Psychological and Biological Variables in the Initial Postpartum Period

Objectives The aims of this study were to evaluate the predictive relationship between psychological symptomatology 24 h postpartum and depression 4 months postpartum, and analyze the relationship between estradiol and postpartum mood. Methods Two hundred women participated in an assessment 24 h postpartum and gave a blood sample for estradiol analysis. One hundred eleven of these women completed the second assessment 4 months postpartum. The Beck Depression Inventory II and the Scale of State-Trait Anxiety were used to assess psychological symptoms. Results At 24 h postpartum, symptoms of depression, trait anxiety, and state anxiety were all significantly correlated with each other. Depression at 24 h postpartum was the only significant independent predictor of depression at 4 months postpartum, explaining 28.7% of the variance. No statistically significant relationship was found between levels of estradiol and mood. Symptoms of depression immediately postpartum thus appear to be a predictor of postpartum depression. Conclusions for Practice These results suggest that early postpartum psychological evaluation of the mother, and intervention as warranted, might prevent or lessen postpartum depression.     

Associations Between Employment and Financial and Parental Stress in Low-Income Single Black Mothers

SUMMARY

Using a sample of 188 low-income single black mothers (93 employed and 95 nonemployed), this study investigated financial strain, maternal depressive affect, and parenting stress among former welfare recipients who are now working, and current welfare recipients who are not employed. The findings suggested that being employed did not reduce financial strain, as the two groups reported similar levels of strain. However, regression analyses indicated that not being employed was associated with reporting higher levels of stress. Parenting stresswas also associated with attaining less education, having boys, reporting more financial strain and depressive affect. Correlates of maternal depressive affect were mother's education and financial strain. Interaction effects were found for employment by financial strain, indicating that higher levels of depressive affect were related to more financial strain among nonemployed mothers. The findings suggest that although employment is associated with better mental health for poor mothers, entry into the workforce is associated with stronger links between financial strain, parenting stress and depressive affect for mothers leaving welfare.     

Reducing Sexual Risk Behavior in Adolescent Girls: Results From a Randomized Controlled Trial

PurposeTeenage girls in low-income urban settings are at an elevated risk for HIV, sexually transmitted infections, and unintended pregnancies. The purpose of this study was to evaluate the efficacy of a sexual risk-reduction (SRR) intervention, supplemented with postintervention booster sessions, targeting low-income, urban, sexually active teenage girls.MethodRandomized controlled trial in which sexually active urban adolescent girls (n = 738) recruited in a midsize northeastern U.S. city were randomized to a theory-based SRR intervention or to a structurally equivalent health promotion control group. Assessments and behavioral data were collected using audio computer-assisted self-interview at baseline, then at 3, 6, and 12 months postintervention. Both interventions included four small-group sessions and two booster sessions.ResultsRelative to girls in the control group, girls receiving the SRR intervention were more likely to be sexually abstinent; if sexually active, they showed decreases in (a) total episodes of vaginal sex at all follow-ups, (b) number of unprotected vaginal sex acts at 3 and 12 months, and (c) total number of sex partners at 6 months. Medical record audits for girls recruited from a clinical setting (n = 322) documented a 50% reduction in positive pregnancy tests at 12 months.ConclusionsTheory-based behavioral interventions tailored to adolescent girls can help to reduce sexual risk and may also reduce unintended pregnancies. Although sexually active at enrollment, many of the girls receiving the intervention were more likely to practice secondary abstinence. Continued refinement of SRR interventions for girls is needed to ensure they are feasible, appealing, and effective.     

Predictors of Smoking Cessation Among College Students in a Pragmatic Randomized Controlled Trial

Prevention Science - An effective strategy to quit smoking should consider demographic aspects, smoking-related characteristics and psychological factors. This study examined potential predictors...     

Dietary Outcomes in a Spanish-Language Randomized Controlled Diabetes Prevention Trial With Pregnant Latinas

Objectives. We evaluated the effectiveness of a community-based healthy lifestyle intervention in improving dietary behaviors of pregnant Latinas from 2004 to 2006 in Detroit, Michigan.Methods. The 11-week, culturally tailored, Spanish-language Healthy Mothers on the Move (MOMs) intervention offered home visits, group classes, related activities, and social support from trained community health workers (CHWs) and peers. Dietary behaviors were measured by food frequency questionnaire. Linear mixed models estimated pre- and post-intervention changes, within and between MOMs intervention and minimal intervention (MI) groups.Results. MOMs (n = 139) and MI (n = 139) participants had similar baseline characteristics and dietary intake. Post-intervention, MOMs participants showed significant improvement in all dietary behaviors, except fruit and fiber consumption. Compared with MI participants, MOMs participants had significantly decreased consumption of added sugar (P = .05), total fat (P < .05), saturated fat (P < .01), percentage of daily calories from saturated fat (P < .001), solid fats and added sugars (P < .001), and had increased vegetable consumption (P < .001). Their increase in fiber consumption (P < .05) was significant relative to MI participants’ decrease in fiber intake.Conclusions. We confirmed the hypothesis that a community-planned, CHW-led healthy lifestyle intervention could improve dietary behaviors of low-income Latina women during pregnancy.Obesity, gestational diabetes, and type 2 diabetes are prevalent among Latina women of childbearing age in the United States.1–6 Dietary intake, particularly low consumption of vegetables and fruits and high consumption of added sugars and solid fats, is associated with these conditions.7–13 In the Diabetes Prevention Program randomized controlled trial, an intensive healthy lifestyle intervention that helped participants develop healthy diet and exercise patterns reduced the risk of developing type 2 diabetes among nonpregnant women with impaired glucose tolerance by half, including those with and without a history of gestational diabetes.14Pregnancy may be an optimum period for interventions to improve dietary behaviors10,15,16 that have consequences for both maternal and child health.11,17–20 Following the success of the Diabetes Prevention Program, it is important to assess whether community-based healthy lifestyle interventions can reduce diabetes risk factors in pregnant women.18 Nonetheless, few randomized controlled studies have included dietary outcomes for pregnant women.21,22 Only 1 pilot study was conducted in pregnant Latinas.23To address this gap, a community-academic partnership used community-based participatory research (CBPR) processes to develop and implement Healthy Mothers on the Move (MOMs), a community health worker (CHW)-led healthy lifestyle intervention tailored to the needs and strengths of pregnant Latinas in Detroit, Michigan.24–26 Healthy MOMs aimed to demonstrate the effectiveness of this intervention to reduce behavioral and clinical risk factors for type 2 diabetes in pregnant and postpartum Latinas. We examined the hypothesis that women randomly assigned to the MOMs intervention group would significantly decrease their intake of added sugars, total fat and saturated fat, and significantly increase their intake of fruit, vegetables and fiber, compared with women assigned to the minimal intervention (MI) control group during pregnancy.     

A Test of Factors Mediating the Relationship Between Unwanted Sexual Activity During Childhood and Risky Sexual Practices Among Women Enrolled in the NIMH Multisite HIV Prevention Trial

SUMMARY

This study examined both the direct and indirect associations between unwanted sexual activity during childhood and HIV-related sexual practices of adult women. The sample consisted of 3,346 women recruited from sexually transmitted disease (STD) clinics and health service organizations. The findings demonstrated that participants who reported unwanted sexual activity as a child (USC) were more likely than women who did not report such experience to indicate that they had problems with alcohol, used drugs, received money or drugs in exchange for sex, had unwanted sex, and used mental health services. The women reporting USC also noted a greater number of unprotected sex acts, a greater number of partners, and a greater proportion of sex acts accompanied by drugs or alcohol in the past 90 days. Mediated analyses showed that drug use, exchange of sex for money/drugs, unwanted sex, and to a lesser extent, problems with alcohol mediated the relationship between USC and unprotected sex acts, number of partners, and sex under the influence of drugs and alcohol. These findings suggest that participation in non-sexual risky behaviors among women who report USC may be a bridge to participation in sexual behaviors that increase their risk of HIV infection.     

Increasing IUD and Implant Use Among Those at Risk of a Subsequent Preterm Birth: A Randomized Controlled Trial of Postpartum Contraceptive Counseling

Objective

To assess the impact of contraceptive counseling on the uptake of long-acting reversible contraception (LARC), namely, intrauterine devices and the contraceptive implant, by 3 months postpartum among women with a recent preterm birth.

Detection of Depression with Different Interpreting Methods Among Chinese and Latino Primary Care Patients: A Randomized Controlled Trial

Language barriers may contribute to the under-detection of depression in Latinos and Asians. A total of 782 English, Spanish, and Chinese-speaking primary care patients were enrolled in a randomized controlled trial. Language discordant patients were randomized to Remote Simultaneous Medical Interpreting (RSMI) or usual and customary (U&C) interpreting. The Beck Depression Inventory-Fast Screen (BDI-FS) was administered. Patients were tracked for 1 year. A total of 462 patients completed the BDI-FS. Thirty-three percent had a positive (≥4) screen. Twenty-seven percent of BDI-FS positive patients were diagnosed with depression. Among BDI-FS positive patients, Chinese-speakers were less likely to be diagnosed compared with English speakers (31% vs. 10%, P < 0.05). There was a trend towards greater diagnosis with RSMI (27% detection with RSMI vs. 20% U&C, P = 0.41). The diagnosis of depression among BDI-FS positive patients in our population was low, particularly among Chinese-speakers. RSMI could be an important part of a multi-faceted approach to improving the detection of depression.     

The Relationship Between Neonatal Surgery,Postpartum Depression,and Infant Clinical Course

Maternal and Child Health Journal - Postpartum depression (PPD) affects 10–15% of mothers in the general population, and studies show increased incidence for mothers of infants with serious...     

The Effect of a Behavioral Weight-Loss Intervention on Depressive Symptoms Among Latino Immigrants in a Randomized Controlled Trial

Evidence of whether behavioral weight-loss interventions reduce depressive symptoms among Latino immigrants is limited. The effect of a behavioral weight-loss intervention on depressive symptoms was assessed using data from a clinical trial among Latino immigrants. Participants were randomized to a usual care (UC) control (n?=?41), case management (CM) alone (n?=?84), or CM with community health worker support (CM+CHW) (n?=?82). Generalized estimating equation models were used to compare the impact of each intervention with UC. Effect modification by poverty level was further investigated. Overall, treatment groups were not significantly associated with 24-month changes in CES-D scores. Among participants below the 100% federal poverty level (FPL), those randomized to CM+CHW had 24-month CES-D scores significantly lower (Β coefficient?=?0.72; 95% CI 0.55–0.93) than those in UC (p?=?0.01). A behavioral weight-loss intervention providing case management and support from a CHW reduced depressive symptoms among Latino immigrants below the 100% FPL.     

医科大学新生抑郁与自我和谐关系分析

目的 研究医科大学新生抑郁情绪状况及其与自我和谐的关系,为医科大学新生的心理健康教育提供参考.方法 选取某医科大学选修<心理健康教育>课程并自愿参加研究的本科一年级学生821名,其中男生284名,女生537名,采用自我和谐量表(SCCS)和抑郁自评量表(SDS)进行测试.结果 医科大学新生抑郁症状检出率为33.4%;不同抑郁水平学生的自我与经验不和谐及自我灵活性水平差异有统计学意义(P值均<0.05);自我和谐中自我与经验不和谐、自我灵活性影响个体的抑郁水平.结论 不和谐的自我可能会引发个体的抑郁情绪.     

The Correlation Between Postpartum Depression and Health Status

To investigate a purported correlation between postpartum depression and self-rated maternal general health status in a sample of mothers in Southern Brazil. As part of this process, the Personal Health Scale (PHS), a self-rated health status measure, was tested for the first time among postpartum women. Research volunteers completed the Structured Clinical Interview for DSM-IV Disorders (SCID), the 12-item General Health Questionnaire (GHQ), the PHS, the Postpartum Depression Screening Scale (PDSS), and the Edinburgh Postnatal Depression Scale (EPDS). Correlation coefficients were computed among the scores of the health status questionnaires and the postnatal depression scales. Bivariate linear regression analyses were conducted to evaluate the prediction of scores of postnatal depression scales having the scores of health status questionnaires as predictors. Significant correlations among both health status questionnaires and both postnatal screening tools attest to a significant interconnection between the expression of depressive symptoms and maternal health status in the postpartum period. The health status measures predicted the scores of postpartum depression scales. This study demonstrates that both general health questionnaires and postpartum depressive rating scales are useful tools for detecting depressive phenomena in postpartum women. The association between self-rated health measures and postpartum depression may be even more significant in the context of socioeconomic deprivation.