The Centers for Disease Control and Prevention (CDC) refers to Postpartum Depression as depression that occurs after giving birth.
Read the lit review provided below and provide a Conclusion with the following:
a summary of what was learned in this Literature Review (i.e., major take-aways).
Discuss gaps in the literature as well as areas of future study that are needed/recommended. Many studies end by suggesting what future studies should focus on
LIT REVIEW:
Introduction
The Centers for Disease Control and Prevention (CDC) refers to Postpartum Depression as depression that occurs after giving birth. They highlight that “Postpartum depression is different from the baby blues” which are characterized by feelings of worry, sadness, and exhaustion. (2022) Postpartum Depression (PPD), on the other hand, is more severe and lasts for a longer period. The condition affects one out of every eight women and makes it more difficult for mothers to form attachments to their newborns (CDC, 2022). PPD symptoms can include anger, anxiety, guilt, hopelessness, irritability, fatigue, restlessness, fear, crying, mood swings, panic attacks, and insomnia. It is important to examine which interventions are most effective for treating postpartum depression in women, as a new CDC study found that “the rate of depression diagnoses at delivery” is increasing and was seven times higher in 2015 than it was in 2000 (2022). This review of literature includes eight articles that focus on effective treatments for postpartum depression, such as psychological-based interventions, medication-based interventions, and exercise-based interventions.
Psychological Based Interventions
Previous research has shown that psychological interventions can help to promote problem-solving, coping skills, role transitions, and interpersonal skills, addressing the need for support systems, fostering a sense of personal agency, and reframing cognitive distortions (Thomas, 2018)
Mindfulness-based cognitive therapy (MBCT) is a customized form of cognitive therapy that includes awareness practices, meditation, and breathing exercises (Shulman, 2018). Shulman, Dueck, and colleagues (2018) conducted a study to determine whether mindfulness-based cognitive therapy could be used to treat postpartum depression and anxiety. The study had 36 participants, but only 30 completed it (Shulman, 2018). A random drawing was used to determine which group the participants would be assigned to (either the intervention group or the control group). The intervention group met once a week for 2.5 hours of MBCT for eight weeks, while the control group received no intervention. Postpartum symptoms were assessed using the Patient Health Questionnaire-9 the Generalized Anxiety Disorder-7 questionnaire, and the Mindful Attention Awareness Scale (Shulman, 2018). At four and eight weeks, the intervention group had significantly lower levels of depression and anxiety than the control group (Shulman, 2018). The study’s findings suggest that MBCT delivered in a group setting is an effective intervention for postpartum depression. However, there were a few limitations in this study. Given the small sample size, it is difficult to generalize these findings. Furthermore, the study did not look at the long-term effects to see if the gains made by participants were maintained.
Mother-infant psychotherapy (MIP) is a form of therapy in which both the mother and child are treated to strengthen their bond and promote attachment (Huang, 2020). Huang, Yang, Lei, and colleagues (2020) conducted a systematic review and meta-analysis to examine the efficiency of Mother-Infant Psychotherapy in treating Postpartum depression. The team conducted an extensive literature search, and the final analysis included data from 11 different studies that were carried out in a variety of countries, with sample sizes ranging from 24 to 536 participants (Huang, 2020). The studies were all randomized controlled trials that looked at the effectiveness of MIP in the treatment of PPD. The Hamilton Depression Rating Scale (HDRS) was used as the primary outcome measure to determine the severity of PPD symptoms. The HDRS had a pooled effect size of -1.17 at 6-8 weeks and a pooled effect size of -1.48 at 12-16 weeks (Huang, 2020). These findings suggest that MIP is effective in reducing PPD symptoms in both the short and long term, and it should be considered as a treatment option for women suffering from this condition
Interpersonal psychotherapy (IPT) is a brief form of attachment-centered psychotherapy that focuses on interpersonal conflict resolution. (Denis, 2020) Dennis, Grigoriadis, and colleagues (2020) carried out a randomized controlled trial to determine the efficacy of telephone-based nurse-delivered interpersonal psychotherapy on the symptoms of postpartum depression. The sample for their study consisted of 241 women who had been diagnosed with postpartum depression (Denis, 2020) The participants were randomly assigned to one of two groups: the first group received IPT, while the second group received standard care. For a period of 12 weeks, the treatment group received weekly 60-minute telephone-based ITP sessions. The primary instrument used to collect data on the outcomes of PPD symptoms was the Hamilton Rating Scale for Depression (Denis, 2020) When it came to alleviating the symptoms of postpartum depression, it looked like interpersonal psychotherapy delivered over the phone by a nurse was more effective than standard care. At 12 weeks, 10.6% of the women in the IPT group and 35% of the women in the control group were still depressed (Dennis, 2020). This study’s findings suggest that ITP delivered over the phone by a nurse can be an effective treatment for postpartum depression. Having said that, this study had some limitations: It did not investigate the intervention’s long-term effects and the sample size was small (Dennis, 2020).
Cognitive behavior therapy (CBT) is a form of therapy that focuses on recognizing and changing negative thought patterns (Nazanin, 2020). Nazanin, Shahrzad, and Ahmadian (2020) conducted a randomized controlled trial to assess the efficacy of treating postpartum depression with a cognitive behavioral therapy program delivered through a mobile application (2020) A total of one hundred female participants were randomly assigned to either a group that would participate in app-based CBT or a control group that would receive standard care. The Edinburgh Postnatal Depression Scale was used to analyze the data (Nazanin, 2020). The group that used the app-based CBT had a significantly lower EPDS score than the control group after 8 weeks. CBT participants had significantly lower levels of depression and anxiety. On measures of postpartum bonding, social support, and sleep quality, there were no statistically significant differences between the groups (Nazanin, 2020) The findings of this study suggest that app-based CBT treatment is effective in reducing symptoms of postpartum depression. However, the study has some limitations. First, extrapolating the results to the general population may be difficult because of the small sample size. Second, we do not know how long these improvements will last because the study did not investigate the long-term effects of the CBT program. More research is needed to back up these findings and assess the program’s impact over a longer time frame (Nazanin, 2020).
Exercise-based interventions
Several studies have found that physical activity is an effective intervention for treating postpartum depression. Exercise elevates endorphin levels, which elevates mood. Regular exercise can also help with stress and sleep disruptions, both of which have been linked to symptoms of postpartum depression in women (Carter, 2019).
Koomaska-Bogucka and colleagues (2019) performed a systematic review of the research literature on physical activity and postpartum depression. The authors used databases such as PubMed, Web of Science, and Scopus to conduct a thorough search of the literature, and their final analysis included data from 21 eligible studies (Koomaska-Bogucka, 2019). Most of the studies were carried out in high-income countries, with sample sizes ranging from 34 to 2,638 participants (Koomaska-Bogucka, 2019). The authors were unable to conduct a meta-analysis of their combined results because the studies included in the review had a wide range of methodological qualities, each utilizing different forms of physical activity and postpartum depression measures. (Koomaska-Bogucka, 2019). On the other hand, the greater part of the studies included in the review found a link between physical activity and postpartum depression treatment outcomes. (Koomaska-Bogucka, 2019). Despite these limitations, this systematic review highlights a large body of prior research on physical activity that suggests it can be an effective intervention for treating postpartum depression. While not all the studies included were of particularly high quality, this systematic review highlights a large body of prior research on physical activity that suggests it can be an effective intervention for treating postpartum depression.
Carter, Bastounis, and colleagues (2019) conducted a meta-analysis and systematic review to determine the efficacy of exercise-based interventions in preventing or treating postpartum depression. They reviewed all previously published randomized controlled trials up to August 2018. The findings of the studies were meta-analyzed, and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system was used to calculate effect sizes with confidence intervals (Carter, 2019) The final analysis included 15 studies with a total of 2,446 participants (Carter, 2019). Their research found that exercise-based interventions had a significant effect size in both reducing postpartum depression symptoms and preventing postpartum depression. It should be noted that this study has some limitations. To begin, all the studies included were conducted in Western countries, making it difficult to determine whether the findings apply to other populations. Second, because most of the included studies were of moderate to high quality, the results may favor exercise-based therapies. The long-term effects of exercise on postpartum depression are unknown because the included studies only looked at the effects of exercise during that period.
Medication-Based Interventions
Selective serotonin reuptake inhibitors are the most widely used medications in the pharmacologic treatment of postpartum depression. They are generally safer than other types of antidepressants, can alleviate the symptoms of moderate to severe depression, and have fewer side effects (De Crescenzo, 2013).
De Crescenzo, Perelli, Armando, and Vicari (2013) conducted a systemic review to explore the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of postpartum depression. The authors looked for randomized clinical trials in multiple databases. The final analysis included 11 studies and 1,206 participants (De Crescenzo, 2013). Despite significant differences in methodological approach and outcome measures, the studies were of high quality. The mean difference in the pooled estimate of the effect of SSRIs on depression scores was -2.39 (De Crescenzo, 2013). All the studies came to the same conclusion: SSRIs help alleviate PPD symptoms. The heterogeneity of the studies included in the analysis and the lack of long-term follow-up data are two of the study’s limitations. However, the overall quality of the evidence is high, and the findings of this review can be applied to other populations of women with PPD.
Hantsoo et al. (2014) conducted a study to test the efficacy of treating postpartum depression with Sertraline. The sample size included 36 women diagnosed with PPD who were randomly assigned to either the treatment group (n=17) or the control group (n=19). The treatment group received sertraline for 6 weeks, while the control group received a placebo (Hantsoo, 2014). The Hamilton Depression Rating Scale (HDRS) and Clinical Global Impressions (CGI) were used as primary outcome measures. The results indicate that Sertraline was found to be more effective than a placebo in treating postpartum depression in the study (Hantsoo, 2014). The sertraline treatment group improved at a rate of 59%, which was significantly higher than the control group’s 26% improvement rate (Hantsoo, 2014). However, the study had some limitations, such as a small sample size and no assessment of whether the two groups had any negative outcomes. Nonetheless, the findings of this study suggest that sertraline may be effective as a treatment for postpartum depression.
References
B. Shulman, R. Dueck, D. Ryan, G. Breau, I. Sadowski, S. Misri, Feasibility of a mindfulness-based cognitive therapy group intervention as an adjunctive treatment for postpartum depression and anxiety, Journal of Affective Disorders, Volume 235, 2018,Pages 61-67,ISSN 0165-0327, https://doi.org/10.1016/j.jad.2017.12.065
Carter T, Bastounis A, Guo B, Jane MC. The effectiveness of exercise-based interventions for preventing or treating postpartum depression: a systematic review and meta-analysis. Archiv Women Mental Health. 2019;22(1):37-53. DOI: 10.1007/s00737-018-0869-3
CDC. (2019). Depression Among Women. Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/depression/index.htm
Chow, R., Huang, E., Li, A., Li, S., Fu, S. Y., Son, J. S., & Foster, W. G. (2021). Appraisal of systematic reviews on interventions for postpartum depression: systematic review. BMC pregnancy and childbirth, 21(1), 18. https://doi.org/10.1186/s12884-020-03496-5
DeCrescenzoac, Perelli, Armando, & Vicari. (2013, October 4). Selective serotonin reuptake inhibitors (SSRIs) for post-partum depression (PPD): A systematic review of randomized clinical trials. Selective Serotonin Reuptake Inhibitors (SSRIs) for Postpartum Depression: A Systematic Review of Randomized Clinical Trials. Retrieved November 25, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S0165032713006939
Dennis, C., Grigoriadis, S., Zupancic, J., Kiss, A., & Ravitz, P. (2020). Telephone-based nurse-delivered interpersonal psychotherapy for postpartum depression: Nationwide randomized controlled trial. The British Journal of Psychiatry, 216(4), 189-196. doi:10.1192/bjp.2019.275
Hantsoo, L., Ward-O’Brien, D., Czarkowski, K. A., Gueorguieva, R., Price, L. H., & Epperson, C. N. (2014). A randomized, placebo-controlled, double-blind trial of sertraline for postpartum depression. Psychopharmacology, 231(5), 939-948. https://doi.org/10.1007/s00213-013-3316-1
J. Nazanin S. Mazhari, L Ahmadian, M Mirzaee, Effectiveness of an app-based cognitive behavioral therapy program for postpartum depression in primary care: A randomized controlled trial, International Journal of Medical Informatics, Volume 141, 2020, 104145, ISSN 1386-5056, https://doi.org/10.1016/j.ijmedinf.2020.104145.
Kappel, J. Webb, L. & Wilson, M. (2019). Does exercise improve postpartum depression symptoms?. Evidence-Based Practice, 22 (4), 13-13. doi: 10.1097/EBP.0000000000000211.
Kołomańska-Bogucka, D., & Mazur-Bialy, A. I. (2019). Physical Activity and the Occurrence of Postnatal Depression-A Systematic Review. Medicina (Kaunas, Lithuania), 55(9), 560. https://doi.org/10.3390/medicina55090560
R. Huang, D. Yang, B. Lei, C. Yan, Y. Tian, X. Huang, J. Lei, The short- and long-term effectiveness of mother-infant psychotherapy on postpartum depression: A systematic review and meta-analysis, Journal of Affective Disorders, Volume 260, 2020, Pages 670-679, ISSN 0165-0327, https://doi.org/10.1016/j.jad.2019.09.056.
Thomas L, Gandhi S, Parel JT (2018) Interventions for Mothers with Postpartum Depression: A Systematic Review. Int J Depress Anxiety 1:002. doi.org/10.23937/ijda-2017/1710002
Collepals.com Plagiarism Free Papers
Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.
Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.
