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K Dalton - One of the best experts on this subject based on the ideXlab platform.
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Oestrogens and progestogens for preventing and treating Postnatal Depression.
The Cochrane database of systematic reviews, 1999Co-Authors: Theresa A Lawrie, A Herxheimer, K DaltonAbstract:BACKGROUND Postnatal Depression, with a prevalence of at least 10%, is probably the most common complication of the puerperium. A deficiency or imbalance of sex hormones has repeatedly been suggested as a cause. OBJECTIVES The objective of this review was to evaluate the role of oestrogens and progestogens in the prevention and treatment of Postnatal Depression. SEARCH STRATEGY The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. SELECTION CRITERIA All trials were considered in which pregnant or postpartum women (up to 18 months) were randomised to receive postpartum oestrogen or progestogen or placebo for the treatment or prevention of Postnatal Depression. DATA COLLECTION AND ANALYSIS Two published randomised placebo controlled trials were identified for inclusion in the analyses for this review. One study was excluded. MAIN RESULTS Depot norethisterone enanthate given within 48 hours of delivery and lasting 8-12 weeks was associated with significantly higher postpartum Depression scores than placebo. Oestrogen therapy in severely depressed women was associated with a greater improvement in Depression scores than placebo. REVIEWER'S CONCLUSIONS There is no place for synthetic progestogens in the prevention of treatment of Postnatal Depression. Long-acting norethisterone enanthate is associated with an increased risk of Postnatal Depression. It and other long-acting progestogen contraceptives should be used with caution in the Postnatal period, especially in women with a history of Depression. The role of progesterone in the prevention and treatment of Postnatal Depression has yet to be evaluated in a randomised placebo-controlled trial. Oestrogen therapy may be of modest value at a late stage of severe Postnatal Depression. Its role in the prevention of recurrent Postnatal Depression has not been evaluated. Further research on its value is unlikely for ethical reasons.
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Premenstrual syndrome and Postnatal Depression
The International journal of prenatal and perinatal psychology and medicine, 1995Co-Authors: K Dalton, W. HoltonAbstract:In 1855 Marce recognised that as patients with puerperal psychosis improved they tended to have recurrences of symptoms at menstruation. Women, who had previously suffered from Postnatal Depression or psychosis and had received progesterone prophylactic treatment, were questioned six months after the birth. Menstruation had restarted in 129 of whom 71 (53%) already recognised they suffered from premenstrual syndrome. This suggests that women who have suffered Postnatal Depression or psychosis should remain under observation for at least six months after menstruation has returned, and if necessary receive treatment for premenstrual syndrome.
F Holsten - One of the best experts on this subject based on the ideXlab platform.
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screening for Postnatal Depression validation of the norwegian version of the edinburgh Postnatal Depression scale and assessment of risk factors for Postnatal Depression
Journal of Affective Disorders, 2003Co-Authors: J Ø Berle, T F Aarre, A Mykletun, A A Dahl, F HolstenAbstract:Abstract Objective: The Edinburgh Postnatal Depression Scale (EPDS) is a self-rating scale developed to screen for Postnatal Depression. The aim of this study was to validate a Norwegian translation of the EPDS, study its psychometric properties, and identify risk factors for Postnatal Depression. Method: EPDS was filled in by 411 women at 6–12 weeks postpartum. Of these, 100 were interviewed using the Mini International Neuropsychiatric Interview for DSM-IV major and minor depressive disorders. Results: When using a cut-off of 11 on the EPDS, 26 of 27 women with major Depression were identified (sensitivity 96%, specificity 78%). An aggregate point prevalence of 10.0% of major and minor Depression was found. A one-factor model accounted for 46.6% of the variance. Strongest risk factors for postpartum Depression were previous Depression, Depression in current pregnancy, and current somatic illness. Limitations: Women screened using the EPDS who had a score above threshold, yet did not attend the diagnostic interview could cause the point prevalence of Depression to be higher than indicated here. Conclusion: The Norwegian translation of EPDS functions equally well as other translations as a screening tool for Postnatal Depression. The risk factors that were found are compatible with other studies.
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Screening for Postnatal Depression. Validation of the Norwegian version of the Edinburgh Postnatal Depression Scale, and assessment of risk factors for Postnatal Depression.
Journal of affective disorders, 2003Co-Authors: J Ø Berle, T F Aarre, A Mykletun, A A Dahl, F HolstenAbstract:The Edinburgh Postnatal Depression Scale (EPDS) is a self-rating scale developed to screen for Postnatal Depression. The aim of this study was to validate a Norwegian translation of the EPDS, study its psychometric properties, and identify risk factors for Postnatal Depression. EPDS was filled in by 411 women at 6-12 weeks postpartum. Of these, 100 were interviewed using the Mini International Neuropsychiatric Interview for DSM-IV major and minor depressive disorders. When using a cut-off of 11 on the EPDS, 26 of 27 women with major Depression were identified (sensitivity 96%, specificity 78%). An aggregate point prevalence of 10.0% of major and minor Depression was found. A one-factor model accounted for 46.6% of the variance. Strongest risk factors for postpartum Depression were previous Depression, Depression in current pregnancy, and current somatic illness. Women screened using the EPDS who had a score above threshold, yet did not attend the diagnostic interview could cause the point prevalence of Depression to be higher than indicated here. The Norwegian translation of EPDS functions equally well as other translations as a screening tool for Postnatal Depression. The risk factors that were found are compatible with other studies.
Theresa A Lawrie - One of the best experts on this subject based on the ideXlab platform.
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Oestrogens and progestogens for preventing and treating Postnatal Depression.
The Cochrane database of systematic reviews, 1999Co-Authors: Theresa A Lawrie, A Herxheimer, K DaltonAbstract:BACKGROUND Postnatal Depression, with a prevalence of at least 10%, is probably the most common complication of the puerperium. A deficiency or imbalance of sex hormones has repeatedly been suggested as a cause. OBJECTIVES The objective of this review was to evaluate the role of oestrogens and progestogens in the prevention and treatment of Postnatal Depression. SEARCH STRATEGY The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. SELECTION CRITERIA All trials were considered in which pregnant or postpartum women (up to 18 months) were randomised to receive postpartum oestrogen or progestogen or placebo for the treatment or prevention of Postnatal Depression. DATA COLLECTION AND ANALYSIS Two published randomised placebo controlled trials were identified for inclusion in the analyses for this review. One study was excluded. MAIN RESULTS Depot norethisterone enanthate given within 48 hours of delivery and lasting 8-12 weeks was associated with significantly higher postpartum Depression scores than placebo. Oestrogen therapy in severely depressed women was associated with a greater improvement in Depression scores than placebo. REVIEWER'S CONCLUSIONS There is no place for synthetic progestogens in the prevention of treatment of Postnatal Depression. Long-acting norethisterone enanthate is associated with an increased risk of Postnatal Depression. It and other long-acting progestogen contraceptives should be used with caution in the Postnatal period, especially in women with a history of Depression. The role of progesterone in the prevention and treatment of Postnatal Depression has yet to be evaluated in a randomised placebo-controlled trial. Oestrogen therapy may be of modest value at a late stage of severe Postnatal Depression. Its role in the prevention of recurrent Postnatal Depression has not been evaluated. Further research on its value is unlikely for ethical reasons.
Joan Webster - One of the best experts on this subject based on the ideXlab platform.
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Prospective testing of the Brisbane Postnatal Depression Index
2006Co-Authors: Joan Webster, Laurie A. Hall, Thierry Somville, Patricia Schneider, Robin Turnbull, Patricia F. SmithAbstract:Background: Over 50 percent of women have one or more risk factors for Postnatal Depression during pregnancy or in the perinatal period but only 10 to 15 percent become clinically depressed. Identifying the women with risks, who will also develop Depression remains elusive and has been the focus of considerable research. The objective of this study was to prospectively test the Brisbane Postnatal Depression Index, to validate a theoretical index which was developed in an earlier study, and to establish whether the Index could be introduced as an administratively simple and clinically useful method for the detection of women who may be at risk for developing Postnatal Depression. Methods: Antenatally, women were asked about social support and about personal and family history of mental illness, including Postnatal Depression. Responses were scored according to pre-defined ratings on the Brisbane Postnatal Depression Index. In the Postnatal wards, 353 women were recruited and their scores for ‘blues’, social support, feelings about the baby, and satisfaction with the birth process were added. Sixteen weeks after hospital discharge, women were asked to complete the Edinburgh Postnatal Depression Scale. The Brisbane Postnatal Depression Index was validated by the number of women scoring >12 on the Edinburgh Postnatal Depression Scale at 16 weeks postpartum who were correctly predicted by a score of > 6 on the Brisbane Postnatal Depression Index. Sensitivity, specificity, positive predictive value and negative predictive value for the Brisbane Postnatal Depression Index using > 6 as a cut off point were calculated. ‘Ease of use’ was assessed informally through discussions with women who completed the questionnaire and with staff responsible for administration and scoring the instrument. Results: Compared with results from the derivation study, prospective testing of the index showed an improvement in sensitivity from 36.3 to 47.5 percent and a small decrease in specificity but there was no improvement on the positive predictive value 39.8 to 39.6 percent. Conclusion: The Brisbane Postnatal Depression Index has been validated in a prospective sample but the sensitivity and specificity of the instrument requires improvement before introduction as a measure of prediction.
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Prospective testing of the Brisbane Postnatal Depression Index.
Birth (Berkeley Calif.), 2006Co-Authors: Joan Webster, Laurie A. Hall, Thierry Somville, Patricia Schneider, Robin Turnbull, Patricia F. SmithAbstract:Abstract: Background: Over 50 percent of women have one or more risk factors for Postnatal Depression during pregnancy or in the perinatal period, but only 10 to 15 percent become clinically depressed. The objective of this study was to prospectively test the Brisbane Postnatal Depression Index (referred to here as Index), to validate a theoretical index that was developed earlier, and to establish whether the index could be introduced as a clinically useful method to detect women who may be at risk for developing Postnatal Depression. Methods: Antenatally, women were asked about social support and about personal and family history of mental illness, including Postnatal Depression. Responses were scored according to predefined ratings on the Index. In the Postnatal wards, 353 women were recruited and their scores for "blues," social support, feelings about the baby, and satisfaction with the birth process were added. Sixteen weeks after hospital discharge, women were asked to complete the Edinburgh Postnatal Depression Scale. The Brisbane Index was validated by the number of women scoring more than 12 on the Edinburgh Postnatal Depression Scale at 16 weeks postpartum who were correctly predicted by a score of more than 6 on the Index. Sensitivity, specificity, positive predictive value, and negative predictive value for the Index, using >6 as a cutoff point, were calculated. "Ease of use" was assessed informally with participants and staff responsible for administration and scoring the instrument. Results: Compared with results from the derivation study, prospective testing of the index showed an improvement in sensitivity from 36.3 to 47.5 percent and a small decrease in specificity, but no improvement on the positive predictive value from 39.8 to 39.6 percent. Conclusion: The Brisbane Postnatal Depression Index was validated in a prospective sample, but its sensitivity and specificity require improvement before introduction as a measure of prediction. (BIRTH 33:1 March 2006)
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IDentify, Educate and Alert (IDEA) trial: an intervention to reduce Postnatal Depression
BJOG : an international journal of obstetrics and gynaecology, 2003Co-Authors: Joan Webster, John W.j. Linnane, Janice A. Roberts, Susan Starrenburg, Janis K. Hinson, Linda M DibleyAbstract:Objective To test the effectiveness of a prenatal intervention in reducing the incidence of Postnatal Depression. Design A randomized controlled trial. Setting A large metropolitan obstetric hospital. Population or sample Pregnant women with risk factors for Postnatal Depression. Methods Women attending their first prenatal visit at the Royal Women's Hospital, Brisbane, were screened for risk factors for Postnatal Depression (IDentify). Positively screened women were randomly allocated to the intervention group or the control group. The intervention consisted of a booklet about Postnatal Depression, which included contact numbers; prenatal screening using the Edinburgh Postnatal Depression Scale; a discussion with the woman about her risk of developing Postnatal Depression (Educate); and a letter to the woman's referring general practitioner and local Child Health Nurse, alerting them of the woman's risk for Postnatal Depression (Alert). Main outcome measure Edinburgh Postnatal Depression Scale Score> 12 at 16 weeks postpartum. Results Of the 509 women who were sent a follow up questionnaire, 371 (72.9%) responded. The proportion of women who reported an Edinburgh Postnatal Depression Scale score of>12 was 26%. There were no significant differences between intervention (46/192, 24%) and control groups (50/177, 28.2%) on this primary outcome measure (OR 0.80; 95% CI 0.50–1.28). Conclusion Over one-quarter of women with risk factors will develop Postnatal Depression. It is a treatable disorder but under-diagnosis is common. Efforts to reduce Postnatal Depression by implementing interventions in the prenatal period have been unsuccessful.
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Improving antenatal recognition of women at risk for Postnatal Depression.
The Australian & New Zealand journal of obstetrics & gynaecology, 2000Co-Authors: Joan Webster, John W.j. Linnane, Linda M Dibley, Margo PritchardAbstract:The purpose of this study was to assess the effectiveness of a practical antenatal screen used at the Royal Women's Hospital, Brisbane, to identify women at risk for Postnatal Depression. It was a prospective, hospital-based, cohort study of 901 women (600 with and 301 without prenatal risk factors for Postnatal Depression). Depression was measured 16 weeks after the birth using the Edinburgh Postnatal Depression Scale. More of the women with a prenatal risk factor for Depression (25.9%)scored above 12 on the Edinburgh Postnatal Depression Scale than those without any risk (10.9%) (p less than or equal to 0.001). Low social support (p less than or equal to 0.001), a personal history of mood disorder (p less than or equal to 0.001) and a past history of Postnatal Depression(p = 0.002) were all strongly associated with Postnatal Depression in this sample. Results indicate that an objective, psychosocial assessment during pregnancy improves recognition of women at risk for Postnatal Depression.
Tony K.h. Chung - One of the best experts on this subject based on the ideXlab platform.
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Postnatal Depression: an update
Best practice & research. Clinical obstetrics & gynaecology, 2006Co-Authors: Dominic T.s. Lee, Tony K.h. ChungAbstract:Apart from causing emotional suffering, Postnatal Depression strains marriage, undermines the mother's confidence, impairs her social functioning and quality of life, and in serious cases contributes to infant abuses, infanticides and suicidal behaviour. Recent studies also show that Postnatal Depression adversely affects emotional, behavioural and cognitive development of the newborn. In addition, there is growing awareness that Depression can occur during pregnancy, and antenatal Depression can adversely affect obstetric and neonatal outcomes. Antenatal depressive symptoms are also the strongest predictor of Postnatal Depression. This paper reviews the epidemiology, clinical presentation, risk factors, prevention and treatment of perinatal Depression. The latest development in research and practice related to this condition are also highlighted.
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Screening for Postnatal Depression: are specific instruments mandatory?
Journal of Affective Disorders, 2001Co-Authors: Dominic T.s. Lee, A S Yip, H F Chiu, Tony Leung, Tony K.h. ChungAbstract:Background: Few studies have examined the utility of rating scales developed in non-puerperal context in detecting Postnatal Depression. This study evaluated the utility of the General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) in screening for Depression among recently delivered women in Hong Kong. Methods: A prospective cohort of 145 Chinese women completed the GHQ, BDI and Edinburgh Postnatal Depression Scale (EPDS) 6 weeks after delivery. They were then assessed using the non-patient version of the Structured Clinical Interview for DSM-III-R (SCID-NP) to establish psychiatric diagnosis, against which the criterion validity of the GHQ and BDI was evaluated against this clinical diagnosis. The psychometric performance of the GHQ, BDI and EPDS in detecting Postnatal Depression was assessed using the receiver operating characteristic (ROC) curves. Results: Both Chinese GHQ and BDI had satisfactory sensitivity and positive predictive value in detecting Postnatal Depression. Their receiver operating characteristic (ROC) curves were comparable to that of the EPDS. Limitation: The study was conducted in Chinese women using translated version of the rating scales. Conclusions: The GHQ and BDI are useful for detecting Postnatal Depression among recently delivered Chinese women. The results of this study suggest that rating scales developed in non-puerperal context may also be applicable for Postnatal Depression.
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Screening for Postnatal Depression: are specific instruments mandatory?
Journal of affective disorders, 2001Co-Authors: Dominic T.s. Lee, A S Yip, H F Chiu, T Y Leung, Tony K.h. ChungAbstract:Few studies have examined the utility of rating scales developed in non-puerperal context in detecting Postnatal Depression. This study evaluated the utility of the General Health Questionnaire (GHQ) and the Beck Depression Inventory (BDI) in screening for Depression among recently delivered women in Hong Kong. A prospective cohort of 145 Chinese women completed the GHQ, BDI and Edinburgh Postnatal Depression Scale (EPDS) 6 weeks after delivery. They were then assessed using the non-patient version of the Structured Clinical Interview for DSM-III-R (SCID-NP) to establish psychiatric diagnosis, against which the criterion validity of the GHQ and BDI was evaluated against this clinical diagnosis. The psychometric performance of the GHQ, BDI and EPDS in detecting Postnatal Depression was assessed using the receiver operating characteristic (ROC) curves. Both Chinese GHQ and BDI had satisfactory sensitivity and positive predictive value in detecting Postnatal Depression. Their receiver operating characteristic (ROC) curves were comparable to that of the EPDS. The study was conducted in Chinese women using translated version of the rating scales. The GHQ and BDI are useful for detecting Postnatal Depression among recently delivered Chinese women. The results of this study suggest that rating scales developed in non-puerperal context may also be applicable for Postnatal Depression.