Assessment and Promotion of Partner Support: A Prevention-Focused Intervention for Perinatal Depression in Primary Care

Perinatal depression significantly impacts the mother, her partner, the unborn fetus, and the infant/child after delivery. A review of the literature supports the need for preventive intervention methods as research has shown that even with successful treatment, disruptions in attachment, temperament, and cognitive development often remain. Primary care settings are ideal targets for prevention given that they can reach a number of people at low-cost without the stigma associated with seeking help in a mental health facility. This paper purposes a preventive intervention method for perinatal depression that can be implemented in primary care settings in both Western and non-Western countries. The intervention targets two of the primary risk factors for perinatal depression; partner support and relationship quality. The intervention is structured around key target periods in gestational development and during the early weeks after delivery. Suggestions for each target visit are based on prior research that has demonstrated how psychoeducation about the transition to parenthood, as well as increased communication, can positively affect partner support and relationship quality. The ultimate goal of the intervention is not only to prevent perinatal depression but also to improve the mental health and wellbeing of the entire family system.

Developing and Validating a Perinatal Depression Screening Tool in Bungoma County, Kenya

Background: Depression-screening tools exist and are widely used in Western settings. There have been few studies done to explore whether or not existing tools are valid and effective to use in sub-Saharan Africa. Our study aimed to develop and validate a perinatal depression-screening tool in rural Kenya.

Methods: We utilized conducted free listing and card sorting exercises with a purposive sample of 12 women and 38 CHVs living in a rural community to explore the manifestations of perinatal depression in that setting. We used the information obtained to produce a locally relevant depression-screening tool that comprised of existing Western psychiatric concepts and locally derived items. Subsequently, we administered the novel depression-screening tool and two existing screening tools (the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9) to 193 women and compared the results of the screening tool with that of a gold standard structured clinical interview to determine validity.

Results: The free listing and card sorting exercise produced a set of 60 screening items. Of the items in this set, we identified the 10 items that most accurately classified cases and non-cases. This 10-item scale had a sensitivity of 100.0 and specificity of 81.2. This compared to 90.0, 31.5 and 90.0, 49.7 for the EPDS and the PHQ-9, respectively. Overall, we found a prevalence of depression of 5.2 percent.

Conclusions: The new scale does very well in terms of diagnostic validity, having the highest scores in this domain compared to the EPDS, EPDS-R and PHQ-9. The adapted scale does very well with regards to convergent validity-illustrating clear distinction between mean scores across the different categories. It does well with regards to discriminant validity, internal consistency reliability, and test-retest reliability- not securing top scores in those domains but still yielding satisfactory results.

Early biomarkers to predict grade of encephalopathy following hypoxic ischaemic injury

The standard early markers for identifying and grading HIE severity, are not sufficient to ensure all children who would benefit from treatment are identified in a timely fashion. The aim of this thesis was to explore potential early biomarkers of HIE. Methods: To achieve this a cohort of infants with perinatal depression was prospectively recruited. All infants had cord blood samples drawn and biobanked, and were assessed with standardised neurological examination, and early continuous multi-channel EEG. Cord samples from a control cohort of healthy infants were used for comparison. Biomarkers studied included; multiple inflammatory proteins using multiplex assay; the metabolomics profile using LC/MS; and the miRNA profile using microarray. Results: Eighty five infants with perinatal depression were recruited. Analysis of inflammatory proteins consisted of exploratory analysis of 37 analytes conducted in a sub-population, followed by validation of all significantly altered analytes in the remaining population. IL-6 and IL-6 differed significantly in infants with a moderate/severely abnormal vs. a normal-mildly abnormal EEG in both cohorts (Exploratory: p=0.016, p=0.005: Validation: p=0.024, p=0.039; respectively). Metabolomic analysis demonstrated a perturbation in 29 metabolites. A Cross- validated Partial Least Square Discriminant Analysis model was developed, which accurately predicted HIE with an AUC of 0.92 (95% CI: 0.84-0.97). Analysis of the miRNA profile found 70 miRNA significantly altered between moderate/severely encephalopathic infants and controls. miRNA target prediction databases identified potential targets for the altered miRNA in pathways involved in cellular metabolism, cell cycle and apoptosis, cell signaling, and the inflammatory cascade. Conclusion: This thesis has demonstrated that the recruitment of a large cohortof asphyxiated infants, with cord blood carefully biobanked, and detailed early neurophysiological and clinical assessment recorded, is feasible. Additionally the results described, provide potential alternate and novel blood based biomarkers for the identification and assessment of HIE.

Stress parental et lien mère-enfant: impact sur le développement de l’enfant âgé d’un an.

Au cours de la grossesse et dans les premières années de vie de l’enfant, plusieurs facteurs externes, tels que le stress maternel ou le lien maternel, peuvent interférer avec son développement et avoir des conséquences à court et à long terme. Bien que le stress maternel périnatal ait souvent été étudié, plusieurs facteurs pré et postnataux potentiellement confondants (comme le stress paternel, la dépression, la prise d’antidépresseurs, etc.) n’ont pas systématiquement été pris en compte. Comparativement à l’attachement de l’enfant (à sa mère), moins de recherches se sont intéressées au lien maternel, en particulier chez des femmes ayant un diagnostic de dépression et/ou d’anxiété et exposées à des antidépresseurs. Notre thèse visait donc à étudier ces deux facteurs et leur association avec le développement du jeune enfant âgé d’un an, dans un contexte où la santé mentale maternelle (présence ou non de troubles psychologiques) et de traitements pharmacologiques associés étaient aussi considérés. Afin d’améliorer le dépistage de retards développementaux, nous avons également évalué l’administration au téléphone de deux instruments de pré-dépistage et dépistage actuellement utilisés. Notre thèse était constituée de quatre phases dont les objectifs étaient: la détermination des propriétés psychométriques de l’échelle de stress perçu de quatre items (en français et en anglais) au sein de la population de femmes enceintes (première étude); évaluer l’effet du stress maternel prénatal et parental postnatal sur le développement de l’enfant âgé d’un an (deuxième étude); estimer l’association entre le lien maternel et le développement de l’enfant âgé d’un an, en stratifiant sur la prise maternelle d’antidépresseurs (troisième étude); et évaluer l’administration au téléphone du ″Ages and Stages Questionnaire″ (ASQ, version de 12 mois) et du ″Revised Pre-screening Denver Questionnaire″(R-PDQ, version de 9-24 mois),deux questionnaires utilisés pour le pré-dépistage et le dépistage du développement infantile (quatrième étude). Ce projet faisait partie d’une plus grande étude, nommée le projet OTIS (The″Organization of Teratology Information Specialists″ Antidepressant in Pregnancy cohort study), qui visait à évaluer l’impact de l’arrêt versus la continuation de la prise d’antidépresseurs au cours de la grossesse sur les comportements maternels et sur le développement de l’enfant âgé de un à trois ans. Ainsi, entre 2006 et 2010, la cohorte prospective OTIS de femmes enceintes a été construite et suivie jusqu’à trois ans postpartum. À partir de 2008, l’évaluation du stress et du lien maternel (thématiques de ce projet de thèse) a été incorporée au projet initial. Aussi, à partir de là, toute femme nouvellement recrutée pour la cohorte OTIS pouvait faire partie des études de cette thèse. Notre population source était composée des femmes enceintes ayant eu recours à un service nord-américain d’information sur les tératogènes ou ayant été suivies à la clinique d'obstétrique et de gynécologie du CHU Ste Justine. Pour être admissibles, les femmes devaient 1) être âgées d’au moins 18 ans, 2) être enceinte d’au maximum 14 semaines (le début de la grossesse étant défini comme étant le premier jour des dernières règles); 3) être exposées à un antidépresseur depuis au moins le premier jour de grossesse (pour le groupe exposé à un antidépresseur), 4) savoir lire et comprendre l’anglais ou le français. Pour les études deux, trois et quatre, les femmes devaient habiter dans un rayon de 250 km autour de Montréal pour recevoir notre visite à domicile, nécessaire à l’évaluation psychométrique du développement infantile. Les pères des enfants ont été recrutés à deux mois postpartum pour évaluer leur stress. Les données ont été collectées par entrevue téléphonique, auto-administration de questionnaires, et évaluation psychométrique du développement infantile. Dans le cadre de cette thèse, les femmes étaient suivies depuis le premier trimestre de grossesse jusqu’à un an postpartum. Les résultats de nos travaux démontrent que le recours à l’échelle de stress perçu de quatre items est une mesure fiable et valide pour mesurer le stress au cours de la grossesse (en recherche ou en clinique). Ensuite, le stress postnatal maternel et paternel serait défavorable au développement moteur et socio-émotionnel de l’enfant d’un an, respectivement. Par contre le stress maternel prénatal favoriserait le développement moteur. Un lien maternel optimal est associé à un meilleur développement socio-émotionnel à un an chez l’enfant, en particulier pour les femmes exposées à des antidépresseurs. Enfin, l’administration au téléphone de l’ASQ et des sous-échelles de langage, de motricité fine et motricité globale du R-PDQ serait une alternative possible au mode auto-administré pour dépister et pré-dépister les retards de développement chez les enfants.

Prevalence of depressive symptoms among Hispanic women attending a public health clinic

Background. Estimates of perinatal depression have ranged from 5% to more than 25% of women (Gavin et al. 2005). Although Hispanics have one of the highest birthrates, few studies have looked at the prevalence of depression among this population. This study aims to describe the prevalence of depressive symptoms among a sample of Hispanic women. Methods. A convenience sample of 439 Hispanic women were screened for depression using the Center for Epidemiologic Studies Depression Scale. Sociodemographic data relating to pregnancy were also collected. Results. Although bivariate analysis found several variables to be significant, multivariate analysis found only marital and pregnancy status to be significant in predicting depression. Conclusions. While marital and pregnancy status proved to the strongest predictors for depression, future research would benefit from collecting information on timing of pregnancy and postpartum to further explore the role of pregnancy status and depressive symptoms. ^

Perinatal and early life factors associated with symptoms of depression in Brazilian children

Background: Few studies have been conducted on the association between perinatal and early life factors with childhood depression and results are conflicting. Our aim was to estimate the prevalence and perinatal and early life factors associated with symptoms of depression in children aged 7 to 11 years from two Brazilian birth cohorts. Methods: The study was conducted on 1444 children whose data were collected at birth and at school age, in 1994 and 2004/2005 in Ribeirao Preto, where they were aged 10-11 years and in 1997/98 and 2005/06 in Sao Luis, where children were aged 7-9 years. Depressive symptoms were investigated with the Child Depression Inventory (CDI), categorized as yes (score >= 20) and no (score < 20). Adjusted and non-adjusted prevalence ratios (PR) were estimated by Poisson regression with robust estimation of the standard errors. Results: The prevalence of depressive symptoms was 3.9% (95% CI = 2.5-5.4) in Ribeirao Preto and 13.7% (95% CI = 11.0-16.4) in Sao Luis. In the adjusted analysis, in Ribeirao Preto, low birth weight (PR = 3.98; 95% CI = 1.72-9.23), skilled and semi-skilled manual occupation (PR = 5.30; 95% CI = 1.14-24.76) and unskilled manual occupation and unemployment (PR = 6.65; 95% CI = 1.16-38.03) of the household head were risk factors for depressive symptoms. In Sao Luis, maternal schooling of 0-4 years (PR = 2.39; 95% CI = 1.31-4.34) and of 5 to 8 years (PR = 1.80; 95% CI = 1.08-3.01), and paternal age < 20 years (PR = 1.92; 95% CI = 1.02-3.61), were independent risk factors for depressive symptoms. Conclusions: The prevalence of depressive symptoms was much higher in the less developed city, Sao Luis, than in the more developed city, Ribeirao Preto, and than those reported in several international studies. Low socioeconomic level was associated with depressive symptoms in both cohorts. Low paternal age was a risk factor for depressive symptoms in the less developed city, Sao Luis, whereas low birth weight was a risk factor for depressive symptoms in the more developed city, Ribeirao Preto.

Changes in depression during and following pregnancy

Rates of depression were studied in a sample of over 9000 women who were participants in the Avon Longitudinal Study of Pregnancy and Childhood. Assessments of depression were made at 18 and 32 weeks gestation, and at 8 and 32 weeks postpartum. Changes in depressive status across time were modelled using latent Markov modelling methods. This analysis showed that when classification errors were taken into account there was relatively high stability in diagnostic status during pregnancy and after pregnancy. However, the transition from late pregnancy to the early postnatal period showed evidence of increased instability and remission of depression. The net effects of this were that rates of depression tended to decline following childbirth. The implications of these results for a series of issues including measurement errors in depression reports and the prevalence of depression before and after childbirth are discussed.

Asfixia perinatal y proteína S100B

La asfixia perinatal es la principal causa de muerte en la primera semana de vida la nivel mundial, los niños que sufren esta complicación y sobreviven pueden presentar trastornos neurológicos de diferente nivel de compromiso que inciden en su desarrollo personal y social. Las cifras de muerte por este problema de salud han disminuido de manera importante, sin embargo en el reporte de la Organización Mundial de Salud (OPS) del 2010, la asfixia perinatal es causa del 29% de muertes infantiles en los países de América Latina y el Caribe 2. Es necesario conocer además la extensión del daño neurológico que sufren estos niños, con este fin se desarrolló un estudio piloto en el Hospital Universitario Mayor Mederi de Bogotá, en el cual se determinó la concentración de un marcador metabólico de daño cerebral, la proteína S100B en suero de 60 recién nacidos sanos, con el objetivo de analizar la asociación del mismo con el peso al nacer, la edad gestacional y el diagnóstico. Los resultados no mostraron diferencias significativas entre este marcador y las variables analizadas que puede asociarse al pequeño número de pacientes, sin embargo han sentado las bases para el desarrollo de un estudio que incluya varios hospitales de Bogotá y sobre todo la determinación del mismo en recién nacidos con diagnóstico de hipoxia en el período perinatal, lo cual aportará información del grado de la alteración que puedan tener a nivel cerebral y contribuya al mejor manejo evolutivo con la aplicación de medidas de intervención en estadios tempranos de la vida.

Reducing the global burden of depression : population level analysis of intervention cost-effectiveness in 14 world regions

International evidence on the cost and effects of interventions for reducing the global burden of depression remain scarce. Aims: To estimate the population-level cost-effectiveness of evidence-based depression interventions and their contribution towards reducing current burden. Method: Primary-care-based depression interventions were modelled at the level of whole populations in 14 epidemiological subregions of the world. Total population-level costs (in international dollars or I$) and effectiveness (disability adjusted life years (DALYs) averted) were combined to form average and incremental cost-effectiveness ratios. Results: Evaluated interventions have the potential to reduce the current burden of depression by 10–30%. Pharmacotherapy with older antidepressant drugs, with or without proactive collaborative care, are currently more cost-effective strategies than those using newer antidepressants, particularly in lower-income subregions. Conclusions: Even in resource-poor regions, each DALYaverted by efficient depression treatments in primary care costs less than 1 year of average per capita income, making such interventions a cost-effective use of health resources. However, current levels of burden can only be reduced significantlyif there is a substantialincrease substantial increase intreatment coverage.

The impact of perceived stage of cancer on carers’ anxiety and depression during the patients’ final year of life

Objective: This paper explores the effects of perceived stage of cancer (PSOC) on carers' anxiety and depression during the patients' final year. Methods: A consecutive sample of patients and carers (N=98) were surveyed at regular intervals regarding PSOC, and anxiety and depression using the Hospital Anxiety and Depression Scale. Means were compared by gender using the Mann-Whitney U-test. The chi-square was used to analyse categorical data. Agreement between carers' and patients' PSOC was estimated using kappa statistics. Correlations between carers' PSOC and their anxiety and depression were calculated using the Spearman's rank correlation. Results: Over time, an increasing proportion of carers reported that the cancer was advanced, culminating at 43% near death. Agreement regarding PSOC was fair (kappa=0.29-0.34) until near death (kappa=0.21). Carers' anxiety increased over the year; depression increased in the final 6 months. Females were more anxious (p=0.049, 6 months; p=0.009, 3 months) than males, and more depressed until 1 month to death. The proportion of carers reporting moderate-severe anxiety almost doubled over the year to 27%, with more females in this category at 6 months (p=0.05). Carers with moderate-severe depression increased from 6 to 15% over the year. Increased PSOC was weakly correlated with increased anxiety and depression. Conclusions: Carers' anxiety exceeded depression in severity during advanced cancer. Females generally experienced greater anxiety and depression. Carers were more realistic than patients regarding the ultimate outcome, which was reflected in their declining mental health, particularly near the end.

Self-talk in upper primary school children : its relationship with irrational beliefs, self-esteem and depression

Self-talk, irrational beliefs, self-esteem and depression were measured in a sample of 105 elementary school children in Grades 4 to 7. Sex and grade differences in positive self-talk were found. The pattern of correlation coefficients for positive self-talk supported the substantive position that positive self-talk is positively related to self-esteem and negatively related to irrational beliefs and depression in a non-clinical sample of children. However, the same support was not forthcoming for the reverse relationships for negative self-talk. Therapeutic implications are outlined as are suggestions for future research in the area of children's self-talk.

The Children's Depression Scale : assessment of factor structure with data from a normal population

A study investigated the reliability and construct validity of the Children's Depression Scale. The revised subscales were shown to have strong construct and face validity and high reliability.