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Friday, February 01, 2013

Preventing Post-Partum Depression in Adolescent Mothers

Post-partum depression (PPD) is a type of depressive disorder that occurs in a parent after childbirth, although it usually occurs in the mother. It is a fairly common problem, with prevalence rates estimated to be as high as 25%.

Signs and symptoms include but are not limited to frequent crying, sadness, irritability, anxiety, social avoidance, tiredness, sleep disturbance, appetite changes, disinterest in the infant, and fear of being left alone with the infant.

PPD onset occurs within 4 weeks after childbirth but usually begins about two weeks after childbirth. The depression typically lasts between several months and 12 months.The cause of PPD is not well understood, although several possible causes in mothers include hormonal changes, vitamin deficiency, lifestyle changes, or a response to inadequate social support. However, there are contradictory studies supporting and refuting some of these hypotheses.

There are numerous treatments available for PPD which include medication, psychological counseling (individual and/or group), dietary changes, and behavioral changes (e.g., improved sleep routine). However, the ideal situation is to prevent PPD from occurring in the first place. Presently, methods of preventing PPD include educating pregnant women about the risks of PPD, proper exercise, and a nutritious diet.

In an upcoming study published in the American Journal of Obstetrics & Gynecology, researchers in Rhode Island reported on the results of a randomized controlled trial to study the effectiveness of a psychological intervention to prevent postpartum depression in adolescent mothers (13 to 17 years old at time of conception) who were pregnant for the first time.

There were 106 mothers in the study. Subjects were not included if they had prior treatment for a mental health disorder or current evidence of an emotional disorder, substance abuse, or psychosis (disengagement from reality). In terms of race, 53% of mothers were Hispanic, 17% were black, and 16% were white.

Of the 106 mothers, 54 were randomly assigned to a new intervention program and 52 (the control group) were assigned to a standard educational program. The new intervention program was known as REACH (Relaxation, Encouragement, Appreciation, Communication, and Helpfulness) and is specifically geared towards adolescents.

REACH is based in a type of therapy known as interpersonal therapy. As such, the program teaches communication strategies to better manage conflicts before and after delivery, how to manage stress, education about motherhood and depression, how to develop a healthy social support system and relationships, how to set realistic goals, and educating the mother about psychosocial resources. All mothers (in the REACH group) and the control group, were provided with the book Baby Basics: Your Month By Month Guide to a Healthy Pregnancy. However, the control group was not provided with access to the material from the REACH program.

The programs took place before delivery of the infant. Each program took place once a week for five weeks with the session length being 30 to 60 minutes. The mothers were monitored at 6 weeks, 3 months, and 6 months after delivery to monitor for depression. The overall results showed that mothers receiving the REACH intervention had half the rate of depression (12.5%) than mothers receiving the non-REACH control program (25%), supporting the usefulness of the REACH intervention.

Suggested reading: Postpartum Depression For Dummies

Related blog entries: Anti-depressants in Pregnancy: What are the Risks?

Reference: Phipps MG, Raker CA, Ware CF, Zlotnick C. (2013, in press). Randomized controlled trial to prevent postpartum depression in adolescent mothers. Am J Obstet Gynecol.

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