Leontien M Van Ravesteyn1, Astrid M Kamperman2, Tom A J Schneider3, Monique E Raats4, Eric A P Steegers3, Henning Tiemeier5, Witte J G Hoogendijk6, Mijke P Lambregtse-van den Berg7. 1. Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: l.vanravesteyn@erasmusmc.nl. 2. Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands; Epidemiological and Social Psychiatric Research Institute (ESPRI), Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: l.vanravesteyn@erasmusmc.nl. 3. Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands. 4. PsyQ, Spijkenisse, The Netherlands. 5. Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands. 6. Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands. 7. Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.
Abstract
BACKGROUND:Depressive symptoms in pregnant women, which are common and debilitating, are often co-morbid with other mental disorders (e.g. anxiety and personality disorders), and related to low socioeconomic status (SES). This situation may hamper treatment outcome, which has often been neglected in previous studies on the treatment of depression during pregnancy. We developed a new group-based multicomponent treatment (GMT) comprising cognitive behavioral therapy, psycho-education and body-oriented therapy and compared the effect on depressive symptoms with individual counseling (treatment as usual, TAU) in a heterogeneous group of pregnant women with co-morbid mental disorders and/or low SES. METHODS: An outpatient sample from a university hospital of 158 pregnant women who met DSM-IV criteria for mental disorders were included and 99 participants were randomized to GMT or TAUfrom January 2010 until January 2013. The Edinburgh Depression Scale (EDS) was used at baseline, every 5 weeks during pregnancy and as the primary outcome measure of depressive symptoms at 6 weeks postpartum. Secondary outcome measures included the clinician-reported Hamilton Depression Rating Scale (HDRS), obstetric outcomes and a 'Patient Satisfaction' questionnaire. RESULTS:155 participants were included the intention-to-treat (ITT)-analysis. GMT was not superior above TAU according to estimated EDS (β = 0.13, CI = - 0.46-0.71, p = 0.67) and HDRS scores (β = - 0.39, CI = - 0.82-0.05, p = 0.08) at 6 weeks postpartum. There were no differences in secondary outcomes between the GMT and TAU, nor between the randomized condition and patient-preference condition. LIMITATIONS: The ability to detect an effect of GMT may have been limited by sample size, missing data and the ceiling effect of TAU. CONCLUSIONS:GMT is an acceptable treatment for a heterogeneous group of pregnant women with depressive symptoms and co-morbid mental disorders and/or low SES, but not superior to TAU. Further research should focus on understanding and treating co-morbid disorders and psychosocial problems during pregnancy. CLINICAL TRIALS REGISTRATION: Dutch trial registry, www.trialregister.nl under reference number: NTR3015.
RCT Entities:
BACKGROUND:Depressive symptoms in pregnant women, which are common and debilitating, are often co-morbid with other mental disorders (e.g. anxiety and personality disorders), and related to low socioeconomic status (SES). This situation may hamper treatment outcome, which has often been neglected in previous studies on the treatment of depression during pregnancy. We developed a new group-based multicomponent treatment (GMT) comprising cognitive behavioral therapy, psycho-education and body-oriented therapy and compared the effect on depressive symptoms with individual counseling (treatment as usual, TAU) in a heterogeneous group of pregnant women with co-morbid mental disorders and/or low SES. METHODS: An outpatient sample from a university hospital of 158 pregnant women who met DSM-IV criteria for mental disorders were included and 99 participants were randomized to GMT or TAU from January 2010 until January 2013. The Edinburgh Depression Scale (EDS) was used at baseline, every 5 weeks during pregnancy and as the primary outcome measure of depressive symptoms at 6 weeks postpartum. Secondary outcome measures included the clinician-reported Hamilton Depression Rating Scale (HDRS), obstetric outcomes and a 'Patient Satisfaction' questionnaire. RESULTS: 155 participants were included the intention-to-treat (ITT)-analysis. GMT was not superior above TAU according to estimated EDS (β = 0.13, CI = - 0.46-0.71, p = 0.67) and HDRS scores (β = - 0.39, CI = - 0.82-0.05, p = 0.08) at 6 weeks postpartum. There were no differences in secondary outcomes between the GMT and TAU, nor between the randomized condition and patient-preference condition. LIMITATIONS: The ability to detect an effect of GMT may have been limited by sample size, missing data and the ceiling effect of TAU. CONCLUSIONS:GMT is an acceptable treatment for a heterogeneous group of pregnant women with depressive symptoms and co-morbid mental disorders and/or low SES, but not superior to TAU. Further research should focus on understanding and treating co-morbid disorders and psychosocial problems during pregnancy. CLINICAL TRIALS REGISTRATION: Dutch trial registry, www.trialregister.nl under reference number: NTR3015.
Authors: Babette Bais; Robert Lindeboom; Leontien van Ravesteyn; Joke Tulen; Witte Hoogendijk; Mijke Lambregtse-van den Berg; Astrid Kamperman Journal: Int J Environ Res Public Health Date: 2019-05-07 Impact factor: 3.390
Authors: Hilary I Okagbue; Patience I Adamu; Sheila A Bishop; Pelumi E Oguntunde; Abiodun A Opanuga; Elvir M Akhmetshin Journal: Open Access Maced J Med Sci Date: 2019-05-14