Barnes et al. 2009
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The utility of volunteer home-visiting support to prevent maternal depression in the first year of life.
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RCT
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Adult mothers, mean age 29.0 years, infant birthweight ≥2500g, ≤5 days in special care baby unit, baseline score on modified version of SDI > 9, 250 subjects
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Home-start-support, included different activities like providing company, assistance with childcare or other household tasks, going out on joint trips to local facilities or giving parenting advice, individual length and frequency, average number of visits 15.1, average months of support were 5.5
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Matched control group receiving no support, those who declined home-start-support also receiving no support
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Primary outcome: major or minor depression occurring between 2 and 12 months by using SCID and depressive symptoms at 12 months by using EPDS, Secondary outcome: ICQ, MSSI, PSI
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More social support at 2 months predictor of lower likelihood of depression,
Significant predictor of more depression symptoms at 12 months was more at 2 months (p<0.0001)
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More social support at 2 months, no depressive symptoms at 2 months
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Dennis CL. 2010
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Postpartum depression peer support: maternal perceptions from a randomized controlled trial.
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RCT
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Adult mothers, mean age 30.9 years, baseline score on EPDS <9, 701 subjects
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Usual postpartum care plus telephone-based peer support, a minimum of four contacts and then interactions as deemed necessary (provision of emotional, informational, and appraisal support), mean of 8.8 contacts with their peer volunteers
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Usual postpartum care
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Maternal perceptions of peer support were evaluated at 12 weeks postpartum using PSEI (supportive interactions, relationship qualities, perceived benefits, satisfaction with support), EPDS
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Significantly lower EPDS at 12 weeks in intervention group (no effect at 24 weeks) (p<0.001) in the domains Life is more enjoyable (r = 0.41), Less depressed (r = 0.62)
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Peer support
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Lara et al. 2010
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Outcome results of a psycho-educational intervention in pregnancy to prevent PPD: a randomized control trial.
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RCT
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Adult pregnant with ≤ 26 weeks gestation, mean age 26.9 years, baseline depression score on CES-D > 16 or self-reported history of depression, 138 subjects
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Psycho-educational manual with 3 components: educational, psychological, group component, 2-h, 8 weekly group counseling sessions
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Usual postpartum care
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Primary outcome: major depression by using SCID, depressive symptoms by using BDI-II, outcomes were collected at baseline, 6-weeks and 4-6 month postpartum
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Significantly fewer new depression cases in the intervention group (p<0.05)
Main effect for treatment and for initial CES-D level was significant (p=0.54), but interaction between initial level of symptoms and treatment was not significant
Within groups significant effects of time (p=0.00), interaction between time by initial level of depression (p=0.00), time by treatment (p=0.02), and time by treatment by initial level of depression (p=0.04)
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Psycho-educational intervention
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Brugha et al. 2011
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Universal prevention of depression in women postnatally: cluster randomized trial evidence in primary care
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RCT
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Adult pregnant, mean age 31.8 years, EPDS score <12 at 6 weeks postnatally, 2241 subjects
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Psychologically orientated sessions based on CBT or person-centered principles, 1-h, maximum 8 weekly sessions
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Usual postpartum care
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Primary outcome: proportion of women scoring ⩾12 on the EPDS at 6 months postnatally, Secondary outcomes: mean EPDS score, CORE-OM score, STAI, SF-12 and PSI-SF scores at 6, 12 and 18 months
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Significantly less women in intervention group scoring ⩾12 on the EPDS at 6 months postpartum compared to control group (p=0.016)
Significant predictor of the EPDS at 6 months were the covariates living alone, previous postnatal depression, the presence of one or more adverse life events and the 6-week EPDS score (p=0.031)
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Receiving psychologically orientated sessions from specially trained Health Visitor
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Lewis et al. 2012
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Examination of a Telephone-Based Exercise Intervention for the Prevention of Postpartum Depression: Design, Methodology, and Baseline Data from The Healthy Mom Study
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RCT
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Adult mothers with a history of depression or a maternal family history of depression, mean age 31.5 years, not exercising, 130 subjects
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Telephone-based exercise intervention including telephone counseling sessions, motivational print materials, and completion of exercise logs, 6 months
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Wellness/support contact control condition including counselor only providing support for general issues related to health and wellness and not information regarding exercise, print-based mailings on various topics related to wellness, 6 months
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Primary outcome: depression by using SCID, Secondary outcome: scores on EPS, PHQ-9, PSQI, PSS
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No significant differences between the PHQ-9 (p=0.09), PSS (p=0.87), and PSQI (p=0.995) between participants in the two groups
Three baseline measures were all correlated with one another: PHQ-9 scores were significantly correlated with the PSS scores (p<0.0001) and PSQI scores, (p<0.0001)
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No significant protective factors
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Mao et al. 2012
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Effectiveness of Antenatal Emotional Self‐Management Training Program in Prevention of Postnatal Depression in Chinese Women
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RCT
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Primiparous pregnant females, mean age 28.6 years, 240 subjects
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Emotional self‐management group training (ESMGT) program, based on CBT with elements of Chinese culture of delivery, 90-min, 4 weekly group sessions and 1 individual counseling session
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Usual antenatal care (childbirth education sessions), 90-min, 4 times
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Depressive symptoms were assessed before and after the intervention and 6 weeks after delivery by using PHQ-9, EPDS, SCID
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Significantly lower mean scores for PHQ-9 (p<0.01), EPDS (p<0.05) and SCID (p<0.05) in intervention group compared to control group
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ESMGT intervention
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Songøygard et al. 2012
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Does exercise during pregnancy prevent postnatal depression?: A randomized controlled trial.
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RCT
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Adult pregnant, mean age 30.5 years, 719 subjects
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12-week exercise program (including aerobic and strengthening), exercise groups once weekly for 60-min, 45-min home exercise program at least twice a week (endurance training and strength/balance exercises), conducted between week 20 and 36 of pregnancy
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Usual antenatal care
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Primary outcome: depressive symptoms at 3 months postpartum by using EPDS
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No significant difference in total EPDS scores between the intervention and the control group (p=0.35)
A subgroup of women in the intervention group who did not exercise regularly prior to pregnancy had a reduced risk of postnatal depression (p<0.05)
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Not exercising regularly prior to pregnancy but then exercising during pregnancy
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Kozinszky et al. 2012
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Can a brief antepartum preventive group intervention help reduce postpartum depressive symptomatology?
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RCT
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All pregnant women living in catchment area were approached, mean age 27.3 years, 1719 subjects
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Group sessions consisting of psychoeducation and psychotherapy for PPD utilizing group therapy, interpersonal psychotherapy, and CBT elements, 3-h, once weekly, 4 times
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Treatment as usual but in group meetings, once weekly, 4 times
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Primary outcome: depressive symptoms by using LQ, 4 times during pregnancy and 6 weeks postpartum
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Significant lower LQ scores (p < 0.001) and PPD prevalences (p<0.01) 6 weeks postpartum in the intervention group than the control group
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Preventive antepartum group
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Mozurkewich et al. 2013
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The Mothers, Omega-3, and Mental Health Study: a double-blind, randomized controlled trial
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RCT
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Adult pregnant with 12–20 weeks gestation, mean age 30.3 years, baseline EPDS score 9–19, history of depression, currently not taking omega-3 fatty acid supplements or eating more than 2 fish meals per week, 126 subjects
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EPA-rich (1060 mg EPA plus 274 mg DHA) fish oil supplementation or DHA-rich (900 mg DHA plus 180 mg EPA) fish oil supplement, 6 capsules twice daily, 3 months
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Soy oil placebo, 6 capsules twice daily, 3 months
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BDI and Mini-International Neuropsychiatric Interview at enrollment, 26–28 weeks, 34–36 weeks, and at 6–8 weeks’ postpartum, serum fatty acids were analyzed at entry and at 34–36 weeks’ gestation
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No differences between groups in BDI scores or other depression endpoints at any of the 3 time points after supplementation (Significance=0.051)
DHA levels did predict BDI score at 34–36 weeks (p<0.05)
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No significant protective factors
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Dugravier et al. 2013
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Impact of a Manualized Multifocal Perinatal Home-Visiting Program Using Psychologists on Postnatal Depression: The CAPEDP Randomized Controlled Trial
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RCT
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Primiparous pregnant females with 12 to 27 weeks gestation, less than 26 years old, at least one of the following criteria: 1) having less than twelve years of education, 2) planning to bring up their child without the child’s father, 3) having low income; mean age 22.3 years, 367 subjects
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CAPEDP: 14 intensive multifocal home visits done by psychologists who promoted perinatal mental and physical health, identified depressive symptoms, provided support and referred to care if necessary, 12 months, 27-month follow-up
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Usual postpartum care
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Primary outcome: depressive symptoms by using EPDS at baseline and 3 months postpartum
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No overall impact on postnatal depression symptomatology
Intervention was effective in reducing levels of PPD for subgroups: women who had few depressive symptoms at baseline (p=0.05), women who were planning to raise the child with the child’s father (p=0.04) and women with a higher educational level (p=0.05)
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No significant protective factors
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Moshki et al. 2014
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The effect of educational intervention on prevention of postpartum depression: An application of health locus of control
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RCT
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Pregnant females with 28–30 weeks gestation, mean age 27.9 years, 230 subjects
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Participatory educational program: information about anatomic and physiological changes, nutrition, common complications during pregnancy, mental health and communication skills, familiarization with pregnancy stages, delivery and pain reduction methods, postpartum health, emotions and attitudes of women with special emphasis on components of HLC including internal HLC, powerful others HLC, chance HLC, 36 hours in total, 9 workshops
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Usual postpartum care
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Primary outcome: health behaviors according to participants' beliefs by using MHLCS immediately after the intervention sessions, depressive symptoms by using EPDS after four weeks postpartum
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Significantly reduced chance HLC (p=0.003) and internal HLC (p=0.03) significantly increased immediately after intervention
Significant difference between the two groups in reducing postpartum depression one month after intervention (p=0.001)
Significant correlation between internal belief (p<0.05) and chance belief (p<0.01) with EPDS
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Person's belief about health control
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Hiscock et al. 2014
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Preventing Early Infant Sleep and Crying Problems and Postnatal Depression: A Randomized Trial
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RCT
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Families with infants >32 weeks gestation, mean age caregiver 33.15 years, 781 infants
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Prevention program for infant sleep and cry problems and postnatal depression including supplying information about normal infant sleep and cry patterns, settling techniques, medical causes of crying and parent self-care, delivered via booklet and DVD (at infant age 4 weeks), telephone consultation (8 weeks), parent group sessions (13 weeks); follow-up at infant age 4- and 6-months
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Usual childcare
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EPDS, sleep quality and quantity, breastfeeding duration
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No group differences in caregiver reports of depression symptoms at 4 months (p=0.07)
Significant greater reduction of depressive symptoms in the intervention caregivers at 6 months (p=0.03)
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More knowledge and appropriate expectations about infant sleep and crying behavior
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Nugent et al. 2014
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Effects of an Infant-focused Relationship-based Hospital and Home Visiting Intervention on Reducing Symptoms of Postpartum Maternal Depression: A Pilot Study
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RCT
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First-time mothers cohabitating with the father of the baby, vaginal delivery of an infant between 36- and 42-weeks gestational age, Apgar scores not less than 7, mean age 28 years, 104 subjects
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Routine care plus Newborn Behavioral Observations (NBO) within two days post-delivery (in hospital) and one-month postpartum (home visit), 18 NBO of the infant’s behavioral repertoire along four dimensions (autonomic, motor, state organization and attentional-interactional), 12 to 25 minutes
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Usual postpartum care and short attention-control home visit to administer the EPDS
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Primary outcome: depressive symptoms at 1 month postpartum using EPDS
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Significantly fewer mothers had elevated depression scores in the intervention group (p=0.05)
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Use of NBO
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Maimburg et al. 2015
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Postpartum depression among first-time mothers – results from a parallel randomised trial
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RCT
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Nulliparous adult pregnant females between 10 + 0 to 21 + 6 days of gestation, singleton pregnancy, mean age 29.3 years, 1062 subjects
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“The Ready for Child" antenatal education program, between the 30th - 35th weeks of gestation: content of the birth module, the newborn module and the parent module with information about PPD (information on prevalence, prevention, symptoms (shared and different symptoms in men and women), and PPD treatment), 3 modules of 3 hours
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Usual antenatal care
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Primary outcomes: demographics, depressive symptoms using EPDS at 6 weeks postpartum and identifying risk factors for PPD
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No significant difference in EPDS at 6 weeks postpartum between the two groups
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No significant protective factors
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Dimidjian et al. 2016
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Staying Well during Pregnancy and the Postpartum: A Pilot Randomized Trial of Mindfulness Based Cognitive Therapy for the Prevention of Depressive Relapse/Recurrence
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RCT
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Adult pregnant females with >32 weeks gestation, meeting criteria for prior major depressive disorder (MDD), exclusion if diagnosis of MDD in the last two months, mean age 29.85 years, 86 subjects
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MBCT-PD, at-home practice for 6 days each week, 42 days in total
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Usual antenatal care
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Primary outcome: baseline diagnostic status via SCID-I/P and SCID-II
Depression relapse/recurrence using LIFE at 8-weeks, 1 month prior to delivery and 1 and 6 months postpartum;
Depression symptom severity using EPDS
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Significant difference in the rate of relapse/recurrence between intervention and control group (p=0.005) in the postpartum period
Significantly lower levels of depressive severity in intervention than in control group (p=0.002)
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MBCT-PD
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Werner et al. 2016
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PREPP: Postpartum Depression Prevention through the Mother-Infant Dyad
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RCT
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Pregnant females in 2nd or 3rd trimester of pregnancy, Predictive Index of Postnatal Depression score > 24, aged 18-45 years, mean age 30.22 years, 54 subjects
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3 PREPP sessions covering: five specific infant behavioral techniques (feeding, day-night rhythm, carrying duration, swaddling)
Supportive psychological interviewing (using Motivational Interviewing techniques)
Psychoeducation
Mindfulness techniques
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Enhanced treatment as usual and 2 meetings with psychologists (34–38 weeks gestation and 6 weeks postpartum): participants were provided with information about PPD and referral for treatment if warranted
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Primary outcome: predictive index of PPD (PPD risk = >24), indexes depressive symptoms via HRSD and PHQ-9
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Significantly decreased depressive symptoms in intervention group in contrast to control group (p=0.01) at 36–38 weeks gestation and 6 weeks postpartum
Significantly more depressive symptoms at 6 weeks postpartum in control group in contrast to intervention group (p=0.02)
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PREPP
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Tsai et al. 2016
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Food Insufficiency, Depression, and the Modifying Role of Social Support: Evidence from a Population-Based, Prospective Cohort of Pregnant Women in Peri-Urban South Africa
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RCT
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All pregnant females living in study catchment area who were willing to participate, 958 subjects
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Home visiting intervention: problem-solving and cognitive-behavioral techniques to address major community health challenges (HIV, tuberculosis, malnutrition, alcohol use), 4 visits and follow-up
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Standard clinic care groups generally consisted of tuberculosis and HIV testing, partner HIV testing, antiretroviral therapy, antenatal and postnatal care, well-child clinics, and primary health care
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Primary outcome: depression symptom severity measured at all time points using EPDS, surveys were conducted at baseline, 6, 18, and 36 months, number of days of hunger in the past week via single-item food insufficiency measure; 10 questions about emotional and instrumental support, 36-month follow-up interview using HFIAS
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Strong significant association between lagged food insufficiency and depression symptom severity (β=0.70; 95% CI, 0.46-0.94)
Significant association between food insufficiency and depression among women with low levels of instrumental support (β=0.79; 95% CI, 0.51-1.07)
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Food sufficiency, instrumental social support
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Lewis et al. 2017
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The relationship between employment status and depression symptomatology among women at risk for postpartum depression
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RCT
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Healthy women who had participated in a randomized trial (see Lewis et al. 2012) and had a personal or maternal family history of depression, aged 18–42 years, mean age 30.8 years, 124 subjects
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Telephone-based exercise intervention, 6 months
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Wellness/support contact, 6 months
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Demographic questionnaire (income, marital status, education level)
Telephone-based interview at baseline (approximately 6 weeks postpartum): race/ethnicity, age, body mass index, antidepressant use
Telephone-based interview at 7 months: employment and breastfeeding statuses, EPDS
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Significant association between employment status and higher depression symptomatology (p=0.010)
Significant association between being single and higher depression symptomatology at 7 months postpartum (p=0.001)
No significant differences between women who worked full- time versus part-time on depression symptomatology (r=−0.022, ns.)
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Employment at 7 months postpartum
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Xu et al. 2017
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Single bolus low-dose of ketamine does not prevent postpartum depression: a randomized, double-blind, placebo-controlled, prospective clinical trial
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RCT
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Pregnant women who were scheduled to undergo caesarean section with spinal anaesthesia, mean age 31.5, 330 subjects
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Ketamine group: subjects received intravenous ketamine (0.25 mg/kg diluted to 10 mL with 0.9% saline) within 5 min following clamping of the neonatal umbilical cord
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Saline group: subjects received intravenous placebo (10 mL of 0.9% saline) within 5 min following clamping of the neonatal umbilical cord
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Primary outcome: degree of depression by using the EPDS (a threshold of 9/10 was used) at 3 days and 6 weeks after delivery
Secondary outcome: numeric rating scale score of pain at 3 day and 6 week postpartum
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No significant differences in the prevalence of postpartum depression between the two groups at 3 days (p=0.965) and 6 weeks (p=0.900) after delivery
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No significant protective factors
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Vaz et al. 2017
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Omega-3 supplementation from pregnancy to postpartum to prevent depressive symptoms: a randomized placebo- controlled trial
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RCT
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Pregnant females, past history of depression or baseline EPDS score ≥9, between 5-13 weeks of gestation at the time of enrolment; aged 20-40 years, mean age 26.25 years, 32 subjects
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6 fish oil capsules (1.08 g of EPA and 0.72 g of DHA) per day starting at week 22–24 of gestation for 16 consecutive weeks
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Soybean oil placebo (6 capsules per day), 16 consecutive weeks
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Primary outcome: Prevalence of EPDS ≥11 (EPDS was scored at 5–13 (baseline), 22–24, 30–32 weeks of gestation and 4–6 weeks’ postpartum)
Secondary outcome: mean and changes in EPDS score, Baseline: blood collection, psychiatric interview using the MINI, general questionnaire, mental health scales (including EPDS)
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No significant difference between intervention and control groups in the prevalence of EPDS (T0 p=0.809, T1 p=0.299, T2 p=0.630, T3 p=1.000)
Women in intervention group with previous history of depression presented a higher reduction on the EPDS score from the second to the third trimester in the fish oil comparing to the control group in the ITT analyses (p=0.038)
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No significant protective factors
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Duncan et al. 2017
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Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison
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RCT
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First-time mothers in the late 3rd trimester of singleton pregnancy, no extensive prior experience with meditation or yoga practice, 29 subjects
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Mind in Labor (MIL): Working with Pain in Childbirth (Preparation course based on Mindfulness-Based Childbirth and Parenting (MBCP) education, subjects completed self-report assessments pre-intervention, post-intervention, and post-birth, and medical record data were collected; 2.5-day weekend workshop
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Usual antenatal care, participants received a list of childbirth courses of comparable length and quality to the MIL intervention, but without any mindfulness meditation, mindful movement/yoga, or other core mind/body component (e.g., hypnosis), they were strongly encouraged to participate in the control childbirth education with a support person, just as with MIL
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Depression using CES-D at average gestational age 29.4 weeks, in the week immediately following intervention, within six weeks after birth
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Perinatal and postpartum depression symptoms: significant interaction between group and time (p=0.04)
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Mindfulness training tailored to address fear and pain of childbirth
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Young et al. 2018
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Placentophagy’s effects on mood, bonding, and fatigue: A pilot trial, part 2
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RCT
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Adult pregnant females who had previously decided they would ingest their placenta after birth, mean age 29.9 years, 27 subjects
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Participants consumed their processed, encapsulated placenta: two 550 mg capsules 3 times daily for the first 4 days of supplementation, decreased dosage of 2 capsules twice daily, on days 5 through 12 of supplementation, and reduced dosage to 2 capsules once daily through completion, 4 meetings with researcher
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Similarly prepared placebo, same intake
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Primary outcome: scored results of the EPDS, KBQ, DASS-21, FAS, MIBS, and SCL-90-R
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No significant main effects (p=0.016)
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No significant protective factors
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