Document Type : Original Article
Authors
1 Medicine, Quran and Hadith Research Center, Faculty of Nursing, Baqiyatallah University of Medical Sciences
2 department of Community Health
3 Medical Surgical, Faculty of Nursing, Baqiyatallah University of Medical Science, Tehran, Iran
4 Departments of Community Health
Abstract
BACKGROUND: Depression during pregnancy is one of the major concerns in mental health, hence
using interventional methods for the treatment or reducing the rate of depression is considered
a priority for maternal and fetal health. The present study aimed to examine the effectiveness of
problem‑solving training in reducing depression in pregnant women.
MATERIALS AND METHODS: This randomized clinical trial was conducted on seventy pregnant
women referring to Prenatal Care Clinics, Najmiyeh hospital in Tehran, Iran. The participants were
randomly allocated divided into experimental and control groups. The experimental group was given
routine prenatal care training at the clinic along with problem‑solving skills training based on the
Identify, Define, Explore, Act, Look back model in five sessions, but the control group only received
routine prenatal care training. Data were collected using the Beck’s Depression Inventory at the
beginning of the study and at the immediately and 1 month after two groups. Data were analyzed
using descriptive and analytical statistical tests.
RESULTS: In the experimental group, the mean depression score significantly reduced
from 16.06 ± 4.73 before intervention to 12.83 ± 4.10 and 13 ± 4.24 after intervention and at
follow‑up (P < 0.05). While in the control group, the mean depression from 15.34 ± 2.94 before
intervention to 14.80 ± 2.76 and 14.86 ± 2.924 after intervention and at follow‑up. It was not statistically
significant in the control group (P > 0.05).
CONCLUSIONS: Problem‑solving training can be used as an optional method of reducing depression
in pregnant women, and it is recommended that should be implemented by the health‑care team.
Keywords
- Katona C, Peveler R, Dowrick C, Wessely S, Feinmann C, Gask L,
et al. Pain symptoms in depression: Definition and clinical
significance. Clin Med (Lond) 2005;5:390‑5.
2. Beck AT, Alford BA. Depression: Causes and Treatment. 2nd ed,
Philadelphia Pennsylvania: University of Pennsylvania Press;
2009.
3. Akiskal HS. Mood disorders: Historical introduction and
conceptual overview. In: Sadock BJ, Sadock VA, Kaplan HI,
editors. Kaplan and Sadock’s Comprehensive Textbook of
Psychiatry. 8th ed. Philadelphia; PA: Lippincott Williams &
Wilkins. 2005. p. 1563‑5.
4. Kessler RC. Epidemiology of women and depression. J Affect
Disord 2003;74:5‑13 - 5. Marmorstein NR, Malone SM, Iacono WG. Psychiatric disorders
among offspring of depressed mothers: Associations with paternal
psychopathology. Am J Psychiatry 2004;161:1588‑94.
6. Romans SE, Seeman MV. Women’s Mental Health: A Life‑Cycle
Approach. Philadelphia. Lippincott Williams & Wilkins; 2006.
7. Sulyman D, Ayanda KA, Dattijo LM, Aminu BM. Postnatal
depression and its associated factors among Northeastern
Nigerian women. Annals of Tropical Medicine and Public Health.
2016; 9(3):184.
8. Andersson L, Sundström‑Poromaa I, Bixo M, Wulff M,
Bondestam K, åStröm M, et al. Point prevalence of psychiatric
disorders during the second trimester of pregnancy:
A population‑based study. Am J Obstet Gynecol 2003;189:148‑54.
9. Andersson L, Sundström‑Poromaa I, Wulff M, Aström M, Bixo M.
Implications of antenatal depression and anxiety for obstetric
outcome. Obstet Gynecol 2004;104:467‑76.
10. de Tychey C, Spitz E, Briançon S, Lighezzolo J, Girvan F, Rosati A,
et al. Pre‑ and postnatal depression and coping: A comparative
approach. J Affect Disord 2005;85:323‑6.
11. Marcus SM, Flynn HA, Blow FC, Barry KL. Depressive symptoms
among pregnant women screened in obstetrics settings. J Womens
Health (Larchmt) 2003;12:373‑80.
12. Stowe ZN, Hostetter AL, Newport DJ. The onset of postpartum
depression: Implications for clinical screening in obstetrical and
primary care. Am J Obstet Gynecol 2005;192:522‑6.
13. Henderson J, Redshaw M. Who is well after childbirth? Factors
related to positive outcome. Birth 2013;40:1‑9.
14. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR.
Prevalence of depression during pregnancy: Systematic review.
Obstet Gynecol 2004;103:698‑709.
15. Nicholson WK, Setse R, Hill‑Briggs F, Cooper LA, Strobino D,
Powe NR, et al. Depressive symptoms and health‑related quality
of life in early pregnancy. Obstet Gynecol 2006;107:798‑806.
16. Evans J, Heron J, Francomb H, Oke S, Golding J. Cohort study
of depressed mood during pregnancy and after childbirth. BMJ
2001;323:257‑60.
17. Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ,
Viguera AC, et al. Relapse of major depression during pregnancy
in women who maintain or discontinue antidepressant treatment.
JAMA 2006;295:499‑507.
18. ZayasLH, CunninghamM, McKeeMD, JankowskiKR. Depression
and negative life events among pregnant African‑American and
Hispanic women. Womens Health Issues 2002;12:16‑22.
19. Veisani Y, Delpisheh A, Sayehmiri K, Rezaeian S. Trends of
postpartum depression in iran: a systematic review and metaanalysis. Depress Res Treat 2013;2013:291029.
20. Kaplan H, Sadock BJ. Comprehensive Textbook of Psychiatry.
7th ed. Philadelphia, USA. Lippincott Williams & Wilkins; 2001.
p. 1559‑2022.
21. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM,
et al. Risk factors for depressive symptoms during pregnancy:
A systematic review. Am J Obstet Gynecol 2010;202:5‑14.
22. Rich‑Edwards JW, Kleinman K, Abrams A, Harlow BL,
McLaughlin TJ, Joffe H, et al. Sociodemographic predictors of
antenatal and postpartum depressive symptoms among women
in a medical group practice. J Epidemiol Community Health
2006;60:221‑7.
23. Jesse DE, Seaver W, Wallace DC. Maternal psychosocial risks
predict preterm birth in a group of women from Appalachia.
Midwifery 2003;19:191‑202.
24. Field T, Diego M, Dieter J, Hernandez-Reif M, Schanberg S,
Kuhn C, et al. Prenatal depression effects on the fetus and the
newborn. Infant Behavior and Development. 2004;27(2):216-29.
25. Kurki T, Hiilesmaa V, Raitasalo R, Mattila H, Ylikorkala O.
Depression and anxiety in early pregnancy and risk for
preeclampsia. Obstet Gynecol 2000;95:487‑90.
26. Wisborg K, Kesmodel U, Henriksen TB, Olsen SF, Secher NJ.
A prospective study of smoking during pregnancy and SIDS.
Arch Dis Child 2000;83:203‑6.
27. Vasilevskaia T. Social problem solving as a moderator in the
relationship between pregnancy-specific stressors and depressive
symptoms: (Ph.D Clinical Psychology), Drexel University; 2010.
28. Kahn DA, Moline ML, Ross RW, Cohen LS, Altshuler LL. Major
depression during conception and pregnancy: A guide for
patients and families. A Postgraduate Medicine Special Reports.
2001:110-1.
29. Hobel C, Culhane J. Role of psychosocial and nutritional stress
on poor pregnancy outcome. J Nutr 2003;133:1709S‑17S.
30. Beck CT. Post‑traumatic stress disorder due to childbirth: The
aftermath. Nurs Res 2004;53:216‑24.
31. Allister L, Lester BM, Carr S, Liu J. The effects of maternal
depression on fetal heart rate response to vibroacoustic
stimulation. Dev Neuropsychol 2001;20:639‑51.
32. Dieter JN, Field T, Hernandez‑Reif M, Jones NA, Lecanuet JP,
Salman FA, et al. Maternal depression and increased fetal activity.
J Obstet Gynaecol 2001;21:468‑73.
33. Monk C, Sloan RP, Myers MM, Ellman L, Werner E, Jeon J, et al.
Fetal heart rate reactivity differs by women’s psychiatric status:
An early marker for developmental risk? J Am Acad Child
Adolesc Psychiatry 2004;43:283‑90.
34. Gorman LL, O’Hara MW, Figueiredo B, Hayes S, Jacquemain F,
Kammerer MH, et al. Adaptation of the structured clinical
interview for DSM‑IV disorders for assessing depression in
women during pregnancy and post‑partum across countries and
cultures. Br J Psychiatry Suppl 2004;46:s17‑23.
35. Rahman A, Bunn J, Lovel H, Creed F. Maternal depression
increases infant risk of diarrhoeal illness: a cohort study. Arch
Dis Child 2007;92:24‑8.
36. Halbreich U, Karkun S. Cross‑cultural and social diversity of
prevalence of postpartum depression and depressive symptoms.
J Affect Disord 2006;91:97‑111.
37. Barrio LM, Burt VK. Depression in pregnancy: strategies for
primary care management. Womens Health Prim Care 2000;3:490‑8.
38. Heron J, O’Connor TG, Evans J, Golding J, Glover V; ALSPAC
Study Team, et al. The course of anxiety and depression through
pregnancy and the postpartum in a community sample. J Affect
Disord 2004;80:65‑73.
39. Pakenham KI, Smith A, Rattan SL. Application of a stress and
coping model to antenatal depressive symptomatology. Psychol
Health Med 2007;12:266‑77.
40. British Psychological Society. Antenatal and Postnatal Mental
Health: the NICE Guideline on Clinical Management and Service
Guidance. British Psychological Society; 2007.
41. Yonkers KA, Wisner KL, Stewart DE, Oberlander TF, Dell DL,
Stotland N, et al. The management of depression during
pregnancy: A Report from the American Psychiatric Association
and the American College of Obstetricians and Gynecologists.
Gen Hosp Psychiatry 2009;31:403‑13.
42. Hendrick V, Stowe ZN, Altshuler LL, Hwang S, Lee E, Haynes D,
et al. Placental passage of antidepressant medications. Am J
Psychiatry 2003;160:993‑6.
43. Cuijpers P, Van Straten A, Warmerdam L, Smits N. Characteristics
of effective psychological treatments of depression:
A metaregression analysis. Psychother Res 2008;18:225‑36.
44. Mynors‑Wallis LM, Gath DH, Day A, Baker F. Randomised
controlled trial of problem solving treatment, antidepressant
medication, and combined treatment for major depression in
primary care. BMJ 2000;320:26‑30.
45. D’Zurilla TJ, Nezu AM. Problem-solving therapy. Handbook of
cognitive-behavioral therapies. . New York, NY, US: Guilford
Press. 2010;3:197-225.
46. Nezu AM, D'Zurilla TJ. Problem-solving therapy: A positive
approach to clinical intervention. 3 edition, Springer Publishing
Company; 2006 Sep 18.
)