Relational-developmental therapy group for postnatal depression

Postnatal depression has been estimated to affect as many as 30% of childbearing women. Emerging evidence offers reason to believe that psychoanalytically-oriented group treatment may be beneficial for some women with postnatal depression. This study was designed to evaluate the effectiveness of one model of analytic group therapy for this clinical population. Our findings suggest that the women had a positive response to the group treatment. The particulars of the psychoanalytic group approach, here referred to as relational-developmental, are described in detail and an analysis is offered about why this approach may be beneficial. Also discussed are limitations of the research design and suggestions for studying a relational-developmental group-centered prevention program for children at-risk from postnatal depression.     

An Open Trial of Web-Based Mindfulness-Based Cognitive Therapy for Perinatal Women at Risk for Depressive Relapse

Depression occurring during pregnancy and postpartum (i.e., the perinatal period) is common and associated with adverse outcomes for women and their offspring. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce risk for depressive relapse among at-risk individuals generally, and recent adaptations document the efficacy of MBCT among perinatal women specifically. In addition, MBCT, when delivered using a web-based format (Mindful Mood Balance [MMB] program), has demonstrated acceptability and feasibility for at-risk individuals generally. The aim of the present open trial study was to examine the feasibility, acceptability, and preliminary outcomes of MMB for use with pregnant women at risk for depressive relapse (N = 37). We predicted that MMB would be feasible and acceptable as assessed by session completion and participation in phone coaching calls, home practice completion, and self-reported satisfaction via questionnaire and interview. We also predicted that women would not demonstrate significant worsening of depression symptom severity during MMB, consistent with our focus on prevention. A brief case example based on a composite of participants is presented to illustrate the MMB structure and content and the phone coaching protocol. Participants demonstrated engagement with the program, reported perceiving benefits in the intended depression prevention targets of MMB, and sustained minimal to mild depressive symptom severity over the course of the program. Given these promising results and the potential benefits of averting depression for women and their families, further development and rigorous testing of MMB among at-risk pregnant women is warranted.     

Factors influencing continuation in a behavioral therapy

One hundred and forty-seven depressed women who either completed, dropped-out of or refused a 10-week, self-control, group therapy program were compared on: demographic variables, depression indices, depression theory-related performances, personality variables and attitudes about therapy. Compared with treatment Completers, treatment Refusers presented a more acute crisis, reported a rapid onset of depression, had experienced fewer prior depressive episodes and were most likely to receive a diagnosis of situational (reactive) depression. Results also indicated that individuals of higher SES and those who endorsed expectancies congruent with the offered treatment rationale were most likely to continue in treatment.     

Treating Depression Among Adolescent Perinatal Women With a Dialectical Behavior Therapy–Informed Skills Group

Depression is a prevalent and impairing problem affecting both women and offspring during the perinatal (pregnancy and the postpartum) period. Despite this, few studies have examined treatments for perinatal adolescents with depressive symptoms. The present study examined the feasibility and preliminary outcomes of a dialectical behavioral therapy (DBT) informed skills group among depressed adolescent perinatal women (N = 25) recruited from both a public health parent education program and an adolescent obstetric clinic. A brief composite case example is included to illustrate how DBT skills were taught, practiced, and applied. Findings suggest the intervention was credible, acceptable, and associated with improvement in depression. Challenges with feasibility of enrolling and retaining adolescent perinatal women were evident, as approximately half of the enrolled participants did not complete the study. This study provides preliminary evidence that a DBT-informed skills group may be a promising intervention for depressed adolescent perinatal women and points to important directions for clinical practice and research, including treatment engagement and retention.     

Hope and social support utilisation among different age groups of women with breast cancer and their spouses

Objective: Social support and hope are considered positive, important contributors to psychological well-being for women with breast cancer and their spouses. Few studies examine the role of age in relation to these variables. The current study compares the relationship between social support, hope and depression among different age groups of women with advanced breast cancer and their healthy spouses.

Design: Cross-sectional sample of 150 women with advanced breast cancer and their spouses.

Main outcome measures: Social support, hope, depression and socio-demographic data. Analysis included comparison of these variables between groups of older and younger patients and their spouses. Structural equation modelling (SEM) was used to examine hope as a mediator of the relationship between social support and depression within each group (older and younger patients and spouses).

Results: Older patients and spouses reported lower levels of depression than younger ones. SEM showed that social support related directly to depression among younger women and older spouses, while hope was directly related to depression among older women and younger spouses and acted as a mediator between social support and depression.

Conclusions: Theoretical, empirical and clinical implications regarding the understanding of the role of age in coping with cancer are discussed.     

Effect of an aerobic training program as complementary therapy in patients with moderate depression

The aim of this study was to assess the effects of an aerobic training program as complementary therapy in patients suffering from moderate depression. 82 female patients weredivided into a group that received traditional pharmacotherapy (Fluoxetine 20 mg) and a group that received pharmacotherapy plus an aerobic training program. This program was carried out for eight consecutive weeks, three days per week, and included gymnastics, dancing, and walking. Depressive symptoms were measured with the Beck Depression Inventory and the ICD-10 Guide for Depression Diagnosis, both administered before and after treatments. The results confirm the effectiveness of the aerobic training program as a complementary therapy to diminish depressive symptoms in patients suffering from moderate depression.     

Latent variable assessment of outcomes in a nurse-managed intervention to increase latent tuberculosis treatment completion in homeless adults.

OBJECTIVE: To assess predictors of latent tuberculosis infection (LTBI) completion by using structural equation modeling (SEM) among homeless adults, a group at great risk for LTBI and active tuberculosis (TB). LTBI therapy is effective in stemming the progression to active TB, yet treatment adherence among homeless persons is difficult to attain. DESIGN: By using SEM, the authors assessed predictors of LTBI completion among a sample of 494 homeless adults in Los Angeles, CA, who received either a nurse case-managed program (NCM) or a usual care program. MAIN OUTCOME MEASURES: Latent variables were created with the baseline variables of site type, age, intervention status, dissatisfaction with health care, depression, TB risk assessment, alcohol use, heroin or cocaine use, and TB knowledge. Outcome variables included many of the same baseline variables as well as treatment completion. RESULTS: LTBI treatment completion (100% adherence) was significantly and positively associated with participation in NCM, older age, and less heroin or cocaine use. NCM also predicted greater TB knowledge, greater ease of treatment, and more satisfaction with treatment (NCM completion rate = 64%, control rate = 42%). CONCLUSION: The culturally competent NCM program, combined with active tracking and incentives, was successful in a difficult-to-treat and highly transient population.     

Effects of a cognitive-behavioural internet program on depression, vulnerability to depression and stigma in adolescent males: a school-based controlled trial

This study evaluated the effectiveness of a cognitive behaviour therapy Internet program (MoodGYM) for depressive symptoms, attributional style, self-esteem and beliefs about depression, and on depression and depression-vulnerable status in male youth. A total of 78 boys age 15 and 16 years were allocated to either undertake MoodGYM or to standard personal development activities. Outcomes were measured before commencement, post-program and 16 weeks post-program. There were no significant between-group differences in change scores pre- to post- or pre- to follow-up using the intention to treat sample or for participants with post- and/or follow-up data. For boys completing 3 or more modules there were small relative benefits of MoodGYM for depressive symptoms (Effect Size, ES = 0.34), attributional style (ES = 0.17) and self-esteem (ES = 0.16) at post-program, although only the effect for self-esteem was sustained at follow-up. Both groups showed improvement in their beliefs about depression at follow-up, with the control group showing a moderate relative benefit (ES = 0.40). While the numbers are small, there was a reduction in the risk of being depressed in the MoodGYM group of 9% at post-treatment compared with a slightly increased risk for the control group. The risk of being classified as vulnerable to depression reduced by 17% in the MoodGYM group at post-treatment compared with no change in risk for the control group. These reductions in risk for the MoodGYM group were not sustained at follow-up. The limitations of the study highlight several important challenges for MoodGYM and other self-directed Internet cognitive behaviour therapy programs. These include how to ensure enough of the program is received and that people who could potentially benefit access the program and continue to remain engaged with it, and how to enhance the sustainability of any benefits.     

A randomized clinical trial of a brief, problem-focused couple therapy for depression

The aim of this study was to evaluate a brief couple therapy for depression targeted for mildly discordant or nondiscordant couples struggling with the negative impact of depression. Subjects included women with major depression or dysthymia who had husbands without clinical depression. Thirty-five couples were randomly assigned to the 5-week intervention (n = 18) or a waitlist control group (n = 17), and followed up 1 and 3 months later. Results showed a significant effect of treatment in reducing women's depressive symptoms, with 67% of women improved and 40% to 47% recovered at follow-up, compared to only 17% improved and 8% recovered among women in the control group. Treatment was also effective in secondarily improving women's marital satisfaction, reducing husbands' levels of psychological distress and depression-specific burden, and improving both partners' understanding and acceptance of depression. The treatment was implemented in five 2-hour sessions, representing an efficient, cost-effective approach. Findings support the growing utility of brief, problem-focused couple interventions that simultaneously target depression, relational functioning, and psychological distress experienced by the loved ones of depressed persons.     

The association between depression and thyroid disorders in a regionally representative Canadian sample

A subsample of six provinces (n = 67,621) from the 2005 Canadian Community Health Survey was used to determine the gender-specific prevalence of depression among those with and without thyroid disorders. Information was not available on the type of thyroid disorder. Logistic regression analyses were conducted to determine the odds and socio-demographic correlates of depression among those with and without thyroid disorders. Women had a significantly higher prevalence of thyroid disorders (9.3%) and depression (6.6%) than men (2.4% and 3.7%, respectively). Thyroid disorders were associated with 22% higher odds of depression in women after adjusting for socio-demographic factors, but no association was found in men. Among women with and without thyroid disorders, younger age, lower income, and limitations in Activities in Daily Living (ADL) were associated with higher odds of depression. Results suggest that women with thyroid disorders are more vulnerable to depression, and socio-demographic correlates of depression are similar among women with and without thyroid disorders.     

The Prevalence of Spirituality, Optimism, Depression, and Fatalism in a Bi-ethnic Stroke Population

To provide insight into the reduced post-stroke all-cause mortality among Mexican Americans, we explored ethnic differences in the pre-stroke prevalence of (1) spirituality, (2) optimism, (3) depression, and (4) fatalism in a Mexican American and non-Hispanic white stroke population. The Brain Attack Surveillance in Corpus Christi (BASIC) project is a population-based stroke surveillance study in Nueces County, Texas. Seven hundred ten stroke patients were queried. For fatalism, optimism, and depression scales, unadjusted ethnic comparisons were made using linear regression models. Regression models were also used to explore how age and gender modify the ethnic associations after adjustment for education. For the categorical spirituality variables, ethnic comparisons were made using Fisher's exact tests. Mexican Americans reported significantly more spirituality than non-Hispanic whites. Among women, age modified the ethnic associations with pre-stroke depression and fatalism but not optimism. Mexican American women had more optimism than non-Hispanic white women. With age, Mexican American women had less depression and fatalism, while non-Hispanic white women had more fatalism and similar depression. Among men, after adjustment for education and age, there was no ethnic association with fatalism, depression, and optimism. Spirituality requires further study as a potential mediator of increased survival following stroke among Mexican Americans. Among women, evaluation of the role of optimism, depression, and fatalism as they relate to ethnic differences in post-stroke mortality should be explored.     

Effectiveness of Dialectical Behavior Therapy for Treating Eating Disorders

This study evaluated the effectiveness of dialectical behavior therapy (DBT) for treating eating disorder episodes and co‐occurring depression symptoms among individuals diagnosed with eating disorders. Separate meta‐analytic procedures for between‐groups and single‐group studies were conducted and yielded large effect sizes, indicating that DBT may be efficacious for decreasing disordered episodes among women diagnosed with eating disorders; medium to large effect sizes were noted for treating depression symptoms. Implications for evidence‐supported practice and study limitations are discussed.     

The thin ideal, depression and eating disorders in women

It is proposed that a cultural ideal of thinness for women causes depression at a higher rate among women than among men. This model accounts for five currently unintegrated trends in the epidemiology of depression. It explains why: (1) twice as many women as men are likely to be depressed; (2) this sex difference emerges at puberty; (3) this sex difference is only found in western countries; (4) there is more depression today; (5) the average age of onset for depression is younger now than in the past. Four parallel trends in eating disorders can also be accounted for by the same factor.     

Attitude and knowledge changes in collegiate dancers following a short-term, team-centered prevention program on eating disorders

Eating knowledge, nutritional knowledge, and psychological changes among female collegiate dancers were examined before and after a 4-wk. team-centered program on sport nutrition, exercise, and disordered eating consequences. Collegiate female dancers from two NCAA Division I institutions participated in a control (n = 19; M age = 19.1 yr., SD = 1.0) or intervention (n = 21; M age = 19.2 yr., SD = 1.2) group. Measures were administered to both groups before and after intervention to assess eating disorders, depression, and nutritional and disordered eating knowledge. There was a statistically significant increase in scores on nutritional and overall eating disorder knowledge in the intervention group compared to the control group. Mean scores on depression, drive for thinness, body dissatisfaction, and maturity fears decreased in the intervention group.     

Feminine sex role and depression in middle-aged women

The present study was designed to investigate the relationship of sex-role orientation and depression in middle-aged women. It was hypothesized that middle-aged females who were clinically depressed would score higher in feminine characteristics on the Bem Sex Role Inventory (BSRI) than similar women who were not depressed. The subjects were two groups of women between the ages of 35 and 50. The clinical group consisted of 15 women who were currently diagnosed as depressive and who were undergoing treatment for depression at three local mental health centers. The nonclinical group consisted of 24 women who were not currently seeking treatment for depression and who had never undergone psychiatric treatment or therapy. All subjects were administered the BSRI and Beck's Depression Inventory.Results supported the hypothesis that depression in middle-aged females is related to their degree of acceptance of the traditional feminine role. For all subjects, depression scores were positively correlated with femininity scores. It was concluded that the woman who subscribes to a traditional feminine role stereotype has a greater vulnerability to depression in her middle years.     

Exercise therapy for depression in middle-aged and older adults: predictors of early dropout and treatment failure.

Psychosocial factors predicting treatment dropout or failure to benefit from treatment were identified in a randomized trial of exercise therapy and pharmacotherapy for major depression. One hundred fifty-six men and women over age 50 diagnosed with major depressive disorder were assigned to a 16-week program of aerobic exercise, medication (sertraline), or a combination of exercise and medication. Thirty-two patients (21%) failed to complete the program and were considered treatment "dropouts." At the end of 16 weeks, 83 patients (53%) were in remission; the remaining patients not in remission were considered treatment "failures." Baseline levels of self-reported anxiety and lift satisfaction were the best predictors of both patient dropout and treatment success or failure across all treatment conditions.     

A Preliminary Study Investigating the Effectiveness of the Caring for Body and Mind in Pregnancy (CBMP) in Reducing Perinatal Depression,Anxiety and Stress

Prenatal mental illness is a significant public health issue with intergenerational consequences. Caring for Body and Mind in Pregnancy (CBMP) is an Australian, 8-week mindful parenting program. The primary aim of this study was to investigate the effectiveness of CBMP in reducing pregnant women’s levels of depression, anxiety, perinatal depression, perinatal anxiety and stress. The sample consisted of 109 pregnant women at-risk for perinatal depression and anxiety. The mean age of the sample was 33.52 years (SD?=?4.90), ranging from 21 to 45 years. A within group, pre-post research design was used to examine whether CBMP improves participants’ scores on outcome measures. Wilcoxon Signed Rank test results indicated that CBMP significantly reduced depression, anxiety, perinatal depression, perinatal anxiety and general stress scores, while significantly increasing self-compassion and mindfulness with moderate to strong effect sizes. The double mediation hypothesis was supported with self-compassion t (71)?=??2.23, p?<?03, b2?=??1.96, SE?=?88, 95% CI?=??3.71, ?.20, having a stronger influence in reducing perinatal depression than mindfulness t (71)?=??2.68, p?<?.01, b3?=??.07, SE?=?.03, 95% CI?=??.13, ?.02. Further research, using a randomized controlled design with appropriate control conditions, is needed to establish the effectiveness of CBMP in reducing psychological distress amongst pregnant women at risk of developing depression, anxiety or stress.     

Marital satisfaction and depression: a replication of the Marital Discord Model in a Latino sample

The Marital Discord Model of Depression maintains that marital discord is an important antecedent in the development of depression. Although empirical evidence supports this premise, none of this research has been done with Latinos. The purpose of this study was to test the longitudinal relationship between marital satisfaction and depression among 99 Brazilian women. Using structural equation modeling, results indicated that marital satisfaction was a strong predictor of depression 2 years later. Marital satisfaction was also related to cooccurring depression. These results provide evidence that the Marital Discord Model of Depression is an appropriate theoretical model for the conceptualization of marital discord and depression with Latina women and suggest the potential utility of using couples therapy for treating depression among this population.     

Reports of attempted suicide among Brazilian addicts

Both substance dependence and depressive mood seem to be associated with increased suicide risk. Clinical information on suicide attempts and depressive symptoms were obtained from a sample of 211 psychoactive substance dependents attending a university clinic program for addicts in Brazil. 49 subjects (23.4%) had attempted suicide at least once, and the frequency of reporting attempts was 4.32 times greater among women than among men. Male addicts also tended to engage in potentially more dangerous attempt methods than women. Depressive male addicts were 2.17 times more likely to have attempted suicide than nondepressive addicted men. Among women, no association could be established between having attempted suicide and the presence of depression. Substance addicts have a relatively high risk of attempting suicide and the co-occurrence of depression seems to increase prevalence of suicidal behavior among men.