Telecare for women with postpartum depression

Data were collected to pilot test the feasibility and effects of telecare as an intervention for depression in a small group of mothers with postpartum depression. Treatment involved a 10-week telecare therapy consisting of three related aspects: cognitive-behavioral therapy, relaxation techniques, and problem-solving strategies. Beck Depression Inventory II scores were significantly lower after telecare treatment. Women identified psycho-education as the greatest help to them.     

Complementary health approaches for postpartum depression: A systematic review

Postpartum Depression (PPD) affects approximately 9 - 20% of women. Many women with PPD go undiagnosed and/ or do not follow through on referrals for treatment. Although the most routinely prescribed treatments for PPD are antidepressant medication and psychotherapy, a significant number of women desire non-traditional options. This article provides a systematic review of ten recently published, randomized clinical trials in the examination of the effectiveness of complementary health approaches—the use of non-mainstream products and interventions—on PPD. A search of nine databases of the English language literature from the years 2006 to 2018 was performed. Review criteria included published work, utilization of randomized-controlled trials, and the use of a reliable and valid measurement tool to identify cases of PPD and monitor changes in symptom severity. The studies reviewed focused on the following interventions: aromatherapy, bright light therapy, electroacupuncture, infant massage, iron supplementation, mindfulness training, omega-3 fatty acids, saffron, and yoga. Outcomes demonstrate the feasibility and safety of these approaches, as well as varying degrees of effectiveness. While many were pilot studies using small sample sizes, the results are encouraging and substantiate the need for additional trials. Studies are summarized and limitations and implications for social work and future research are described.     

Screening for depression and suicide: self-report instruments that work

Self-report instruments for depression and suicide risk can help busy clinicians identify adult clients who may be at risk for depressive disorders. These instruments provide a baseline measure of clients' behavioral status, reflect response to treatment, and improve clinical decision making. Such scales can also detect symptoms of depression regardless of whether they are reported or observed. Clinicians' recognition of depression is improved when self-report screening tools are used. When it is not feasible to conduct a thorough psychiatric evaluation, screening instruments can identify at-risk clients who need further evaluation.     

Using social media-based drama therapy and family counselling to treat symptoms of postpartum depression among women

This study examines the impact of social media-based drama therapy and family counselling in reducing symptoms of postpartum depression (PPD) in women aged 18–34. The researchers used a quasi-experimental design and randomly assigned the participants (n = 303) to the control, drama therapy, and family counselling groups. The key findings of the study are as follows. First, at baseline, women not only showed more symptoms of PPD than their male counterparts, but men also reached the PPD threshold of 12/13. Second, the difference between women and men regarding their PPD scores achieved statistical significance (p = 0.004). However, during the post-intervention assessment, men who received drama therapy intervention reported a significant drop in their PPD below the threshold of 12/13. Only women whose spouses received family counselling on spousal support reported a significant drop in their PPD. However, those whose partners did not receive family counselling on spousal support still reported PPD scores within the threshold. In both instances, women in the control group still had high PPD scores. Finally, during the 6-month follow-up assessment, even men in the control group did not have significant symptoms of PPD as their scores dropped below the threshold. On the contrary, women in the control group still had high PPD, indicating that PPD lasted more in women than in men. Also, women whose husbands received family counselling on spousal support reported PPD scores below the threshold. However, women whose husbands did not receive spousal counselling still had PPD scores at the threshold, even though their scores marginally dropped.     

Screening for trauma exposure, and posttraumatic stress disorder and depression symptoms among mothers receiving child welfare preventive services

The role of parental trauma exposure and related mental health symptoms as risk factors for child maltreatment for parents involved with the child welfare (CW) system has received limited attention. In particular, little is known about the extent to which mothers receiving CW services to prevent maltreatment have experienced trauma and suffered trauma-related psychopathology. This study examined screening data collected from 127 mothers receiving CW preventive services. There were high levels of trauma exposure among screened mothers and their young children. Among mothers, 91.6% experienced at least one traumatic event (M = 2.60) and 92.2% reported their children had been exposed to one or more traumas (M = 4.85). Mothers reported high levels of trauma-related symptoms: 54.3% met probable criteria for posttraumatic stress disorder (PTSD) or depression (61.7%). Nearly half (48.8%) met criteria for co-morbid PTSD and depression. The large majority of the clients with trauma-related disorders were not receiving mental health services. Latina women had significantly more severe PTSD symptoms than African American women. Case planners reported that the screening process was useful and feasible. These findings underscore the feasibility and importance of trauma screening among parents receiving CW preventive services.     

Tuberculosis Screening for International Students

Abstract

Nonimmigrant, international students entering colleges in the United States are not required to undergo screening for tuberculosis (TB). Thirty-nine percent of active TB cases in the United States are in foreign-born individuals. In an effort to minimize the occurrence of active TB on a community campus with an increasing international student population, the college health service implemented a TB-screening policy for all newly enrolled international students. For the 1997/98 school year, 171 international students from 70 different countries enrolled in classes. Fifty-nine students (35%) screened for TB had a positive skin test (greater than 10 mm induration). Of those, 34 initiated isoniazid therapy, and 27 successfully completed the prescribed regimen under supervision of the campus health office.     

Vagus nerve stimulation for severe depression

Treatment-resistant depression is a serious problem with significant costs in terms of health care dollars and patients' well-being. Vagus nerve stimulation (VNS) is one novel, device-based therapy that may be effective in this population. In this article, we review the evidence to date on the use of VNS in major depression and describe the process of VNS treatment initiation, device implantation, and dosage adjustment and monitoring. It is important for psychiatric nurses to understand the evidence base for and how VNS is used in treatment so they may enhance care of patients with treatment-resistant depression.     

Screening college students for hypercholesterolemia.

Selective screening for children and mass screening for adults are the two strategies for detecting hypercholesterolemia and identifying individuals at risk for early heart attacks that have been recommended by the American Academy of Pediatrics and the American Medical Association. The interval marking the end of childhood and the beginning of adulthood is a time of transition without an unwavering demarcation line. It is a time when many adult disorders that demand attention and detection begin. Because of the close relationship of elevated cholesterol levels in youth to subsequent cardiovascular disease, a small liberal arts university began mandatory mass cholesterol screening for all full- or part-time students who matriculated in September 1977. More than thirty 18- and 19-year-old first-year students with unknown hypercholesterolemia were detected each year. The mean cost per case identified is estimated to have been $212. The author concluded that mass screening of students entering college can identify, at a reasonable cost, students who have high levels of cholesterol.     

Dietary supplement drug therapies for depression

Many dietary supplements are readily accessible and commonly used for the treatment of depression. A dietary supplement is a product intended to supplement the diet but is not intended to treat, diagnose, prevent, or cure disease. The U.S. Food and Drug Administration can take action against dietary supplement manufacturers for products only after they are marketed, mainly if the product is found to be unsafe or if false or misleading claims are made about the product. Few dietary supplement products have been adequately studied for their safety and efficacy. Of the five products reviewed in this article (L-methylfolate, S-adenosyl-L-methionine [SAM-e], omega-3 fatty acids, L-tryptophan, and inositol), only omega-3 fatty acids and SAM-e have sufficient supporting evidence for their efficacy to warrant safe use.     

Screening for hypercholesterolemia in college students

Two national panels have recommended similar, specific strategies for detecting hypercholesterolemia: selective screening for children aged 2 to 19, and mass screening for individuals aged 20 and over. It is, however, unclear how best to apply these recommendations to a college student population. In order to determine which strategy is more efficient, this study compared mass with selective screening of college students for hypercholesterolemia. In the mass screening strategy, all entering students were asked to have their cholesterol levels measured and to provide other coronary risk factor information. In the selective screening strategy, all sophomores with a family history of heart disease were asked to participate in a risk factor screening program. In this study, mass screening identified more hypercholesterolemic students with less effort per case found than did selective screening. We recommend that college health practitioners consider mass screening programs to identify students who could benefit from coronary risk reduction.     

Use of endocrine hormones for treating depression

Disturbances in some endocrine hormones have been implicated in the pathophysiology of depression. Some of these hormones (and drugs that affect hormone function) have been used as therapeutic agents for the treatment of depression, especially adrenal, thyroid, and gonadal axis hormones. Open-label and controlled studies of various drugs that directly suppress or inhibit adrenal axis function have shown some benefit for the treatment of major depression, including treatment-resistant depression. Thyroid hormone augmentation is effective for nonresponders to antidepressant agents, although it has not been studied extensively. Estrogen may improve mild mood symptoms in perimenopausal women but may not be effective alone for major depression. Evidence of the antidepressant effects of testosterone in men is inconsistent, with mixed results from controlled studies. The adrenal steroid hormone dehydroepiandrosterone has an important role in mood regulation and may have significant antidepressant effects.     

Sleep interventions for the treatment of depression

Sleep disturbances are common in depressed patients. Insomnia may predate the onset of major depression, increases the likelihood of a depressive relapse, and is associated with an impaired response to treatment. Benzodiazepine drugs may have inherent antidepressant effects; thus, these and other sedative-hypnotic drugs can be beneficial for treating insomnia in depressed patients and may enhance the overall effectiveness of antidepressant drugs. Sedating antidepressant drugs are used for treating primary insomnia, but their sleep-promoting effects have been demonstrated primarily in depressed patients. Several second-generation antipsychotic drugs are used in low doses to promote sleep, but they also have inherent antidepressant effects. Cognitive-behavioral therapy targeting insomnia can effectively enhance the response to antidepressant medication. Sleep deprivation, which is also associated with a transient antidepressant effect, is difficult to use in routine clinical practice but might be an appropriate strategy for treatment-resistant forms of depression.     

Screening for pediatric bipolar disorder in primary care

A child or adolescent with pediatric bipolar disorder (PBD) is at higher risk for suicide, violence, and impaired psychosocial functioning. The prevalence of diagnosed PBD has increased 40-fold in less than 2 decades, leading some to believe that PBD is inaccurately diagnosed. Complicating this issue, disagreements exist among clinicians as to the utility of current screening methods. The assessment picture is further muddied by the high rate of comorbid psychiatric conditions. A literature review was performed to describe the present understanding of PBD and identify current practices of screening for the disorder. Although screening tools are available, the literature suggests they lack validity. Awareness, a thorough interview, and expedient referral may assist clinicians in making a correct diagnosis. Accurate assessment will help ease the psychological and economic burden of PBD.     

Esketamine for depression faces real‐world barriers

Like its predecessor intravenous ketamine, an anesthetic that has been used off‐label to treat depression, esketamine has shown great promise in treating a disease that can destroy quality of life and lead to suicide. The Food and Drug Administration (FDA) approved esketamine (Spravato) last spring for treating depression that is resistant to traditional treatments.     

Neurosurgical approaches to therapeutic brain stimulation for treatment-resistant depression

During the 1940s and 1950s, psychosurgery was used for the treatment of severe mental disorders but was associated with significant complications. These problems and the advent of psychotropic drugs led to a decline in the use of psychosurgery. Neuroanatomical and brain imaging studies have revealed distinct brain regions and the pathways that connect them, which may underlie depression and other mental disorders. On the basis of this knowledge, modern stereotactic neurosurgical methods have been used to implant electrodes in the brain to provide therapeutic stimulation. Electrical stimulation by these electrodes with pacemaker-like devices can be used to modulate brain function by stimulating or inhibiting the activity of specific brain regions, without causing permanent or destructive lesions that cannot be reversed. Deep brain stimulation and cortical brain stimulation are two such neurosurgical approaches to therapeutic brain stimulation for treatment-resistant depression.