Group-based multicomponent treatment to reduce depressive symptoms in women with co-morbid psychiatric and psychosocial problems during pregnancy: A randomized controlled trial

Leontien M Van Ravesteyn; Astrid M Kamperman; Tom A J Schneider; Monique E Raats; Eric A P Steegers; Henning Tiemeier; Witte J G Hoogendijk; Mijke P Lambregtse-van den Berg

doi:10.1016/j.jad.2017.09.019

Group-based multicomponent treatment to reduce depressive symptoms in women with co-morbid psychiatric and psychosocial problems during pregnancy: A randomized controlled trial

Leontien M Van Ravesteyn, Astrid M Kamperman, Tom A J Schneider, Monique E Raats, Eric A P Steegers, Henning Tiemeier, Witte J G Hoogendijk, Mijke P Lambregtse-van den Berg

Research output: Contribution to journal › Article › Academic › peer-review

11 Citations (Scopus)

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 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.

Original language	English
Pages (from-to)	36-44
Number of pages	9
Journal	Journal of Affective Disorders
Volume	226
DOIs	https://doi.org/10.1016/j.jad.2017.09.019
Publication status	Published - 15-Jan-2018
Externally published	Yes

Keywords

Adult
Cognitive Behavioral Therapy
Comorbidity
Counseling
Depression, Postpartum/epidemiology
Depressive Disorder/epidemiology
Female
Humans
Mental Disorders/epidemiology
Patient Education as Topic
Patient Satisfaction
Pregnancy
Pregnant Women
Psychiatric Status Rating Scales
Surveys and Questionnaires
Treatment Outcome
Young Adult

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Van Ravesteyn, L. M., Kamperman, A. M., Schneider, T. A. J., Raats, M. E., Steegers, E. A. P., Tiemeier, H., Hoogendijk, W. J. G., & Lambregtse-van den Berg, M. P. (2018). Group-based multicomponent treatment to reduce depressive symptoms in women with co-morbid psychiatric and psychosocial problems during pregnancy: A randomized controlled trial. Journal of Affective Disorders, 226, 36-44. https://doi.org/10.1016/j.jad.2017.09.019

@article{d8c7c3dda72047799921d2d3fe0e1f44,

title = "Group-based multicomponent treatment to reduce depressive symptoms in women with co-morbid psychiatric and psychosocial problems during pregnancy: A randomized controlled trial",

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 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.",

keywords = "Adult, Cognitive Behavioral Therapy, Comorbidity, Counseling, Depression, Postpartum/epidemiology, Depressive Disorder/epidemiology, Female, Humans, Mental Disorders/epidemiology, Patient Education as Topic, Patient Satisfaction, Pregnancy, Pregnant Women, Psychiatric Status Rating Scales, Surveys and Questionnaires, Treatment Outcome, Young Adult",

author = "{Van Ravesteyn}, {Leontien M} and Kamperman, {Astrid M} and Schneider, {Tom A J} and Raats, {Monique E} and Steegers, {Eric A P} and Henning Tiemeier and Hoogendijk, {Witte J G} and {Lambregtse-van den Berg}, {Mijke P}",

year = "2018",

month = jan,

day = "15",

doi = "10.1016/j.jad.2017.09.019",

language = "English",

volume = "226",

pages = "36--44",

journal = "Journal of Affective Disorders",

issn = "0165-0327",

publisher = "ELSEVIER SCIENCE BV",

}

Van Ravesteyn, LM, Kamperman, AM, Schneider, TAJ, Raats, ME, Steegers, EAP, Tiemeier, H, Hoogendijk, WJG & Lambregtse-van den Berg, MP 2018, 'Group-based multicomponent treatment to reduce depressive symptoms in women with co-morbid psychiatric and psychosocial problems during pregnancy: A randomized controlled trial', Journal of Affective Disorders, vol. 226, pp. 36-44. https://doi.org/10.1016/j.jad.2017.09.019

Group-based multicomponent treatment to reduce depressive symptoms in women with co-morbid psychiatric and psychosocial problems during pregnancy: A randomized controlled trial. / Van Ravesteyn, Leontien M; Kamperman, Astrid M; Schneider, Tom A J et al.
In: Journal of Affective Disorders, Vol. 226, 15.01.2018, p. 36-44.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Group-based multicomponent treatment to reduce depressive symptoms in women with co-morbid psychiatric and psychosocial problems during pregnancy

T2 - A randomized controlled trial

AU - Van Ravesteyn, Leontien M

AU - Kamperman, Astrid M

AU - Schneider, Tom A J

AU - Raats, Monique E

AU - Steegers, Eric A P

AU - Tiemeier, Henning

AU - Hoogendijk, Witte J G

AU - Lambregtse-van den Berg, Mijke P

PY - 2018/1/15

Y1 - 2018/1/15

N2 - 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.

AB - 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.

KW - Adult

KW - Cognitive Behavioral Therapy

KW - Comorbidity

KW - Counseling

KW - Depression, Postpartum/epidemiology

KW - Depressive Disorder/epidemiology

KW - Female

KW - Humans

KW - Mental Disorders/epidemiology

KW - Patient Education as Topic

KW - Patient Satisfaction

KW - Pregnancy

KW - Pregnant Women

KW - Psychiatric Status Rating Scales

KW - Surveys and Questionnaires

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1016/j.jad.2017.09.019

DO - 10.1016/j.jad.2017.09.019

M3 - Article

C2 - 28950157

SN - 0165-0327

VL - 226

SP - 36

EP - 44

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

ER -

Group-based multicomponent treatment to reduce depressive symptoms in women with co-morbid psychiatric and psychosocial problems during pregnancy: A randomized controlled trial

Abstract

Keywords

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