Association between maternity leave policies and postpartum depression: a systematic review.

PURPOSE: Working mothers are at greater risk for postpartum depression. Maternity leave characteristics, including length, wage replacement and employment protection, could have relevant implications for mothers' mental health. We propose to explore whether there is an association between maternity leave characteristics and postpartum depression. METHODS: We conducted a systematic review searching for randomized controlled trials, quasi-experimental, cohort or cross-sectional studies on five databases using search terms including maternity and parental leave and depression, as well as references in relevant articles. We identified 500 articles and included 23 of those. We used the EPHPP Quality Assessment Tool for Quantitative Studies to assess the quality of the studies. RESULTS: Paid and longer maternity leaves tend to be associated with a reduction of postpartum depression symptoms in high-income countries. No studies explored the association between employment protection and postpartum depression. The quality of studies ranged from strong to weak, mostly influenced by study design. CONCLUSION: More restrictive maternity leave policies tend to be associated with higher rates of postpartum depression, although more research needs to be conducted in the Global South.

Recruitment, training and supervision of nurses and nurse assistants for a task-shifting depression intervention in two RCTs in Brazil and Peru.

BACKGROUND: Task-shifting and technology in psychological interventions are two solutions to increasing access to mental health intervention and overcoming the treatment gap in low and middle-income countries. The CONEMO intervention combines a smartphone app with support from non-specialized professionals, aiming to treat depression in patients with diabetes and/or hypertension. The aim of this paper is to describe the process of recruitment, training and supervision of the non-specialized professionals who participated in the CONEMO task-shifting intervention in Brazil and Peru. METHODS: We described and analyzed data related to the recruitment, training and supervision of 62 nurse assistants from the health system in Sao Paulo, Brazil, and three hired nurses in Lima, Peru. The data were collected from information provided by nurses and nurse assistants, supervisor records from supervision meetings and the CONEMO platform database. RESULTS: We found that task-shifting was feasible using existing resources in Sao Paulo and additional human resources in Lima. Training and supervision were found to be crucial and well received by the staff; however, time was a limitation when using existing human resources. Ensuring technological competence prior to the start of the intervention was essential. Group supervision meetings allowed non-specialized professionals to learn from each other's experiences. CONCLUSION: Carefully considering recruitment, training and supervision of non-specialized professionals is important for effective task-shifting when delivering an mHealth intervention for depression. Opportunities and challenges of working in different health systems are described, which should be considered in future implementation, either for research or real settings. Trial registration NCT028406662 (Sao Paulo), NCT03026426 (Peru).

Effect of a Digital Intervention on Depressive Symptoms in Patients With Comorbid Hypertension or Diabetes in Brazil and Peru: Two Randomized Clinical Trials.

Importance: Depression is a leading contributor to disease burden globally. Digital mental health interventions can address the treatment gap in low- and middle-income countries, but the effectiveness in these countries is unknown. Objective: To investigate the effectiveness of a digital intervention in reducing depressive symptoms among people with diabetes and/or hypertension. Design, Setting, and Participants: Participants with clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) who were being treated for hypertension and/or diabetes were enrolled in a cluster randomized clinical trial (RCT) at 20 sites in São Paulo, Brazil (N=880; from September 2016 to September 2017; final follow-up, April 2018), and in an individual-level RCT at 7 sites in Lima, Peru (N=432; from January 2017 to September 2017; final follow-up, March 2018). Interventions: An 18-session, low-intensity, digital intervention was delivered over 6 weeks via a provided smartphone, based on behavioral activation principles, and supported by nurse assistants (n = 440 participants in 10 clusters in São Paulo; n = 217 participants in Lima) vs enhanced usual care (n = 440 participants in 10 clusters in São Paulo; n = 215 participants in Lima). Main Outcomes and Measures: The primary outcome was a reduction of at least 50% from baseline in PHQ-9 scores (range, 0-27; higher score indicates more severe depression) at 3 months. Secondary outcomes included a reduction of at least 50% from baseline PHQ-9 scores at 6 months. Results: Among 880 patients cluster randomized in Brazil (mean age, 56.0 years; 761 [86.5%] women) and 432 patients individually randomized in Peru (mean age, 59.7 years; 352 [81.5%] women), 807 (91.7%) in Brazil and 426 (98.6%) in Peru completed at least 1 follow-up assessment. The proportion of participants in São Paulo with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 40.7% (159/391 participants) in the digital intervention group vs 28.6% (114/399 participants) in the enhanced usual care group (difference, 12.1 percentage points [95% CI, 5.5 to 18.7]; adjusted odds ratio [OR], 1.6 [95% CI, 1.2 to 2.2]; P = .001). In Lima, the proportion of participants with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 52.7% (108/205 participants) in the digital intervention group vs 34.1% (70/205 participants) in the enhanced usual care group (difference, 18.6 percentage points [95% CI, 9.1 to 28.0]; adjusted OR, 2.1 [95% CI, 1.4 to 3.2]; P < .001). At 6-month follow-up, differences across groups were no longer statistically significant. Conclusions and Relevance: In 2 RCTs of patients with hypertension or diabetes and depressive symptoms in Brazil and Peru, a digital intervention delivered over a 6-week period significantly improved depressive symptoms at 3 months when compared with enhanced usual care. However, the magnitude of the effect was small in the trial from Brazil and the effects were not sustained at 6 months. Trial Registration: ClinicalTrials.gov: NCT02846662 (São Paulo) and NCT03026426 (Lima).

[Insulin: prices, availability, and affordability in public and private Peruvian pharmaciesPreço, disponibilidade e acessibilidade à insulina em farmácias públicas e privadas no Peru]. / Precios, disponibilidad y asequibilidad de insulina en farmacias públicas y privadas en Perú.

OBJECTIVE: Measure and compare the price, availability, and affordability of insulin and metformin in public and private pharmacies in six regions of Peru. METHODS: Cross-sectional study using the World Health Organization/Health Action International (WHO/HAI) revised methodology. Public and private pharmacies in six regions of Peru were surveyed. Data were collected on availability and prices for insulin (all types) and 850 mg metformin. Availability is expressed as percentages and prices are reported in medians. Affordability is defined as the number of days that a person must work at minimum wage to cover the cost of one month of treatment. RESULTS: Availability in public pharmacies is 63.2% for regular insulin and 68.4% for NPH (isophane) insulin, but differences in availability were observed between levels of care and between regions. Private pharmacies have a greater variety of insulin, but availability is less than 11%. The median price of human insulin was three to four times higher in private pharmacies than in public pharmacies. In comparison, availability of metformin was 89.5% in public pharmacies and 77.7% in private ones. Affordability in public pharmacies for one month of treatment with human insulin or generic metformin is less than one day's wages. CONCLUSIONS: The price for human insulin and generic metformin in public pharmacies is affordable. However, efforts are needed to improve their availability in the different regions and levels of care.

OBJETIVO: Avaliar o preço, a disponibilidade e a acessibilidade à insulina e metformina, como comparativo, em farmácias públicas e privadas em seis regiões do Peru. MÉTODOS: Estudo transversal conduzido com metodologia adaptada da Organização Mundial da Saúde/Ação Internacional para a Saúde (OMS/AIS). Farmácias públicas e privadas foram pesquisadas em seis regiões do Peru com a coleta de dados sobre a disponibilidade e os preços da insulina (de todos os tipos) e metformina na apresentação de 850 mg. A disponibilidade é expressa em porcentagem e os preços estão descritos como mediana. A acessibilidade foi definida no estudo como o número de dias que um indivíduo que ganha salário mínimo precisa trabalhar para arcar com o custo de um mês de tratamento. RESULTADOS: A disponibilidade em farmácias públicas da insulina regular foi de 63,2% e da insulina isófana (NPH) foi de 68,4%, porém se observou diferença de disponibilidade entre os níveis de atenção e as regiões. Nas farmácias privadas, a variedade de insulinas é maior, mas a disponibilidade é inferior a 11%. A mediana de preços para a insulina humana nas farmácias privadas é 3 a 4 vezes maior que nas farmácias públicas. Comparativamente, a disponibilidade da metformina foi de 89,5% nas farmácias públicas e 77,7% nas farmácias privadas. A acessibilidade nas farmácias públicas para um mês de tratamento com insulina humana ou metformina genérica é inferior à remuneração de um dia de trabalho. CONCLUSÕES: As insulinas humanas e a metformina genérica têm preço acessível nas farmácias públicas. Porém, esforços devem ser empreendidos para aumentar a disponibilidade destes medicamentos nos níveis de atenção e nas regiões.

One-year recovery rates for young people with depression and/or anxiety not receiving treatment: a systematic review and meta-analysis.

OBJECTIVES: To systematically review 1-year recovery rates for young people experiencing depression and/or anxiety who are not receiving any specific mental health treatment. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, Embase, PsycINFO, Web of Science and Global Health were searched for articles published from 1980 through to August 2022. ELIGIBILITY CRITERIA: Articles were peer-reviewed, published in English and had baseline and 1-year follow-up depression and/or anxiety outcomes for young people aged 10-24 years without specific treatment. DATA EXTRACTION AND SYNTHESIS: Three reviewers extracted relevant data. Meta-analysis was conducted to calculate the proportion of individuals classified as recovered after 1 year. The quality of evidence was assessed by the Newcastle-Ottawa Scale. RESULTS: Of the 17 250 references screened for inclusion, five articles with 1011 participants in total were included. Studies reported a 1-year recovery rate of between 47% and 64%. In the meta-analysis, the overall pooled proportion of recovered young people is 0.54 (0.45 to 0.63). CONCLUSIONS: The findings suggest that after 1 year about 54% of young people with symptoms of anxiety and/or depression recover without any specific mental health treatment. Future research should identify individual characteristics predicting recovery and explore resources and activities which may help young people recover from depression and/or anxiety. PROSPERO REGISTRATION NUMBER: CRD42021251556.

Systematic Review of Policies and Interventions to Prevent Sexual Harassment in the Workplace in Order to Prevent Depression.

BACKGROUND: Sexual harassment in the workplace (SHWP) is highly prevalent and has a negative impact, including depression, on its victims, as well as a negative economic impact resulting from absenteeism and low productivity at work. This paper aims to outline the available evidence regarding the prevention of depressive symptoms among workers through policies and interventions that are effective in preventing SHWP. METHODS: We conducted two systematic reviews. The first focused on the association of depression and SHWP, and the second on policies and interventions to prevent SHWP. We conducted a meta-analysis and a narrative synthesis, respectively. We identified 1831 and 6107 articles for the first and second review. After screening, 24 and 16 articles were included, respectively. RESULTS: Meta-analysis results show a prevalence of depression of 26%, as well as a 2.69 increased risk of depression among workers who experience SHWP. Variables such as number of harassment experiences and exposure to harassment from coworkers and other people increase this risk. CONCLUSIONS: There is limited evidence regarding the effectiveness of policies and training to prevent SHWP, mostly focused on improvements in workers' knowledge and attitudes about SHWP. However, there is no available evidence regarding its potential impact on preventing depression.

Using Arts-Based Methodologies to Understand Adolescent and Youth Manifestations, Representations, and Potential Causes of Depression and Anxiety in Low-Income Urban Settings in Peru.

BACKGROUND: Arts-based methodologies can be beneficial to identify different representations of stigmatized topics such as mental health conditions. This study used a theater-based workshop to describe manifestations, representations, and potential causes of depression and anxiety as perceived by adolescents and young adults. METHODS: The theater company Teatro La Plaza conducted three online sessions with a group of adolescents and another with a group of young adults from Lima, Peru. The artistic outputs, which included images, similes, monologues, and narrations, were used to describe the experiences of depression and anxiety symptoms following a content analysis using posteriori categories. RESULTS: Seventeen participants joined the sessions. The artistic outputs showed: physical, behavioral, cognitive, and emotional manifestations of depression and anxiety; a perception that both disorders have a cyclical nature; and an awareness that it is often difficult to notice symptom triggers. The mandatory social isolation due to the COVID-19 pandemic was highlighted as an important symptom trigger, mostly linked to anxiety. CONCLUSIONS: The findings are consistent with the literature, especially with regard to the manifestations, representations, and potential causes that trigger depression and anxiety. Using arts-based methods allowed adolescents and young adults to expand the articulation of their representations of mental disorders.

Identifying resources used by young people to overcome mental distress in three Latin American cities: a qualitative study.

OBJECTIVE: To explore which resources and activities help young people living in deprived urban environments in Latin America to recover from depression and/or anxiety. DESIGN: A multimethod, qualitative study with 18 online focus groups and 12 online structured group conversations embedded into arts workshops. SETTING: This study was conducted in Bogotá (Colombia), Buenos Aires (Argentina) and Lima (Peru). PARTICIPANTS: Adolescents (15-16 years old) and young adults (20-24 years old) with capacity to provide assent/consent and professionals (older than 18 years of age) that had experience of professionally working with young people were willing to share personal experience within a group, and had capacity to provide consent. RESULTS: A total of 185 participants took part in this study: 111 participants (36 adolescents, 35 young adults and 40 professionals) attended the 18 focus groups and 74 young people (29 adolescents and 45 young adults) took part in the 12 arts workshops. Eight categories captured the resources and activities that were reported by young people as helpful to overcome mental distress: (1) personal resources, (2) personal development, (3) spirituality and religion, (4) social resources, (5) social media, (6) community resources, (7) activities (subcategorised into artistic, leisure, sports and outdoor activities) and (8) mental health professionals. Personal and social resources as well as artistic activities and sports were the most common resources identified that help adolescents and young adults to overcome depression and anxiety. CONCLUSION: Despite the different contexts of the three cities, young people appear to use similar resources to overcome mental distress. Policies to improve the mental health of young people in deprived urban settings should address the need of community spaces, where young people can play sports, meet and engage in groups, and support community organisations that can enable and facilitate a range of social activities.