Adult separation anxiety during pregnancy and its relationship to depression and anxiety.

AIMS: The current study, the first of its kind, investigated the overlap between adult separation anxiety (ASA) and the symptoms of depression and anxiety in the context of pregnancy. METHODS: Women attending an antenatal clinic were screened using the Adult Separation Anxiety Scale (ASA-27). As most perinatal clinics use the Edinburgh Depression Scale (EDS), this study explored the relationship between ASA and the anxiety and depression symptoms by comparing the ASA-27 scores with the scores on the EDS. A subsample including both screen positives and screen negatives on ASA-27 was clinically interviewed using the Mini International Neuropsychiatric Interview (MINI). RESULTS: Women with ASA were significantly more likely to be screened positive for depression (EDS total score) and anxiety (EDS-3A anxiety subscale) than those without ASA. The diagnosis of ASA disorder in this population had only a moderate but significant association with the diagnoses of generalized anxiety disorder [χ2 (1) = 25.9, P = 0.000, Φ = 0.443] and major depression [χ2 (1) = 16, P = 0.000, Φ = 0.348] made using the MINI. CONCLUSION: Adult separation anxiety warrants independent assessment in order to tailor appropriate interventions for the individual subtypes of anxiety in the perinatal period.

Adult separation anxiety in pregnancy: how common is it?

The present study, the first to examine adult separation anxiety (ASA) in the context of pregnancy, found that ASA is a common yet unrecognized condition. Women attending an antenatal clinic were evaluated for the presence of ASA. A quarter of the women reached an established symptom threshold for ASA, with significantly more primigravida women (P = 0.003) identified as having the problem. There were no significant differences in the sociodemographic characteristics between those with and without ASA. Around one-third acknowledged that ASA was causing significant impairment in day-to-day functioning, suggesting the clinical importance of the pattern. Further research is indicated to explore this clinical entity and its impact on maternal and infant psychosocial wellbeing.

Citalopram for major depressive disorder in adults: a systematic review and meta-analysis of published placebo-controlled trials.

Objective To assess the effectiveness of citalopram for major depressive disorder (MDD) in adults, in a systematic review of all published, randomised, double-blind studies comparing it with a placebo. Data sources Cochrane Central Register of Controlled Trials, Medline, PsychINFO and Embase. Study selection Randomised, double-blind, placebo-controlled studies of citalopram in adults with MDD were included. Studies with medically ill or treatment resistant subjects were excluded, as were studies of relapse prevention. Remission of MDD was defined as a primary outcome, and response or change from baseline scores were defined as secondary. Data extraction Remission, response and symptom improvement scores on the Hamilton Depression Scale, Montgomery-Asberg Depression Rating Scale and Clinical Global Impressions-Severity scales were extracted. A random-effects meta-analysis was carried out on the response rates and symptom improvement scores. Included studies were examined for the presence of bias and small study effects. Results Eight studies (n=2025) met the inclusion criteria. Two studies provided data on remission, but only one of these showed a significant difference between citalopram and placebo (RR=1.59, 95% CI 1.10 to 2.31). Meta-analysis of response rates in five studies (n=1010) revealed significant superiority of citalopram (RR=1.42, 95% CI 1.17 to 1.73). Meta-analysis of change from baseline scores in five studies (n=1541) gave a standardised mean difference (Hedges' g) of -0.27 (95% CI -0.38 to to -0.16), showing a reduction in MDD symptoms to be significant for citalopram relative to placebo. There was no evidence of any significant small study effects. The overall quality of reporting was poor, with insufficient information on the methodology or outcomes. Seven studies received industry sponsorship. Conclusions Data concerning remission rates for citalopram, relative to placebo, are inconclusive. Response rates and symptom reduction scores in citalopram-treated patients with MDD are significantly better relative to placebo treatment, according to a meta-analysis of published reports. Evaluation of unpublished data is necessary to assess more definitively the effectiveness of citalopram for MDD.