Suicide Attempts during Pregnancy and Postpartum: A Systematic Review and Meta-Analysis.

PURPOSE: Suicide attempts (SA) during perinatal period have the potential to adversely affect a woman's health and her developing infant. To date, little is known about perinatal SA and their risk factors. This study aimed to synthetize the evidence on risk factors of SA in pregnant and postpartum women. METHODS: We systematically reviewed studies retrieved from PubMed/Medline, PsycINFO, and CINAHL, following the PRISMA guidelines for reporting. A meta-analysis was conducted only for risk factors examined in at least three distinct samples. RESULTS: A total of ten studies were eligible for inclusion. All the studies found significant associations in regression models between perinatal SA and other variables (sociodemographic, clinical factors obstetric, neonatal, and psychosocial). The meta-analysis showed that unmarried women (pooled OR = 1.87, 95% CI = 1.26-2.78), with no higher education (pooled OR = 1.89, 95% CI = 1.31-2.74) and affected by a mood disorder (pooled OR = 11.43, 95% CI = 1.56-83.87) have a higher risk of postpartum SA; women who smoke during pregnancy (pooled OR = 3.87, 95% CI = 1.35-11.11) have a higher risk of SA in pregnancy; and women with previous suicidal behavior(pooled OR = 38.04, 95% CI = 3.36-431.17) have a higher risk of perinatal SA, whether during pregnancy or in the postpartum period. The type of sample, whether community or clinical, is a relevant moderating factor. CONCLUSION: Our study extends prior reviews about suicidal behaviors in women by studying perinatal suicide attempts independently, as well as it synthesized data on some sociodemographic, clinical, and obstetric/neonatal risk factors. Further studies about specific risk factors for perinatal SA are needed in order to improve early detection and intervention of women at risk.

SIGNIFICANCE: Suicide attempts during pregnancy and the postpartum period pose a severe risk to the health of women and the development of their infants. Despite their importance, little is known about specific risk factors for these attempts during the perinatal period. This study is the first meta-analysis to synthesize risk factors associated with suicide attempts in pregnant and postpartum women. We found that unmarried women, those without higher education, and those with mood disorders are at higher risk for postpartum suicide attempts; women who smoke during pregnancy are at higher risk for suicide attempts during pregnancy; and those with previous suicidal behavior are at higher risk for perinatal suicide attempts. Our study extends prior reviews by independently examining perinatal suicide attempts and synthesizing data on sociodemographic, clinical, and obstetric/neonatal risk factors. Further studies on specific risk factors for perinatal suicide attempts are needed to improve early detection and intervention for women at risk.

Efficacy of EMDR for early intervention after a traumatic event: A systematic review and meta-analysis.

BACKGROUND: Eye Movement Desensitization and Reprocessing (EMDR) is a well-established psychological therapy for the treatment of post-traumatic stress disorder, based on the recommendations of clinical practice guidelines. However, these guidelines are not as consistent in recommending EMDR interventions for the early treatment of post-traumatic symptoms. The main objective of this review is to evaluate the effectiveness of EMDR therapy for early intervention after a traumatic event. METHODS: A systematic search for randomized clinical trials has been carried out in the PUBMED, CINAHL, Psyc-INFO and Cochrane Library search engines. We included individuals exposed to a recent traumatic event (within 3 months of a traumatic incident). Outcomes on PTSD, depression and anxiety in post-treatment, and at follow-up at 3, 6 and 12 months, as well as on safety and tolerability were extracted. RESULTS: A total of 11 RCTs were found. Studies showed beneficial effects of early EMDR interventions on post-traumatic symptoms at post-treatment and at 3-month follow-up. No differences were found between EMDR and no intervention or another intervention in the remaining analyses. LIMITATIONS: The main limitations are the low quality of the studies, the small number of studies per outcome assessed, and the small sample sizes. CONCLUSIONS: There is evidence for the short-term beneficial effect of early EMDR interventions on post-traumatic symptoms. Although it appears to be a safe therapeutic choice, more studies are necessary that include safety data.

Efficacy of contextual therapies in perinatal depression and anxiety: A systematic review and meta-analysis.

BACKGROUND: There are previous meta-analyses on the efficacy of cognitive behavioral therapy or mindfulness-based therapies in the perinatal period, but no previous review has focused on contextual therapies as a whole. The aim of this study was to carry out a systematic review and meta-analysis of the efficacy of contextual therapies on depressive and anxious symptoms in women in the perinatal period. METHODS: A systematic search for randomized clinical trials has been carried out in the PUBMED, CINAHL, Psyc-INFO and Cochrane Library search engines. For the quantitative synthesis, the Morris effect size measure has been used. RESULTS: A total of 34 RCTs have been found, of which 30 have been used for meta-analysis. The mean effect size of the studies on depression scores was dppc2 = -0.81 (95% CI = -1.12 to -0.50), while it was dppc2 = -1.04 (95% CI = -1.54 to -0.53) in the case of studies on anxiety scores. These effect sizes decreased to medium effect sizes when corrected for publication bias. LIMITATIONS: The main limitations are the quality of the included studies, publication bias, and the limited number of studies on contextual therapies other than mindfulness-based therapies. CONCLUSIONS: In conclusion, this systematic review found a large number of efficacy studies on mindfulness-based therapies and a small number of studies on the other contextual therapies. The effect sizes found are consistent with previous meta-analyses in the perinatal period.

Grupo de vínculo madre-bebé para mujeres con trastorno mental perinatal y sus lactantes / Grup de vincle mare-nadó per a dones amb trastorn mental perinatal i els seus lactants / Mother-Baby Bonding Group for women with perinatal mental disorders and their infants

Este estudio presenta el Grupo de Vínculo Madre-Bebé, una intervención grupal diseñada para la mejoría del vínculo en madres y sus lactantes menores de seis meses en tratamiento en nuestra unidad. Los resultados de las primeras 32 díadas participantes muestran una mejoría significativa en los sentimientos y la interacción de las madres hacia sus hijos tras la participación en el grupo, con menor rechazo y rabia hacia el bebé (p = 0,014), menor ansiedad en el cuidado, menos conductas de control, más sensibilidad materna, más colaboración del bebé y mejor sincronicidad entre ambos. Además, el porcentaje de mujeres con trastorno del vínculo al inicio del grupo disminuye tras la intervención. En conclusión, este estudio muestra la importancia de detectar y tratar las alteraciones del vínculo materno-filial en mujeres con trastorno mental perinatal, y hacerlo lo más precozmente posible para prevenir el impacto que puedan tener sobre el desarrollo del bebé.(AU)

This study presents the Mother-Baby Bonding Group, a group intervention treated in our Unit, designed to improve bonding between mothers and their infants under six months. Results from the first 32 participating dyads show a significant improvement in mothers' feelings and interaction towards their infants after participation in the group, with less rejection and anger towards the infant (p = 0.014), less caregiving anxiety, less controlling behaviours, more maternal sensitivity, more infant collaboration, and better synchronicity between them. In addition, the percentage of women with attachment disorder at baseline decreased after the intervention. In conclusion, this study shows the importance of detecting and treating maternal-filial bonding disorders in women with perinatal mental disorders, and to do so as early as possible to prevent the impact they may have on the baby's development.(AU)

Aquest estudi presenta el Grup de Vincle Mare-Nadó, una intervenció grupal dissenyada per a la millora del vincle en mares i els seus lactants menors de sis mesos en tractament a la nostra unitat. Els resultats de les primeres 32 díades participants mostren una milloria significativa en els sentiments i en la interacció de les mares envers els seus fills després de la participació en el grup, amb menor rebuig i ràbia cap al nadó (p = 0,014), menor ansietat en la cura, menys conductes de control, més sensibilitat materna, més col·laboració del nadó i millor sincronicitat entre tots dos. A més, el percentatge de dones amb trastorn del vincle a l'inici del grup disminueix després de la intervenció. En conclusió, aquest estudi mostra la importància de detectar i tractar les alteracions del vincle maternofilial en dones amb trastorn mental perinatal, i fer-ho el més precoçment possible per prevenir l'impacte que puguin tenir sobre el desenvolupament del nadó.(AU)

External Validation and Test-Retest Reliability of Postpartum Bonding Questionnaire in Spanish Mothers.

The aim of the present study was to validate the Spanish Postpartum Bonding Questionnaire (PBQ) against external criteria of bonding disorder, as well as to establish its test-retest reliability. One hundred fifty-six postpartum women consecutively recruited from a perinatal mental health outpatient unit completed the PBQ at 4-6 weeks postpartum. Four weeks later, all mothers completed again the PBQ and were interviewed using the Birmingham Interview for Maternal Mental Health to establish the presence of a bonding disorder. Receiver operating characteristic curve analysis revealed an area under the curve (AUC) value for the PBQ total score of 0.93, 95% CI [0.88, 0.98], with the optimal cut-off of 13 for detecting bonding disorders (sensitivity: 92%, specificity: 87%). Optimal cut-off scores for each scale were also obtained. The test-retest reliability coefficients were moderate to good. Our data confirm the validity of PBQ for detecting bonding disorders in Spanish population.

Paternal symptoms of anxiety and depression in the first month after childbirth: A comparison between fathers of full term and preterm infants.

BACKGROUND: Although men have a higher risk of developing a mental disorder during the perinatal period, few studies have focused on new fathers' mental health screening. This study compares anxiety and depression symptoms between fathers with newborn infants in the neonatal intensive care unit (NICU) and fathers of healthy full-term infants, assessing the impact of stress caused by the NICU.. METHODS: A longitudinal and prospective study with control (n= 33) and study groups (n=51) was designed. The dependent variables assessed were post-natal depression and anxiety-state while the social and demographic information, health background and the parental stress in the neonatal unit were the independent variables. The fathers were assessed twice during the first month after birth. RESULTS: Significant differences in the EPDS scores were found between both groups in the first assessment (p = .006) but not in the second assessment (p = .60). Significant differences in STAI scores were found between the groups for both assessments (p = .003 and p = .002). The stress caused by the infant's appearance and behavior was predictive of depression and anxiety in the study group. LIMITATIONS: The sample was collected at one hospital, immigrants were underrepresented, and no prenatal assessment of paternal mental health is available. CONCLUSIONS: Our results suggest that the hospitalization of newborn infants increases the risk of developing anxiety or depression disorder in fathers. Health providers should be aware of the emotional changes in men shortly after childbirth and include them in the screening of and support for mental health disorders.