A Non-Randomized Controlled Trial for Reducing Postpartum Depression in Low-Income Minority Women at Community-Based Women's Health Clinics.

OBJECTIVE: To analyze an intervention that delivered tailored clinic staff training on postpartum depression (PPD) followed by awareness raising and social support aimed at lowering PPD among low-income Bedouin women in southern Israel. METHODS: We conducted a non-randomized controlled trial at two women's health clinics. The study included 332 of the 384 eligible women recruited at baseline (intervention = 169, control = 163), who completed two face-to-face interviews, one at 26-38 weeks of pregnancy (Time 1) and one 2-4 months postpartum (Time 2). PPD was measured by the Edinburgh Postnatal Depression Scale (EPDS) and dichotomized using a ≥ 10 score cutoff. We calculated EPDS change (rate difference of dichotomous EPDS from Time 1 to Time 2) (no change, positive change, or negative change), and compared EPDS changes in a control clinic vs. an intervention clinic. RESULTS: The intervention group showed a greater decrease in dichotomous EPDS ≥ 10 between times 1 and 2 (38.5% to 17.2%) than the control group (31.9% to 29.4%, PV = 0.008). Multinomial logistic regression showed that high PPD awareness significantly contributed to positive EPDS change in the intervention group (PV = 0.003) and high social support significantly protected against negative EPDS change in both groups, intervention (PV = 0.001) and control (PV = 0.003). CONCLUSIONS: In low-income women, an intervention focusing on increasing PPD awareness and social support following staff training was associated with reduced EPDS and positive EPDS change following the intervention. Similar interventions should be implemented in women's clinics during pregnancy. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov NCT02862444.

Direct and indirect determinants of prenatal depression among Arab-Bedouin women in Israel: The role of stressful life events and social support.

OBJECTIVE: Prenatal depression (PND) negatively affects the health and well-being of both mother and child. The aim of this study was to identify the direct and indirect determinants of prenatal depression symptoms (PNDS) among Arab-Bedouin women in southern Israel. DESIGN: Data collection was conducted in two women's health centers from October 2017 to February 2018. SETTING: Participants were recruited during visits to women's health centers in southern Israel. PARTICIPANTS: We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. All women were 18+ years of age and 26-38 weeks of gestational age. MEASUREMENTS: PNDS were measured by an Arabic version of the Edinburgh Postnatal Depression Scale. We computed path analyses to identify direct and indirect determinants of PND and estimated the contribution of stressful life events and social support. RESULTS: Positive direct associations emerged between stressful life events, history of depression and gestational age, and PNDS; direct inverse associations were found between social support, PND awareness, and education, and PNDS. History of depression was the single strongest direct predictor of PNDS yet when considering combined direct and indirect effects, the contribution of stressful life events is greater. Stressful life events (via history of depression and PND awareness) and education (via PND awareness) had both direct and indirect effects on PNDS. Age of the mother indirectly affects PNDS via education and PND awareness. Polygamy emerged as neither a direct nor indirect predictor of PNDS. CONCLUSIONS: PNDS in the underserved and understudied Bedouin women has serval direct and indirect predictors. Interventions aiming at reducing stress and increasing social support, via PND awareness might be successful in reducing PND and possibly future postpartum depression.

Delirium associated with lithium-quetiapine combination.

OBJECTIVES: Acute lithium intoxication is a frequent complication of this treatment used for manic depressive disorders. Because lithium has a narrow therapeutic index and widespread use, its neuropsychiatric side effects are more prevalent than those of other psychotropic medications. There are only few reports about it within therapeutic serum levels. The question of toxic interactions resulting from combinations of lithium and neuroleptic drugs is largely based on anecdotal reports. METHODS: We report here a case of a patient with schizophrenia with severe delirium developed shortly after initiation of a lithium-quetiapine combination therapy, despite therapeutic doses of both medications. CONCLUSIONS: The psychiatric symptoms disappeared when lithium was stopped. We interpret these symptoms as delirium with pseudodementia at therapeutic lithium serum levels. Our conclusion is that lithium-induced neurotoxicity should be suspected in any patient receiving lithium in combination with neuroleptics or any other clinical variable. In such cases, regardless of lithium serum levels, the clinician should consider immediate discontinuation of the medication.