Does One Treatment Fit All? Effectiveness of a Multicomponent Cognitive Behavioral Therapy Program in Data-Driven Subtypes of Perinatal Depression

被引:8
作者
Waqas, Ahmed [1 ]
Rahman, Atif [1 ]
机构
[1] Univ Liverpool, Inst Populat Hlth, Dept Primary Care & Mental Hlth, Liverpool, Merseyside, England
来源
FRONTIERS IN PSYCHIATRY | 2021年 / 12卷
关键词
perinatal depression; heterogeneity; disability; subtypes; machine learning; cluster analysis; postpartum depression; clinical phenotypes; RATING-SCALE; LOW-INCOME; INTERVENTION; SYMPTOMS; LONG; HETEROGENEITY; CHILDREN; OUTCOMES;
D O I
10.3389/fpsyt.2021.736790
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
Background: Current diagnostic systems of mental disorders are criticized for their poor validity and reliability, owing to the within disorder heterogeneity and between disorder homogeneity. The issue is important if treatments for mental disorders are to be tailored to individual needs. There is little information in this area on perinatal depression (PND), a highly prevalent condition globally.Aims: i) Quantify heterogeneity attributable to the polythetic diagnostic framework for PND and, ii) present evidence for the effectiveness of a multicomponent and low-intensity cognitive behavioral Thinking Healthy Programme (THP) across the heterogeneous presentations of PND.Methods: This investigation presents secondary analyses of a cluster randomized controlled trial, conducted in Kallar Syedan, Pakistan. A total of 903 pregnant women were randomized to an intervention group receiving the THP intervention or control group receiving enhanced usual care. Principal component analyses and clustering algorithm were utilized to identify heterogenous subtypes of PND. Linear mixed effects models were used to assess effectiveness of the intervention across the identified subtypes of PND.Results: Four different clusters of PND were identified: mixed anxiety-depression, somatic depression, mild depression, and atypical depression. All clinical phenotypes responded well to the THP intervention. Compared to their counterparts in the control group, mothers with mild depression in the treatment group yielded lowest risk ratios 0.24 (95% CI: 0.15 to 0.37), followed by mothers with anxiety-depression 0.50 (95% CI: 0.37 to 0.68), atypical depression 0.51 (95% CI: 0.27 to 0.99) and somatic depression 0.59 (95% CI: 0.42 to 0.83).Conclusion: The Thinking Healthy Programme was found to be effective in reducing severity of depressive symptoms and disability across the four subtypes of PND.
引用
收藏
页数:12
相关论文
共 44 条
  • [1] Depression Subtypes in Predicting Antidepressant Response: A Report From the iSPOT-D Trial
    Arnow, Bruce A.
    Blasey, Christine
    Williams, Leanne M.
    Palmer, Donna M.
    Rekshan, William
    Schatzberg, Alan F.
    Etkin, Amit
    Kulkarni, Jayashri
    Luther, James F.
    Rush, A. John
    [J]. AMERICAN JOURNAL OF PSYCHIATRY, 2015, 172 (08) : 743 - 750
  • [2] The Hamilton depression rating scale: Has the gold standard become a lead weight?
    Bagby, RM
    Ryder, AG
    Schuller, DR
    Marshall, MB
    [J]. AMERICAN JOURNAL OF PSYCHIATRY, 2004, 161 (12) : 2163 - 2177
  • [3] A systematic review of growth curve mixture modelling literature investigating trajectories of perinatal depressive symptoms and associated risk factors
    Baron, Emily
    Bass, Judith
    Murray, Sarah M.
    Schneider, Marguerite
    Lund, Crick
    [J]. JOURNAL OF AFFECTIVE DISORDERS, 2017, 223 : 194 - 208
  • [4] A network theory of mental disorders
    Borsboom, Denny
    [J]. WORLD PSYCHIATRY, 2017, 16 (01) : 5 - 13
  • [5] Antidepressant treatment for postnatal depression
    Brown, Jennifer Valeska Elli
    Wilson, Claire A.
    Ayre, Karyn
    Robertson, Lindsay
    South, Emily
    Molyneaux, Emma
    Trevillion, Kylee
    Howard, Louise M.
    Khalifeh, Hind
    [J]. COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2021, (02):
  • [6] The role of epigenetics in perinatal depression: Are there any candidate biomarkers?
    Carnevali, Greta Silvia
    Buoli, Massimiliano
    [J]. JOURNAL OF AFFECTIVE DISORDERS, 2021, 280 : 57 - 67
  • [7] A Hierarchical Taxonomy of Psychopathology Can Transform Mental Health Research
    Conway, Christopher C.
    Forbes, Miriam K.
    Forbush, Kelsie T.
    Fried, Eiko I.
    Hallquist, Michael N.
    Kotov, Roman
    Mullins-Sweatt, Stephanie N.
    Shackman, Alexander J.
    Skodol, Andrew E.
    South, Susan C.
    Sunderland, Matthew
    Waszczuk, Monika A.
    Zald, David H.
    Afzali, Mohammad H.
    Bornovalova, Marina A.
    Carragher, Natacha
    Docherty, Anna R.
    Jonas, Katherine G.
    Krueger, Robert F.
    Patalay, Praveetha
    Pincus, Aaron L.
    Tackett, Jennifer L.
    Reininghaus, Ulrich
    Waldman, Irwin D.
    Wright, Aidan G. C.
    Zimmermann, Johannes
    Bach, Bo
    Bagby, R. Michael
    Chmielewski, Michael
    Cicero, David C.
    Clark, Lee Anna
    Dalgleish, Tim
    DeYoung, Colin G.
    Hopwood, Christopher J.
    Ivanova, Masha Y.
    Latzman, Robert D.
    Patrick, Christopher J.
    Ruggero, Camilo J.
    Samuel, Douglas B.
    Watson, David
    Eaton, Nicholas R.
    [J]. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE, 2019, 14 (03) : 419 - 436
  • [8] Toward the future of psychiatric diagnosis: the seven pillars of RDoC
    Cuthbert, Bruce N.
    Insel, Thomas R.
    [J]. BMC MEDICINE, 2013, 11
  • [9] Difference in treatment outcome in outpatients with anxious versus nonanxious depression: A STAR*D report
    Fava, Maurizio
    Rush, A. John
    Alpert, Jonathan E.
    Balasubramani, G. K.
    Wisniewski, Stephen R.
    Carmin, Cheryl N.
    Biggs, Melanie M.
    Zisook, Sidney
    Leuchter, Andrew
    Howland, Robert
    Warden, Diane
    Trivedi, Madhukar H.
    [J]. AMERICAN JOURNAL OF PSYCHIATRY, 2008, 165 (03) : 342 - 351
  • [10] Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review
    Fisher, Jane
    de Mello, Meena Cabral
    Patel, Vikram
    Rahman, Atif
    Thach Tran
    Holton, Sara
    Holmes, Wendy
    [J]. BULLETIN OF THE WORLD HEALTH ORGANIZATION, 2012, 90 (02) : 139 - 149