Article

A Pilot Study of Heart Rate Variability Biofeedback Therapy in the Treatment of Perinatal Depression on a Specialized Perinatal Psychiatry Inpatient Unit

November 2012
Archives of Women's Mental Health 16(1)

Source
PubMed

Authors:

University of North Carolina at Chapel Hill

Heart rate variability biofeedback (HRVB) therapy may be useful in treating the prominent anxiety features of perinatal depression. We investigated the use of this non-pharmacologic therapy among women hospitalized with severe perinatal depression. Three questionnaires, the State Trait Anxiety Inventory (STAI), Warwick-Edinburgh Mental Well-Being Scale, and Linear Analog Self Assessment, were administered to 15 women in a specialized inpatient perinatal psychiatry unit. Participants were also contacted by telephone after discharge to assess continued use of HRVB techniques. The use of HRVB was associated with an improvement in all three scales. The greatest improvement (-13.867, p < 0.001 and -11.533, p < 0.001) was among STAI scores. A majority (81.9 %, n = 9) of women surveyed by telephone also reported continued frequent use at least once per week, and over half (54.6 %, n = 6) described the use of HRVB techniques as very or extremely beneficial. The use of HRVB was associated with statistically significant improvement on all instrument scores, the greatest of which was STAI scores, and most women reported frequent continued use of HRVB techniques after discharge. These results suggest that HRVB may be particularly beneficial in the treatment of the prominent anxiety features of perinatal depression, both in inpatient and outpatient settings.

Investigating heart rate variability measures during pregnancy as predictors of postpartum depression and anxiety: an exploratory study

Article

Full-text available

May 2024

Perinatal affective disorders are common, but standard screening measures reliant on subjective self-reports might not be sufficient to identify pregnant women at-risk for developing postpartum depression and anxiety. Lower heart rate variability (HRV) has been shown to be associated with affective disorders. The current exploratory study aimed to evaluate the predictive utility of late pregnancy HRV measurements of postpartum affective symptoms. A subset of participants from the BASIC study (Uppsala, Sweden) took part in a sub-study at pregnancy week 38 where HRV was measured before and after a mild stressor (n = 122). Outcome measures were 6-week postpartum depression and anxiety symptoms as quantified by the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Anxiety Inventory (BAI). In total, 112 women were included in a depression outcome analysis and 106 women were included in an anxiety outcome analysis. Group comparisons indicated that lower pregnancy HRV was associated with depressive or anxious symptomatology at 6 weeks postpartum. Elastic net logistic regression analyses indicated that HRV indices alone were not predictive of postpartum depression or anxiety outcomes, but HRV indices were selected as predictors in a combined model with background and pregnancy variables. ROC curves for the combined models gave an area under the curve (AUC) of 0.93 for the depression outcome and an AUC of 0.83 for the anxiety outcome. HRV indices predictive of postpartum depression generally differed from those predictive of postpartum anxiety. HRV indices did not significantly improve prediction models comprised of psychological measures only in women with pregnancy depression or anxiety.

Pre-partum HRV as a predictor of postpartum depression: The potential use of a smartphone application for physiological recordings

Article

Sep 2022
J AFFECT DISORDERS

Background This study aimed to investigate the role of a time-domain Heart Rate Variability index (the root mean square of successive difference between NN intervals, rMSSD) as a predictor of the onset of postpartum depression. HRV has been related to an increased risk of depression in the general population. However, its role in pregnant women is not clear, and the potential use of smartphone applications to evaluate HRV in this population has not been investigated. Methods In study 1, simultaneous electrocardiogram and smartphone photoplethysmography were collected. The rMSSD was determined from each recording to evaluate the accuracy of a smartphone application in the measurement of HRV. In study 2, 135 pregnant women provided rMSSD values measured through a smartphone application in the prepartum (second or third trimester) and filled in the Edinburgh Postnatal Depression Scale in the postpartum (one month after the childbirth). Results Study 1 showed the excellent accuracy of the smartphone application in the measurement of rMSSD. Study 2 indicated that lower prepartum rMSSD predicted higher depressive symptoms in the postpartum (β = −0.217, p = 0.010) after controlling for prepartum depressive symptoms and other potential covariates. Limitations Artefacts (e.g., hand movements) might have corrupted the physiological signal registered. Conclusion This study showed that a reduced vagal tone, indexed by lower rMSSD, during pregnancy was a predictor of depressive symptoms one month after childbirth. The prepartum period may offer an important timeframe to implement preventive intervention on vagal modulation in order to prevent depressive symptoms in the postpartum.

Biofeedback to treat anxiety in young people at clinical high risk for developing psychosis

Article

Aug 2016
EARLY INTERV PSYCHIA

Aim: Anxiety is a common presenting concern for individuals at clinical high risk (CHR) for psychosis. Treatment for CHR is still in the early stages and has focused on transition to psychosis and positive symptom reduction, but little is known about what may be effective in reducing anxiety for these young people. One treatment that may be effective for anxiety is heart rate variability (HRV) biofeedback. The aim of this study was to test the efficacy and feasibility of using HRV biofeedback to reduce anxiety and distress in those at CHR. Methods: Twenty participants who met minimum scores for anxiety and distress completed 4 weeks of an HRV biofeedback intervention and received pre- and post-intervention assessments. Repeated measures were used to examine changes in scores over time. Results: There was a significant decrease in impaired ability to tolerate normal stressors (P ≤ 0.001) and dysphoric mood (P ≤ 0.001) over time. There was no change on self-reported measures of anxiety and distress. However, when two outliers were removed there was a trend towards improvement in self-reported anxiety (P = 0.07). These results were not impacted by including usage time as a covariate. Feedback and adherence were significant. Conclusions: HRV biofeedback may be a feasible treatment option for individuals at CHR who have concerns with impaired stress tolerance and dysphoric mood. Future studies with a randomized controlled trial design will be necessary to further determine efficacy.

Heart rate variability and perinatal depressive symptoms: A scoping review protocol

Article

Full-text available

Oct 2024

Objective An emerging marker of depression in the perinatal period is represented by a reduction in the autonomic nervous system (ANS) activity, reflected by heart rate variability (HRV). This scoping review aims to map the association between HRV and depression during the perinatal period and to understand its potential clinical implications. Introduction Previous evidence associated ANS dysfunction and depressive symptomatology in the general population. Few observational and intervention studies investigated how HRV could be related to both pre- and post-partum depressive symptoms. However, high heterogeneity in the study designs and methods has been reported. Therefore, this scoping review plans to combine all these findings to build a starting point for future research. Inclusion criteria This scoping review will consider articles focusing on the association between HRV and depression in the peripartum and – when available – on the impact of interventions on HRV and how this correlates with changes in depressive symptoms. Studies will be included with no restrictions on participants’ age, peripartum time points for the assessment, and HRV parameters collected. Methods We will perform a systematic search using the Medline (PubMed), PsychInfo, and Web of Science (WoS) databases. Two authors will independently screen titles, abstracts, and then full-text articles that meet the inclusion criteria. The review will include only journal articles published in English, with no time limitations. Data will be extracted and presented in tables and/or graphical representations to summarise and describe the results. Extracted data will be reported in a comprehensive summary.

A Biological Approach to Building Resilience and Wellness Capacity Among Police Exposed to Posttraumatic Stress Injuries: Protocol for a Randomized Controlled Trial

Article

Full-text available

May 2023

Background: Law enforcement officers are routinely exposed to hazardous, disturbing events that can impose severe stress and long-term psychological trauma. As a result, police and other public safety personnel (PSP) are at increased risk of developing posttraumatic stress injuries (PTSIs) and disruptions to the autonomic nervous system (ANS). ANS functioning can be objectively and noninvasively measured by heart rate (HR), heart rate variability (HRV), and respiratory sinus arrhythmia (RSA). Traditional interventions aimed at building resilience among PSP have not adequately addressed the physiological ANS dysregulations that lead to mental and physical health conditions, as well as burnout and fatigue following potential psychological trauma. Objective: In this study, we will investigate the efficacy of a web-based Autonomic Modulation Training (AMT) intervention on the following outcomes: (1) reducing self-reported symptoms of PTSI, (2) strengthening ANS physiological resilience and wellness capacity, and (3) exploring how sex and gender are related to baseline differences in psychological and biological PTSI symptoms and response to the AMT intervention. Methods: The study is comprised of 2 phases. Phase 1 involves the development of the web-based AMT intervention, which includes 1 session of baseline survey measures, 6 weekly sessions that integrate HRV biofeedback (HRVBF) training with meta-cognitive skill practice, and 1 session of follow-up survey measures. Phase 2 will use a cluster randomized control design to test the effectiveness of AMT on the following prepost outcomes: (1) self-report symptoms of PTSI and other wellness measures; (2) physiological indicators of health and resilience including resting HR, HRV, and RSA; and (3) the influence of sex and gender on other outcomes. Participants will be recruited for an 8-week study across Canada in rolling cohorts. Results: The study received grant funding in March 2020 and ethics approval in February 2021. Due to delays related to COVID-19, phase 1 was completed in December 2022, and phase 2 pilot testing began in February 2023. Cohorts of 10 participants in the experimental (AMT) and control (prepost assessment only) groups will continue until a total of 250 participants are tested. Data collection from all phases is expected to conclude in December 2025 but may be extended until the intended sample size is reached. Quantitative analyses of psychological and physiological data will be conducted in conjunction with expert coinvestigators. Conclusions: There is an urgent need to provide police and PSP with effective training that improves physical and psychological functioning. Given that help-seeking for PTSI is reduced among these occupational groups, AMT is a promising intervention that can be completed in the privacy of one's home. Importantly, AMT is a novel program that uniquely addresses the underlying physiological mechanisms that support resilience and wellness promotion and is tailored to the occupational demands of PSP. Trial registration: ClinicalTrials.gov NCT05521360; https://clinicaltrials.gov/ct2/show/NCT05521360. International registered report identifier (irrid): PRR1-10.2196/33492.

Autonomic Modulation Training Protocol: Biological Approach to Building Resilience and Wellness Capacity Among Police Exposed to Post-traumatic Stress Injuries (Preprint)

Preprint

Feb 2023

BACKGROUND Law enforcement officers are routinely exposed to hazardous, disturbing events that can impose severe stress and long-term potential psychological trauma. As a result, police and other public safety personnel (PSP) are at increased risk of developing posttraumatic stress injuries (PTSI) and disruptions to the autonomic nervous system (ANS). ANS functioning can be objectively and non-invasively measured by heart rate (HR), heart rate variability (HRV), and respiratory sinus arrhythmia (RSA). Traditional interventions aimed at building resilience among PSP have not adequately addressed the physiological ANS dysregulations that lead to mental and physical health conditions, as well as burnout and fatigue following potential psychological trauma. OBJECTIVE In the current study we will investigate the efficacy of a web-based Autonomic Modulation Training (AMT) intervention on the following outcomes: 1) reducing self-reported symptoms of PTSI, 2) strengthening ANS physiological resilience and wellness capacity, and 3) explore how sex and gender are related to baseline differences in psychological and biological PTSI symptoms, and response to the AMT intervention. METHODS The study is comprised of two phases: Phase 1 involves the development of the online AMT intervention, which includes one session of baseline survey measures, six weekly sessions that integrate HRV biofeedback (HRVBF) training with meta-cognitive skill practice, and one session of follow-up survey measures. Phase 2 will use a cluster randomized control design to test the effectiveness of AMT on the following pre-post outcomes: 1) self-report symptoms of PTSI and other wellness measures; 2) physiological indicators of health and resilience including resting HR, HRV, and RSA; 3) the influence of sex and gender on other outcomes. Participants will be recruited for an eight-week study across Canada in rolling cohorts. RESULTS The study received grant funding in March 2020 and ethics approval in February 2021. Due to delays related to COVID-19, the study is currently in Phase 1 with Phase 2 pilot testing anticipated for February 2023. Cohorts of 10 participants in the experimental (AMT) and control (pre-post assessment only) groups will continue until a total of 250 participants are tested. Data collection from all phases is expected to conclude in December 2025, but may be extended until the intended sample size is reached. Quantitative analyses of psychological and physiological data will be conducted in conjunction with expert co-investigators. CONCLUSIONS There is an urgent need to provide police and PSP with effective training that improves physical and psychological functioning. Given that help-seeking for PTSI is reduced among these occupational groups, AMT is a promising intervention that can be completed in the privacy of one’s home. Importantly, AMT is a novel program that uniquely addresses the underlying physiological mechanisms that support resilience and wellness promotion and is tailored to the occupational demands of PSP. CLINICALTRIAL ClinicalTrials.gov NCT05521360; https://clinicaltrials.gov/ct2/show/NCT05521360?term=NCT05521360&draw=2&rank=1

Postnatal depression : exploratory study of the biopsychophysiological trajectory involved during pregnancy and postpartum and protective / preventive factors (mindfulness) : applications for management

Thesis

Dec 2021

Dahlia Tharwat

Pre and postnatal phases are thought to be associated with physiological, biological, et psychical upheavals. The perinatal period constitutes a time of psychical vunerability during which women are at risk of developping a mental illness.Postpartum depression (PPD) forms one of the major complications of postpartum and affects 20% of women. It's considered to be one of the great model of chronic stress.This thesis' main aim is to study the physiopathological mechanisms inducing the emergence of a PPD, with the help of psychological, physiopathological, biological and genetical measures of pregnancy monitoring. More precisely, we want to identify a predictive value for the emergence of PPD by evaluating if the mindfulness disposition is a protecting factor in the occurence of PPD.Indeed, numerous studies have shown that mindfulness is an asset for overall health, especially in the scope of stress prevention and its consequences.Results underline the protective role of the mindfulness functioning on the risk of PPD occurence. Psychological factors linked with mood and perceived social support are also suggested for pregnancy monitoring.Concomitantly, we've sought to evaluate the perinatal healthcare providers' scope of knowledge of post-partum psychical complications, especially on PPD. The results highlight that these professionals are poorly trained in the identification and management of these complications and there are a number of personal and organizational obstacles to this observation.Considering these results, we've proposed preventing counter measures of PPD by targeting pregnant women and perinatal health providers.In this context, we've started the inception of a training tool for healthcare providers in order to assist them in better prevention, screening and undertaking one of the gravest psychical complications of PPD, with the help of Virtual Reality environment. This thesis work is part of the current consideration of the deleterious consequences of PND on the family unit and on the development of the child.

Technology-Based Approaches for Supporting Perinatal Mental Health

Article

Full-text available

Sep 2022
Curr Psychiatr Rep

Purpose of Review This review explores advances in the utilization of technology to address perinatal mood and anxiety disorders (PMADs). Specifically, we sought to assess the range of technologies available, their application to PMADs, and evidence supporting use. Recent Findings We identified a variety of technologies with promising capacity for direct intervention, prevention, and augmentation of clinical care for PMADs. These included wearable technology, electronic consultation, virtual and augmented reality, internet-based cognitive behavioral therapy, and predictive analytics using machine learning. Available evidence for these technologies in PMADs was almost uniformly positive. However, evidence for use in PMADs was limited compared to that in general mental health populations. Summary Proper attention to PMADs has been severely limited by issues of accessibility, affordability, and patient acceptance. Increased use of technology has the potential to address all three of these barriers by facilitating modes of communication, data collection, and patient experience.

Following the Rhythm of the Heart: HeartMath Institute’s Path to HRV Biofeedback

Article

Full-text available

Jun 2022
APPL PSYCHOPHYS BIOF

Rollin McCraty

This paper outlines the early history and contributions our laboratory, along with our close advisors and collaborators, has made to the field of heart rate variability and heart rate variability coherence biofeedback. In addition to the many health and wellness benefits of HRV feedback for facilitating skill acquisition of self-regulation techniques for stress reduction and performance enhancement, its applications for increasing social coherence and physiological synchronization among groups is also discussed. Future research directions and applications are also suggested.

Efficacy of group biofeedback treatment on hyperemesis gravidarum with psychosomatic symptoms diagnosed with the revised version of Diagnostic Criteria for Psychosomatic Research (DCPR-R): study protocol for a randomised controlled trial

Article

Full-text available

Mar 2022

Introduction Hyperemesis gravidarum (HG) is a condition characterised by dehydration, electrolyte imbalance, lack of nutrition and at least 5% loss in body weight, occurring in the first half of pregnancy. The aim of this trial is to examine the efficacy of group biofeedback treatment on patients with HG with psychosomatic symptoms, which will be evaluated through the revised version of Diagnostic Criteria for Psychosomatic Research (DCPR-R). Methods and analysis In this single-blinded randomised controlled clinical trial, 68 patients with HG diagnosed with at least one psychosomatic syndrome according to DCPR-R and aged 18–40 years, will be recruited in a Chinese Maternal and Child Health Hospital. The sample will be randomised (1:1) into two arms: experimental group, which will undergo group biofeedback treatment, psycho-education and treatment as usual (TAU); and control group, which will undergo psycho-education and TAU only. The primary outcomes will be reduction of the frequency of psychosomatic syndromes, severity of nausea/vomiting, quality of life and heart rate variability. The secondary outcomes will include days of hospitalisation, repeated hospitalisation and laboratory investigations. Ethics and dissemination This study has received ethical approval from the Nanjing Medical University (No. 2019/491, granted 22 February 2019). All participants will be required to provide written informed consent. Study outcomes will be disseminated through peer-reviewed publications and academic conferences, and used to confirm a tailored biofeedback intervention for patients with HG with psychosomatic symptoms. Trial registration number Chinese Clinical Trial Registry (ChiCTR2000028754).

Substance Use And Addiction Affect More Than the Brain: The Promise of Neurocardiac Interventions

Article

Full-text available

Sep 2021

Purpose of Review: Addiction and excessive substance use contribute to poor mental and physical health. Much research focuses tightly on neural underpinnings and centrally-acting interventions. To broaden this perspective, this review focuses on bidirectional pathways between the brain and cardiovascular system that are well-documented and provide innovative, malleable targets to bolster recovery and alter substance use behaviors. Recent Findings: Cardiovascular signals are integrated via afferent pathways in networks of distributed brain regions that contribute to cognition, as well as emotion and behavior regulation, and are key antecedents and drivers of substance use behaviors. Heart rate variability (HRV), a biomarker of efficient neurocardiac regulatory control, is diminished by heavy substance use and substance use disorders. Promising evidence-based adjunctive interventions that enhance neurocardiac regulation include HRV biofeedback, resonance paced breathing, and some addiction medications. Summary: Cardiovascular communication with the brain through bidirectional pathways contributes to cognitive and emotional processing but is rarely discussed in addiction treatment. New evidence supports cardiovascular-focused adjunctive interventions for problematic substance use and addiction.

MAternal Mental Health in the WORKplace (MAMH@WORK): A Protocol for Promoting Perinatal Maternal Mental Health and Wellbeing

Article

Full-text available

Mar 2021
Int J Environ Res Publ Health

Women are exposed to increased burden of mental disorders during the perinatal period: 13-19% experience postpartum depression. Perinatal psychological suffering affects early mother-child relationship, impacting child's emotional and cognitive development. Return-to-work brings additional vulnerability given the required balance between parenting and job demands. The MAternal Mental Health in the WORKplace (MAMH@WORK) project aims to develop and evaluate the effectiveness of a brief and sustainable intervention, promoting (a) maternal mental health throughout pregnancy and first 12 months after delivery, and (b) quality of mother-child interactions, child emotional self-regulation, and cognitive self-control, while (c) reducing perinatal absenteeism and presenteeism. MAMH@WORK is a three-arm randomized controlled trial. A short-term cognitive-behavioral therapy-based (CBT-based) psychoeducation plus biofeedback intervention will be implemented by psychiatrists and psychologists, following a standardized procedure manual developed after consensus (Delphi method). Participants (n = 225, primiparous, singleton pregnant women at 28-30 weeks gestational age, aged 18-40 years, employed) will be randomly allocated to arms: CBT-based psychoeducation intervention (including mindfulness); psychoeducation plus biofeedback intervention; and control. Assessments will take place before and after delivery. Main outcomes (and main tools): mental health literacy (MHLS), psychological wellbeing (HADS, EPDS, KBS, CD-RISC, BRIEF COPE), quality of mother-child interaction, child-mother attachment, child emotional self-regulation and cognitive self-control (including PBQ, Strange Situation Procedure, QDIBRB, SGS-II, CARE-Index), job engagement (UWES), and Citation: Costa, J.; Santos, O.; Virgolino, A; Pereira, M.E.; Stefanovska-Petkovska, M.; Silva, H.; Navarro-Costa, P.; Barbosa, M.; César das Neves, R.; Duarte e Silva, I.; et al. MAternal Mental Health in the WORKplace (MAMH@WORK): A Protocol for Promoting Perinatal Maternal Mental Health and Wellbeing. Int.

The Current Evidence Levels for Biofeedback and Neurofeedback Interventions in Treating Depression: A Narrative Review

Article

Full-text available

Feb 2021
Neural Plast

Mikhail Melnikov

This article is aimed at showing the current level of evidence for the usage of biofeedback and neurofeedback to treat depression along with a detailed review of the studies in the field and a discussion of rationale for utilizing each protocol. La Vaque et al. criteria endorsed by the Association for Applied Psychophysiology and Biofeedback and International Society for Neuroregulation & Research were accepted as a means of study evaluation. Heart rate variability (HRV) biofeedback was found to be moderately supportable as a treatment of MDD while outcome measure was a subjective questionnaire like Beck Depression Inventory (level 3/5, “probably efficacious”). Electroencephalographic (EEG) neurofeedback protocols, namely, alpha-theta, alpha, and sensorimotor rhythm upregulation, all qualify for level 2/5, “possibly efficacious.” Frontal alpha asymmetry protocol also received limited evidence of effect in depression (level 2/5, “possibly efficacious”). Finally, the two most influential real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback protocols targeting the amygdala and the frontal cortices both demonstrate some effectiveness, though lack replications (level 2/5, “possibly efficacious”). Thus, neurofeedback specifically targeting depression is moderately supported by existing studies (all fit level 2/5, “possibly efficacious”). The greatest complication preventing certain protocols from reaching higher evidence levels is a relatively high number of uncontrolled studies and an absence of accurate replications arising from the heterogeneity in protocol details, course lengths, measures of improvement, control conditions, and sample characteristics.

Understanding the experiences of self-injurious behavior in autism spectrum disorder: Implications for monitoring technology design

Article

Sep 2020
J AM MED INFORM ASSN

Objective: Monitoring technology may assist in managing self-injurious behavior (SIB), a pervasive concern in autism spectrum disorder (ASD). Affiliated stakeholder perspectives should be considered to design effective and accepted SIB monitoring methods. We examined caregiver experiences to generate design guidance for SIB monitoring technology. Materials and methods: Twenty-three educators and 16 parents of individuals with ASD and SIB completed interviews or focus groups to discuss needs related to monitoring SIB and associated technology use. Results: Qualitative content analysis of participant responses revealed 7 main themes associated with SIB and technology: triggers, emotional responses, SIB characteristics, management approaches, caregiver impact, child/student impact, and sensory/technology preferences. Discussion: The derived themes indicated areas of emphasis for design at the intersection of monitoring and SIB. Systems design at this intersection should consider the range of manifestations of and management approaches for SIB. It should also attend to interactions among children with SIB, their caregivers, and the technology. Design should prioritize the transferability of physical technology and behavioral data as well as the safety, durability, and sensory implications of technology. Conclusions: The collected stakeholder perspectives provide preliminary groundwork for an SIB monitoring system responsive to needs as articulated by caregivers. Technology design based on this groundwork should follow an iterative process that meaningfully engages caregivers and individuals with SIB in naturalistic settings.

Autonomic Dysfunction in Preeclampsia: A Systematic Review

Article

Full-text available

Aug 2019

Background: Preeclampsia (PE) is a major obstetric complication that leads to severe maternal and fetal morbidity. Early detection of preeclampsia can reduce the severity of complications and improve clinical outcomes. It is believed that the autonomic nervous system (ANS) is involved in the pathogenesis of PE. We aimed to review the current literature on the prevalence and nature of ANS dysfunction in women with PE and the possible prognostic value of ANS testing in the early detection of PE. Methods: Literature search was performed using Medline (1966–2018), EMBase (1947–2018), Google Scholar (1970–2018), BIOSIS (1926–2018), Web of science (1900–2018); CINAHL (1937–2018); Cochrane Library, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Methodology Register (1999–2018). Additionally, the reference lists of articles included were screened. Results: A total of 26 studies were included in the present review presenting data of 1,854 pregnant women. Among these women, 453 were diagnosed with PE, 93.6% (424/453) of which displayed autonomic dysfunction. ANS function was assessed by cardiovascular reflex tests (n = 9), heart rate variability (n = 11), cardiac baroreflex gain (n = 5), muscle sympathetic nerve activity (MSNA) (n = 3), and biomarkers of sympathetic activity (n = 4). Overall, 21 studies (80.8%) reported at least one of the following abnormalities in ANS function in women diagnosed with PE compared to healthy pregnant control women: reduced parasympathetic activity (n = 16/21, 76%), increased sympathetic activity (n = 12/20, 60%), or reduced baroreflex gain (n = 4/5, 80%). Some of these studies indicated that pressor and orthostatic stress test may be useful in early pregnancy to help estimate the risk of developing PE. However, autonomic function tests seem not to be able to differentiate between mild and severe PE. Conclusions: Current evidence suggests that autonomic dysfunction is highly prevalent in pre-eclamptic women. Among autonomic functions, cardiovascular reflexes appear to be predominantly affected, seen as reduced cardiac parasympathetic activity and elevated cardiac sympathetic activity. The diagnostic value of autonomic testing in the prediction and monitoring of autonomic failure in pre-eclamptic women remains to be determined.

Psychotherapy Beyond All the Words: Dyadic Expansion, Vagal Regulation, and Biofeedback in Psychotherapy

Article

Full-text available

Apr 2019

Charlotte Fiskum

Psicoterapia más allá de todas las palabras: Expansión diádica, regulación vagal y biofeedback en psicoterapia La consideración de la fisiología hasta ahora no ha sido muy prominente en muchas formas de psicoterapia. Debido a que algunos pacientes no se benefician de métodos altamente cognitivos verbales, una integración de enfoques más orientados fisiológicamente puede ampliar la caja de herramientas de los terapeutas que trabajan con pacientes desregulados. Los disturbios fisiológicas como la desregulación vagal y neurovisceral, como se detalla en la teoría polivagal y el modelo de integración neurovisceral, parecen estar implicadas en la psicopatología y pueden indexarse a través de la variabilidad de la frecuencia cardíaca (HRV) y la complejidad cardíaca (CC). La evidencia hasta ahora muestra que la psicopatología generalmente se asocia con VFC o CC reducida o atípica, lo que sugiere una capacidad reducida para la autorregulación compleja. Las intervenciones que pueden fortalecer los procesos de autorregulación incluyen terapias que incorporan estados de conciencia expandidos diádicamente, corregulación autonómica y vagal dirigida, y abordajes sensoriomotores y somáticos, así como biofeedback HRV.

The Relationship Between Perinatal Mental Health and Stress: a Review of the Microbiome

Article

Full-text available

Mar 2019
Curr Psychiatr Rep

Purpose of Review Our current understanding of the underlying mechanisms and etiologies of perinatal mood and anxiety disorders (PMADs) is not clearly identified. The relationship of stress-induced adaptations (i.e., the hypothalamic-pituitary-adrenal (HPA) axis, the autonomic nervous system (ANS), the immune system) and the microbiota are potential contributors to psychopathology exhibited in women during pregnancy and postpartum and should be investigated. Recent Findings The stress response activates the HPA axis and dysregulates the ANS, leading to the inhibition of the parasympathetic system. Sustained high levels of cortisol, reduced heart variability, and modulated immune responses increase the vulnerability to PMAD. Bidirectional communication between the nervous system and the microbiota is an important factor to alter host homeostasis and development of PMAD. Summary Future research in the relationship between the psychoneuroimmune system, the gut microbiota, and PMAD has the potential to be integrated in clinical practice to improve screening, diagnosis, and treatment.

Biofeedback: An Important but Often-Ignored Ingredient in Psychotherapy

Article

Mar 2017

Paul Lehrer

Although evidence supports the efficacy of biofeedback for treating a number of disorders and for enhancing performance, significant barriers block both needed research and payer support for this method. Biofeedback has demonstrated effects in changing psychophysiological substrates of various emotional, physical, and psychosomatic problems, but payers are reluctant to reimburse for biofeedback services. A considerable amount of biofeedback research is in the form of relatively small well-controlled trials (Phase II trials). This article argues for greater payer support and research support for larger trials in the “real life” clinical environment (Phase III trials) and meta-analytic reviews.

Heart rate variability biofeedback increases sexual arousal among women with female sexual arousal disorder: Results from a randomized-controlled trial

Article

Full-text available

Apr 2019
BEHAV RES THER

Low resting heart rate variability (HRV) has been associated with poor sexual arousal function in women. In a recent study, a single session of autogenic training increased HRV and facilitated improvements in both sexual arousal and perceived genital sensations among women experiencing decreased arousal. The current study expands upon these findings by examining the efficacy of HRV biofeedback, with and without autogenic training, as a treatment for sexual arousal dysfunction in an at-home setting. Participants (N = 78) were randomized into one of three conditions: HRV biofeedback, HRV biofeedback + autogenic training, or waitlist control. Each condition included three laboratory sessions; participants in the two active conditions completed 4–6 biofeedback sessions at home, and participants in the HRVB + A condition listened to a 14-min autogenic training recording before completing the biofeedback. Across the three laboratory visits, participants in the three conditions singficnatly differed in their genital arousal, subjective sexual arousal, and their perceived genital sensations. Compared to women in the control group, women who engaged in HRV biofeedback at home, with and without additional autogenic training, experienced increases in genital arousal, subjective sexual arousal, and perceived genital sensations. These results provide preliminary support for the contribution of heart rate variability level to female sexual arousal function and for the use of either of these interventions in the treatment of sexual arousal concerns.

BreathCoach: A Smart In-home Breathing Training System with Bio-Feedback via VR Game

Conference Paper

Oct 2018

RSA-BT (Respiratory Sinus Arrhythmia biofeedback-based Breathing Training) is a common cardiorespiratory intervention that has been commonly used as a complementary treatment to diseases (e.g., asthma), and as an effective exercise to reduce anxiety. In this demo, we propose BreathCoach, a smart and unobtrusive system using sensors on smartwatch and smartphone-based VR that enables in-home RSA-BT coaching. Specifically, BreathCoach uses off-the-shelf devices to continuously monitor key bio-signals including breathing pattern (BP), inter-beat interval (IBI), and the amplitude of RSA, and intelligently calculates the optimal breathing pattern based on current and historical measurements. The recommended breathing pattern is then conveyed to the user in the form of an intuitive VR game to provide an immersive training experience. We will showcase a research prototype implemented on Android smartphone and smartwatch with two proof-of-concept VR game designs.

Systematic Review of Biofeedback Interventions for Addressing Anxiety and Depression in Children and Adolescents with Long-Term Physical Conditions

Article

Full-text available

Sep 2018
APPL PSYCHOPHYS BIOF

Children and adolescents with long-term physical conditions are at increased risk of psychological problems, particularly anxiety and depression, and they have limited access to evidence-based treatment for these issues. Biofeedback interventions may be useful for treating symptoms of both psychological and physical conditions. A systematic review of studies of biofeedback interventions that addressed anxiety or depression in this population was undertaken via MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Central Register of Controlled Trials databases. Primary outcomes included changes in anxiety and depression symptoms and 'caseness'. Secondary outcomes included changes in symptoms of the associated physical condition and acceptability of the biofeedback intervention. Of 1876 identified citations, 9 studies (4 RCTs, 5 non-RCTs; of which all measured changes in anxiety and 3 of which measured changes in depression) were included in the final analysis and involved participants aged 8-25 years with a range of long-term physical conditions. Due to the heterogeneity of study design and reporting, risk of bias was judged as unclear for all studies and meta-analysis of findings was not undertaken. Within the identified sample, multiple modalities of biofeedback including heart rate variability (HRV), biofeedback assisted relaxation therapy and electroencephalography were found to be effective in reducing symptoms of anxiety. HRV was also found to be effective in reducing symptoms of depression in two studies. A range of modalities was effective in improving symptoms of long-term physical conditions. Two studies that assessed acceptability provided generally positive feedback. There is currently limited evidence to support the use of biofeedback interventions for addressing anxiety and depression in children and adolescents with long-term physical conditions. Although promising, further research using more stringent methodology and reporting is required before biofeedback interventions can be recommended for clinical use instead or in addition to existing evidence-based modalities of treatment.

Resting Heart Rate Variability and the Effects of Biofeedback Intervention in Women with Low-Risk Pregnancy and Prenatal Childbirth Fear

Article

Full-text available

Jun 2018
APPL PSYCHOPHYS BIOF

Anxiety about labor in women at the end of pregnancy sometimes reaches levels that are clinically concerning. We investigated whether low-risk pregnant women with childbirth fear during the last trimester demonstrate specific findings with regard to resting heart rate variability (HRV) and examined whether HRV biofeedback can reduce this fear and alter resting HRV. We measured the levels of childbirth fear (Wijma delivery expectancy/experience questionnaire, W-DEQ) and resting HRV indexes in 97 low-risk pregnant women in their 32nd–34th week of gestation and advised women with W-DEQ scores of ≥ 66 (n = 40) to practice HRV biofeedback (StressEraser) at home. We then reassessed these measures 3–4 weeks later in the 36th–37th week of gestation regardless of whether the women practiced the method. We found that childbirth fear had no significant effect on resting HRV indexes when the W-DEQ cutoff was conventionally set at ≥ 66. However, women with W-DEQ scores of ≥ 90 (n = 5) had a significantly lower high-frequency power than their counterparts (p = 0.028). The W-DEQ scores reduced significantly in women who performed HRV biofeedback (n = 18, p < 0.001), but there was no change in those who did not perform the method (n = 20). These findings suggested that very high W-DEQ scores (≥ 90), but not the conventional criteria (W-DEQ score ≥ 66), of the fear of childbirth were associated with low parasympathetic activity among low-risk pregnant women and that HRV biofeedback intervention can effectively decrease the fear of childbirth in these women.

One Session of Autogenic Training Increases Acute Subjective Sexual Arousal in Premenopausal Women Reporting Sexual Arousal Problems

Article

Full-text available

Jan 2018
J SEX MED

Background: Below average heart rate variability (HRV) has been associated with sexual arousal dysfunction and overall sexual dysfunction in women. Autogenic training, a psychophysiologic relaxation technique, has been shown to increase HRV. In a recent study, sexually healthy women experienced acute increases in physiologic (ie, genital) and subjective sexual arousal after 1 brief session of autogenic training. Aim: To build on these findings by testing the effects of a single session of autogenic training on sexual arousal in a sample of women who reported decreased or absent sexual arousal for at least 6 months. Methods: Genital sexual arousal, subjective sexual arousal, and perceived genital sensations were assessed in 25 women 20 to 44 years old before and after listening to a 22-minute autogenic training recording. HRV was assessed with electrocardiography. Outcomes: Change in genital sexual arousal, subjective sexual arousal, and perceived genital sensations from the pre-manipulation erotic film to the post-manipulation erotic film. Results: Marginally significant increases in discrete subjective sexual arousal (P = .051) and significant increases in perceived genital sensations (P = .018) were observed. In addition, degree of change in HRV significantly moderated increases in subjective arousal measured continuously over time (P < .0001). There were no significant increases in genital arousal after the manipulation. Clinical implications: The results of this study suggest that autogenic training, and other interventions that aim to increase HRV, could be a useful addition to treatment protocols for women who are reporting a lack of subjective arousal or decreased genital sensations. Strengths and limitations: There are few treatment options for women with arousal problems. We report on a new psychosocial intervention that could improve arousal. Limitations include a relatively small sample and the lack of a control group. Conclusion: Our findings indicate that autogenic training significantly improves acute subjective arousal and increases perceived genital sensations in premenopausal women with self-reported arousal concerns. Stanton AM, Hixon JG, Nichols LM, Meston CM. One Session of Autogenic Training Increases Acute Subjective Sexual Arousal in Premenopausal Women Reporting Sexual Arousal Problems. J Sex Med 2018;15:64-76.

Comprehensive Integrated Care Model to Improve Maternal Mental Health

Article

Sep 2017
J Obstet Gynecol Neonatal Nurs

In this article, we describe an integrated care model in a perinatal psychiatry program to improve access to care for women who experience mood changes during the perinatal period. A nurse-practitioner trained in psychiatry and obstetrics is embedded in the obstetric clinic, and perinatal nurses, often the first professionals to recognize women who are experiencing mood changes, can easily refer women for follow-up. Barriers, lessons learned, and goals for implementation are described. © 2017 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses

Perinatal depression: An evidence-based review of integrative treatment

Article

Nov 2016

Improvements in Acute Subjective Sexual Arousal after a Brief Session of Autogenic Training in Women with Sexual Arousal Problems

Article

Full-text available

Jun 2017

Presented at the 2017 Annual Meeting of the International Society for the Study of Women’s Sexual Health

Best practice for perinatal mental health care: The economic case

Technical Report

Full-text available

Dec 2016

Building resilience with the Stress Resilience Training System: Design validation and applications

Article

Full-text available

May 2016

Background: Resilience to stress is critical in today's military service. Past work has shown that experts handle stress in more productive ways compared to novices. Training that specifically addresses stress regulation, such as the Graduated Stress Exposure paradigm, can build individual and unit resilience as well as adaptability so that stressors trigger effective stress coping skills rather than stress injury. Objective: We developed the Stress Resilience Training System (SRTS), a product of of Perceptronics Solutions Inc., to demonstrate that a software training app can provide an effective individualized method for mitigating the negative effects of situational and mission-related stress, at the same time eliciting potentially positive effects on performance. Methods: Seven separate evaluations including a usability study, controlled experiments, and field evaluations have been conducted to date. Results: These studies have shown that the SRTS training system effectively engages users to manage their stress, effectively reduces stress symptoms, and improves job performance. Conclusions: The SRTS system is a highly effective method for individualized training to inoculate professionals against the negative consequences of stress, while teaching them to harness its positive effects. SRTS is a technology that can be widely applied to many professions that are concerned with well-being. We discuss applications to law enforcement, athletics, personal fitness and healthcare in the Appendix.

Guidelines for Reporting Articles on Psychiatry and Heart rate variability (GRAPH): recommendations to advance research communication

Article

Full-text available

May 2016

The number of publications investigating heart rate variability (HRV) in psychiatry and the behavioral sciences has increased markedly in the last decade. In addition to the significant debates surrounding ideal methods to collect and interpret measures of HRV, standardized reporting of methodology in this field is lacking. Commonly cited recommendations were designed well before recent calls to improve research communication and reproducibility across disciplines. In an effort to standardize reporting, we propose the Guidelines for Reporting Articles on Psychiatry and Heart rate variability (GRAPH), a checklist with four domains:participant selection, interbeat interval collection, data preparation and HRV calculation. This paper provides an overview of these four domains and why their standardized reporting is necessary to suitably evaluate HRV research in psychiatry and related disciplines. Adherence to these communication guidelines will help expedite the translation of HRV research into a potential psychiatric biomarker by improving interpretation, reproducibility and future meta-analyses.

Science of the Heart, Volume 2 Exploring the Role of the Heart in Human Performance An Overview of Research Conducted by the HeartMath Institute

Technical Report

Full-text available

Feb 2016

Rollin McCraty

This insightful and comprehensive monograph provides fundamental and detailed summaries of HeartMath Institute’s many years of innovative research. It presents brief overviews of heart rate variability, resilience, coherence, heart-brain interactions,intuition and the scientific discoveries that shaped techniques developed to increase fulfillment and effectiveness. Included are summary reports of research conducted in the business, education, health and first responder fields. Both the layperson and science professional will appreciate its simplicity and thoroughness.

The new UNC Perinatal Psychiatry Inpatient Unit (USA): Report on the first year

Article

Jan 2013

Breathing techniques in the treatment of depression: A scoping review and proposal for classification

Article

Jun 2024
Counsell Psychother Res J

Background Breathing practices are increasingly being utilised in therapeutic interventions for mental health problems, including depression. One of the challenges of evaluating the impact of breathing exercises on the treatment of depression is the variability in the type of exercises used. Aims To bring greater clarity in this area, this scoping review aimed to identify, categorise and synthesise breathing interventions that have been evaluated for depression, in order to inform further research and reviews. Method A thematic synthesis approach was used to analyse the descriptions of breathing interventions in order to categorise these via their common features. Results Thirty papers were included in the final synthesis. Main themes developed from thematic synthesis were related to procedural aspects of breathing interventions, namely: attention and awareness, using the body and senses, and paced breathing. Clinical implications and suggestions for further research are discussed.

Effect of virtual reality-based biofeedback for depressive and anxiety symptoms: Randomized controlled study

Article

Jun 2024
J AFFECT DISORDERS

Heart Rate Variability Biofeedback and Cognitive Restructuring for Self-Regulation: A Case Study

Article

Dec 2023

The present study investigated the effects of a psychophysiological intervention programme consisting of heart rate variability biofeedback (HRV BFB) and cognitive restructuring (CR) on the self-regulation skills of an 18-year-old female squash athlete on the Korean national team. The participant participated in 10 sessions of the programme in a laboratory. The HRV was measured during 10 minutes of natural breathing to set a baseline and for breathing training on a BFB device. In addition, two questionnaires, namely, the competitive state anxiety inventory-2 (CSAI-2) and the cognitive emotion regulation questionnaire (CERQ), were used to measure the participant’s psychological state. Descriptive statistics were reported to see the changes in HRV and psychological state between the initial test and post-test, and the qualitative results indicated improvements in the participant’s self-regulation skills to change her negative thoughts. In conclusion, this programme could be effective in enhancing self-regulation in athletes.

Mind-Body Techniques in Pregnancy and Postpartum

Article

Jun 2021
CLIN OBSTET GYNECOL

Maternal stress can perturb physiology and psychiatric health leading to adverse outcomes. This review investigates the effectiveness of several mind-body therapies-namely biofeedback, progressive muscle relaxation, guided imagery, tai chi, and yoga-as interventions in reducing maternal stress and other pregnancy-related conditions. Through randomized trials, these techniques have shown promising benefits for reducing pain, high blood pressure, stress, anxiety, depressive symptoms, labor pain and outcomes, and postpartum mood disturbances. As these interventions are easy to implement, low cost, and safe to perform in pregnancy, they should be considered as alternative, nonpharmaceutical interventions to use during pregnancy and postpartum care.

Apport des nouvelles technologies à la gestion du stress : e-TCC et biofeedback de variabilité de fréquence cardiaque

Thesis

Nov 2020

Anne-Claire Leterme

Le stress est un enjeu majeur de santé public, responsable du développement et de l’aggravation d’un grand nombre de troubles somatiques (maladies cardio-vasculaires,cancers, maladies infectieuses …) et psychiatriques (anxiété, dépression …). La gestion du stress par les thérapies comportementales, cognitives et émotionnelles (TCCE) est efficace pour réduire les conséquences négatives du stress et prévenir les troubles chez les sujets àrisque, mais son accès reste limité. Internet et les nouvelles technologies du numérique,notamment les self-help, les e-TCC et le biofeedback de variabilité de fréquence cardiaque(biofeedback de VFC) peuvent enrichir les programmes de gestion du stress par les TCCEet faciliter leur accès. Dans ce contexte, l’objectif de ce travail de thèse était de développeret d’évaluer des formats de traitements novateurs combinant TCCE et nouvellestechnologies.Dans un premier temps, le programme Seren@ctif, premier programme francophone de e-TCC dédié à la gestion du stress, a fait l’objet d’un essai contrôlé randomisé sur 120patients répondant au diagnostic de trouble d’adaptation avec anxiété (TAA) selon lescritères du DSM-5 et venant consulter en service de psychiatrie ambulatoire du CHU deLille. Les résultats ont mis en évidence que la TCCE administrée sur internet et guidée parun temps de contact humain en face-à-face avec un professionnel de santé supervisé(TCCE mixte) est tout aussi efficace que la TCCE entièrement administrée en face-à-facepour le traitement du TAA, par comparaison à un groupe contrôle de patients bénéficiantd’un suivi habituel par leur médecin généraliste.Dans un second temps, un nouveau biofeedback de VFC directement basé sur l’activationvagale, a été élaboré à partir d’une nouvelle mesure d’activation parasympathiquedéveloppée par l’équipe du centre d’investigation clinique, innovations technologiques deLille. Cette thèse présente les étapes d’élaboration de ce nouveau biofeedback, suiviesd’une preuve de concept portant sur plusieurs patients présentant divers troubles anxieuxet dépressifs. Ce nouveau biofeedback de VFC constitue une approche prometteusepermettant de stimuler de manière non-invasive le nerf vague. Il pourrait permettreégalement d’améliorer durablement l’activation vagale et d’objectiver physiologiquementl’effet bénéfique de la Mindful Breathing. Cette approche pourrait être complémentaire autraditionnel biofeedback d’arythmie sinusale respiratoire et permettrait de diversifier lestechniques comportementales associées au biofeedback.Les recherches présentées dans cette thèse contribuent à faire avancer la recherche dans ledomaine des technologies de l’information appliquées à la santé mentale etcomportementale. Elles ouvrent des perspectives innovantes sur une nouvelle façond’administrer les TCCE sur internet, sur l’efficacité potentielle d’un nouveau biofeedbackde VFC, ou encore, sur l’intérêt d’un nouveau marqueur de flexibilité du système nerveuxautonome dans l’évaluation objective de l’efficacité des TCC de troisième vague, notammentla Mindfulness

Daily self-regulation with biofeedback to improve stress and job satisfaction in a primary care clinic

Article

Full-text available

Feb 2021

Background: Burnout in healthcare professions is higher than other careers. An undesirable work-life balance has resulted in declining job satisfaction among primary care physicians. Biofeedback devices teach self-regulation techniques, which reduce stress and increase resilience. Objectives: We assessed whether self-regulation with biofeedback is effective at decreasing stress and improving job satisfaction among primary care clinicians and nurses. Methods: Two naturally occurring cohorts of clinicians and nurses were followed over 12 weeks. The treatment group (N = 9) completed 12 weeks of self-regulation with optional clinic-based biofeedback and received peer support for the first half. The control group (N = 9) started a delayed intervention after 6 weeks without peer support. Descriptive and bivariate analyses were conducted. Results: The treatment group averaged one biofeedback session weekly for 6 min and the control group two sessions for 11 min. Adherence differed by age. Subjects also reported using self-regulation techniques without biofeedback. Perceived stress initially increased in both groups with intervention implementation, more so in the treatment group (P = 0.03) whose stress then decreased but was not significant. Overall and extrinsic job satisfaction similarly increased but were not significance. Conclusion: The initial increase in perceived stress was related to daily biofeedback adherence and clinic responsibilities. Treatment group stress then decreased with self-regulation but was difficult to quantify in a small cohort. Larger studies could increase daily self-regulation adherence by improving biofeedback accessibility for leisurely use. Using self-regulation with biofeedback may be an innovative approach to reduce stress and improve job satisfaction in primary care.

Heartrate variability biofeedback for migraine using a smartphone application and sensor: A randomized controlled trial

Article

Jan 2021
GEN HOSP PSYCHIAT

Introduction Although hand temperature and electromyograph biofeedback have evidence for migraine prevention, to date, no study has evaluated heartrate variability (HRV) biofeedback for migraine. Methods 2-arm randomized trial comparing an 8-week app-based HRV biofeedback (HeartMath) to waitlist control. Feasibility/acceptability outcomes included number and duration of sessions, satisfaction, barriers and adverse events. Primary clinical outcome was Migraine-Specific Quality of Life Questionnaire (MSQv2). Results There were 52 participants (26/arm). On average, participants randomized to the Hearthmath group completed 29 sessions (SD = 29, range: 2–86) with an average length of 6:43 min over 36 days (SD = 27, range: 0, 88) before discontinuing. 9/29 reported technology barriers. 43% said that they were likely to recommend Heartmath to others. Average MSQv2 decreases were not significant between the Heartmath and waitlist control (estimate = 0.3, 95% CI = −3.1 - 3.6). High users of Heartmath reported a reduction in MSQv2 at day 30 (−12.3 points, p = 0.010) while low users did not (p = 0.765). Discussion App-based HRV biofeedback was feasible and acceptable on a time-limited basis for people with migraine. Changes in the primary clinical outcome did not differ between biofeedback and control; however, high users of the app reported more benefit than low users.

Integration of New Technologies in Assessment, Research, and Treatment Delivery

Article

Sep 2020

Technology is integral to mental health‐care practice. Advanced technologies have the potential to reduce mental health‐care disparities, improve treatment outcomes, and facilitate multidisciplinary collaboration. They can also lead to advances in mental health treatment, ushering in a new era of mental health care. While research on the use of advanced technologies in systemic family therapy lags behind the rest of the mental health‐care field, conclusions can still be drawn from the extant literature for evidence‐based systemic family therapy. Three advanced technologies show the greatest potential for impact in systemic family therapy: teleconferencing with a particular emphasis on videoconferencing, mHealth, or the use of mobile technologies and biofeedback. Other advanced technologies such as gaming software, virtual reality, voice assistant, and smart speaker technologies are also identified as technologies that are rapidly developing and that hold promise for impact in systemic family therapy. Clinicians are encouraged to look to other fields, some of which may not be related to mental health care, for advanced technologies that may have use in systemic family therapy. Responsible use of technology includes conducting research on how technology is used in practice.

Integration of New Technologies in Assessment, Research, and Treatment Delivery

Article

Aug 2020

Assistive Wearable Technology for Mental Wellbeing: Sensors and Signal Processing Approaches

Conference Paper

Sep 2019

Roya Haratian

BreathCoach: A Smart In-home Breathing Training System with Bio-Feedback via VR Game

Article

Nov 2019

RSA-BT (Respiratory Sinus Arrhythmia biofeedback-based Breathing Training) is a cardio-respiratory intervention that has been commonly used as a complementary treatment to respiratory diseases, as well as an exercise to help manage stress and anxiety. Despite its health benefits, today's RSA-BT still relies on in-person sessions and cumbersome sensing devices in a clinical setting, which limits its accessibility. In this paper, we propose BreathCoach, a smart and unobtrusive system that enables effective in-home RSA-BT using sensors on a smartwatch and smartphone-based VR. Specifically, BreathCoach continuously measures key bio-signals including breathing pattern (BP), inter-beat interval (IBI), amplitude of RSA, and intelligently calculates the optimal BP based on current and historical measurements. The recommended BP is conveyed to users through a VR game to provide intuitive guidance. BreathCoach is implemented on a smartphone and a smartwatch with two proof-of-concept VR games. We conducted experiments with 10 participants and evaluated BreathCoach in three aspects: accuracy of physiological measurement, effectiveness of training, and user experience. The results suggest that BreathCoach is able to reliably measure needed bio-signals and intelligently calculate BP recommendations which result in improved performance compared with the traditional approach.

New Frontiers in Heart Rate Variability and Social Coherence Research: Techniques, Technologies, and Implications for Improving Group Dynamics and Outcomes

Article

Full-text available

Oct 2017

Rollin McCraty

Concepts embraced by the term coherence have been identified as central to fields such as quantum physics, physiology, and social science. There are different types of coherence, although the term always implies a harmonious relationship, correlations and connections between the various parts of a system. A specific measure derived from heart rate variability (HRV) provides a measure of physiological coherence. Another type of coherence, social coherence, relates to the harmonious alignment between couples or pairs, family units, small groups, or larger organizations in which a network of relationships exists among individuals who share common interests and objectives. A high degree of social coherence is reflected by stable and harmonious relationships, which allows for the efficient flow and utilization of energy and communication required for optimal collective cohesion and action. Social coherence requires that group members are attuned and are emotionally connected with each other, and that the group’s emotional energy is organized and regulated by the group as a whole. A number of studies are reviewed which have explored various types of synchronization in infants, pairs and groups, indicating that feelings of cooperation, trust, compassion and increased prosocial behaviors depends largely on the establishment of a spontaneous synchronization of various physiological rhythms between individuals. This article discusses a new application using HRV monitoring in social coherence research and the importance of physiological synchronization in group developmental processes and dynamics. Building on the extensive body of research showing that providing feedback of HRV coherence level at the individual level can improve self-regulation, we suggest the following hypotheses: (1) providing feedback of individual and collective HRV coherence and the degree of heart rhythm synchronization will increase group coherence, and heart rhythm synchronization among group members. (2) Training in techniques to increase group coherence and heart rhythm synchronization will correlate with increased prosocial behaviors, such as kindness and cooperation among individuals, improved communication, and decreases in social discord and adversarial interactions. (3) Biomagnetic fields produced by the heart may be a primary mechanism in mediating HRV synchronization among group members. Data supporting each of the hypothesis is discussed.

Heart rate variability biofeedback and other psychophysiological procedures as important elements in psychotherapy

Article

Full-text available

Sep 2017
INT J PSYCHOPHYSIOL

Paul Lehrer

Lang's distinction of psychophysiological, behavioral, and cognitive domains in psychological problems and therapies provides a useful heuristic for guiding psychotherapy. Much psychotherapy practice emphasizes the cognitive domain, but behavioral and psychophysiological interventions show at least equivalent effectiveness for some kinds of problems. Most descriptions of cognitive behavior therapy emphasize cognitive procedures, although most CBT approaches also incorporate behavioral interventions such as social skills training, exposure, and behavior activation. The contribution of psychophysiological methods is often underemphasized. Muscle relaxation and breathing interventions, particularly heart rate variability biofeedback, have been shown to have clinically significant therapeutic effects for a variety of problems. Although used more sporadically in the West, similar methods are part of traditional medical practice in Eastern countries. Examples are given for how these methods can be integrated into more generic psychotherapy practice, using Lang's distinctions, for a variety of psychological problems.

Emerging Directions

Chapter

Mar 2013

Inna Khazan

This chapter provides a brief overview and suggestions for biofeedback assessment and treatment of various disorders, including major depressive disorder (MDD), heart disease, diabetes, arthritis, and insomnia. It suggests biofeedback modalities to consider. While more randomized controlled studies are necessary to firmly establish the efficacy of heart rate variability (HRV) biofeedback in the treatment of major depressive disorder, the existing evidence is encouraging of the use of HRV biofeedback in treating MDD. Emerging evidence is showing that HRV biofeedback may be effective in improving the physiological function and severity of symptoms of people with heart disease. Thermal and surface electromyography (sEMG) biofeedback may be beneficial in treating arthritis related pain.

The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis

Article

May 2017

Background Some evidence suggests that heart rate variability (HRV) biofeedback might be an effective way to treat anxiety and stress symptoms. To examine the effect of HRV biofeedback on symptoms of anxiety and stress, we conducted a meta-analysis of studies extracted from PubMed, PsycINFO and the Cochrane Library. Methods The search identified 24 studies totaling 484 participants who received HRV biofeedback training for stress and anxiety. We conducted a random-effects meta-analysis. Results The pre-post within-group effect size (Hedges' g ) was 0.81. The between-groups analysis comparing biofeedback to a control condition yielded Hedges' g = 0.83. Moderator analyses revealed that treatment efficacy was not moderated by study year, risk of study bias, percentage of females, number of sessions, or presence of an anxiety disorder. Conclusions HRV biofeedback training is associated with a large reduction in self-reported stress and anxiety. Although more well-controlled studies are needed, this intervention offers a promising approach for treating stress and anxiety with wearable devices.

Other Studies

Chapter

Sep 2014

Gernot Ernst

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous clinical syndrome found in 6–8 % of the population (Handa et al. 2012), correlated to smoking habits and social structure. Prevalence of COPD in some countries has started to decline in male population, while prevalence in females is still increasing. Today, COPD is also a disease of lower social classes and the Third World, where smoking habits are different to parts of the industrialized world and particularly to the habits of the middle and upper class.

Teaching Literacy with functional skills to students with significant intellectual disability.

Article

Full-text available

Jan 2014

Heart Rate Variability

Book

Jan 2014

Gernot Ernst

This book not only discusses clinical applications, but also links HRV to systems biology and theories of complexity. This publication should be interesting for several groups of clinicians and scientists, including cardiologists, anesthesiologists, intensivists and physiologists. Heart Rate Variability is in principle easy and cheap, making it interesting for all kind of hospitals and private practice. The book will be an example of using translational medicine (bench to bedside) where newest theoretical results are linked to newest clinical research.

Effectiveness of Online Information and Support Services on the Education of Parents of Children with Intellectual Disabilities.

Article

Full-text available

Jan 2014

Oktay Cem ADIGÜZEL

Rates and Risk of Postpartum Depression-a Meta-Analysis

Article

Full-text available

Jul 2009

The average prevalence rate of non-psychotic postpartum depression based on the results of a large number of studies is 13%. Prevalence estimates are affected by the nature of the assessment method (larger estimates in studies using self-report measures) and by the length of the postpartum period under evaluation (longer periods predict high prevalences). A meta-analysis was undertaken to determine the sizes of the effects of a number of putative risk factors, measured during pregnancy, for postpartum depression. The strongest predictors of postpartum depression were past history of psychopathology and psychological disturbance during pregnancy, poor marital relationship and low social support, and stressful life events. Finally, indicators of low social status showed a small but significant predictive relation to postpartum depression. In sum, these findings generally mirror the conclusions from earlier qualitative reviews of postpartum depression risk factors.

The Relationship between Post-natal Depression and Mother–Child Interaction

Article

Full-text available

Feb 1991

The study was based on an index group of 49 mothers who had had depressive disorders in the post-natal year, and 49 control mothers who had been free from any psychiatric disorder since delivery. Nineteen months after childbirth, the interaction between mother and child was assessed by blind assessors using defined observational methods. Compared with controls, index mother-child pairs showed a reduced quality of interaction (e.g. mothers showed less facilitation of their children, children showed less affective sharing and less initial sociability with a stranger). Similar but reduced effects were seen in a subgroup of index mothers and children where the mother had recovered from depression by 19 months. Social and marital difficulties were associated with reduced quality of mother-child interaction.

Onset and Persistence of Postpartum Depression in an Inner-City Maternal Health Clinic System

Article

Full-text available

Dec 2001

Postpartum depressive disorders lead to maternal disability and disturbed mother-infant relationships, but information regarding the rates of major depressive disorder in minority women is noticeably lacking. The goal of this study was to determine whether the risk factors for and rate of postpartum major depressive disorder in a predominantly African American and Hispanic clinic population would be similar to those reported for Caucasian women. Investigators systematically screened all women scheduled for their first postpartum visit on selected days at four publicly funded inner-city community maternal health clinics in Dallas County (N=802). A multistage screening process included the Edinburgh Postnatal Depression Scale, the Inventory of Depressive Symptomatology, and the Structured Clinical Interview for DSM-IV for a maximum of three assessments during the initial 3-5-week postpartum period. The estimated rate of major depressive disorder during the postpartum period among women in this setting was between 6.5% and 8.5%. Only 50% of the depressed women reported onset following birth. Bottle-feeding and not living with one's spouse or significant other were associated with depression at the first evaluation; persistent depressive symptoms were linked with the presence of other young children at home. Greater severity of depressive symptoms at first contact predicted major depressive disorder several weeks later. Rates of postpartum depression among Latina and African American postpartum women are similar to epidemiologic rates for Caucasian postpartum and nonpostpartum women. As previously shown for Caucasian women, major depressive disorder in many Latina and African American postpartum women begins before delivery, revealing the need to screen pregnant women for depression.

Does the Edinburgh Postnatal Depression Scale measure anxiety?

Article

Full-text available

Dec 2001
J PSYCHOSOM RES

The existence of a separate anxiety and depression dimension within the Edinburgh Postnatal Depression Scale (EPDS) has been reported previously. However, the concurrent validity of this anxiety subscale was never evaluated. We investigated whether (1) this existence of an anxiety subscale could be confirmed and (2) it more highly correlated with other measures of anxiety than the total EPDS. The SCL-90-R, the EPDS, and the State-Trait Anxiety Inventory (STAI) were filled out by 197 pregnant women. A principal component analysis (PCA) was used for confirmation of the subscales and correlations were computed between the (subscales of the) EPDS and the other measures of anxiety. The existence of an anxiety scale within the EPDS was confirmed. However, this subscale did not yield higher correlations with other measures of anxiety than did the total EPDS. Investigators using the EPDS to screen for depression should realise that the instrument does not exclusively measure depression. It seems that both anxiety symptoms and depressive symptoms are more accurately measured when using the total 10-item EPDS than when using the subscales.

Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes

Article

Full-text available

Mar 2005
Evid Rep Tech Assess

A Pilot Study of the Efficacy of Heart Rate Variability (HRV) Biofeedback in Patients with Fibromyalgia

Article

Full-text available

Apr 2007

Fibromyalgia (FM) is a non-inflammatory rheumatologic disorder characterized by musculoskeletal pain, fatigue, depression, cognitive dysfunction and sleep disturbance. Research suggests that autonomic dysfunction may account for some of the symptomatology of FM. An open label trial of biofeedback training was conducted to manipulate suboptimal heart rate variability (HRV), a key marker of autonomic dysfunction. Twelve women ages 18-60 with FM completed 10 weekly sessions of HRV biofeedback. They were taught to breathe at their resonant frequency (RF) and asked to practice twice daily. At sessions 1, 10 and 3-month follow-up, physiological and questionnaire data were collected. There were clinically significant decreases in depression and pain and improvement in functioning from Session 1 to a 3-month follow-up. For depression, the improvement occurred by Session 10. HRV and blood pressure variability (BPV) increased during biofeedback tasks. HRV increased from Sessions 1-10, while BPV decreased from Session 1 to the 3 month follow-up. These data suggest that HRV biofeedback may be a useful treatment for FM, perhaps mediated by autonomic changes. While HRV effects were immediate, blood pressure, baroreflex, and therapeutic effects were delayed. This is consistent with data on the relationship among stress, HPA axis activity, and brain function.

Preliminary Results of an Open Label Study of Heart Rate Variability Biofeedback for the Treatment of Major Depression

Article

Full-text available

Apr 2007

Major depressive disorder (MDD) is a common mood disorder that can result in significant discomfort as well as interpersonal and functional disability. A growing body of research indicates that autonomic function is altered in depression, as evidenced by impaired baroreflex sensitivity, changes in heart rate, and reduced heart rate variability (HRV). Decreased vagal activity and increased sympathetic arousal have been proposed as major contributors to the increased risk of cardiovascular mortality in participants with MDD, and baroreflex gain is decreased. To assess the feasibility of using HRV biofeedback to treat major depression. This was an open-label study in which all eleven participants received the treatment condition. Participants attended 10 weekly sessions. Questionnaires and physiological data were collected in an orientation (baseline) session and Treatment Sessions 1, 4, 7 and 10. Significant improvements were noted in the Hamilton Depression Scale (HAM-D) and the Beck Depression Inventory (BDI-II) by Session 4, with concurrent increases in SDNN, standard deviation of normal cardiac interbeat intervals) an electrocardiographic estimate of overall measure of adaptability. SDNN decreased to baseline levels at the end of treatment and at follow-up, but clinically and statistically significant improvement in depression persisted. Main effects for task and session occurred for low frequency range (LF) and SDNN. Increases in these variables also occurred during breathing at one's resonant frequency, which targets baroreflex function and vagus nerve activity, showing that subjects performed the task correctly. HRV biofeedback appears to be a useful adjunctive treatment for the treatment of MDD, associated with large acute increases in HRV and some chronic increases, suggesting increased cardiovagal activity. It is possible that regular exercise of homeostatic reflexes helps depression even when changes in baseline HRV are smaller. A randomized controlled trial is warranted.

The Warwick-Edinburgh mental well-being scale (WEMWBS): Development and UK validation

Article

Full-text available

Feb 2007
HEALTH QUAL LIFE OUT

There is increasing international interest in the concept of mental well-being and its contribution to all aspects of human life. Demand for instruments to monitor mental well-being at a population level and evaluate mental health promotion initiatives is growing. This article describes the development and validation of a new scale, comprised only of positively worded items relating to different aspects of positive mental health: the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). WEMWBS was developed by an expert panel drawing on current academic literature, qualitative research with focus groups, and psychometric testing of an existing scale. It was validated on a student and representative population sample. Content validity was assessed by reviewing the frequency of complete responses and the distribution of responses to each item. Confirmatory factor analysis was used to test the hypothesis that the scale measured a single construct. Internal consistency was assessed using Cronbach's alpha. Criterion validity was explored in terms of correlations between WEMWBS and other scales and by testing whether the scale discriminated between population groups in line with pre-specified hypotheses. Test-retest reliability was assessed at one week using intra-class correlation coefficients. Susceptibility to bias was measured using the Balanced Inventory of Desired Responding. WEMWBS showed good content validity. Confirmatory factor analysis supported the single factor hypothesis. A Cronbach's alpha score of 0.89 (student sample) and 0.91 (population sample) suggests some item redundancy in the scale. WEMWBS showed high correlations with other mental health and well-being scales and lower correlations with scales measuring overall health. Its distribution was near normal and the scale did not show ceiling effects in a population sample. It discriminated between population groups in a way that is largely consistent with the results of other population surveys. Test-retest reliability at one week was high (0.83). Social desirability bias was lower or similar to that of other comparable scales. WEMWBS is a measure of mental well-being focusing entirely on positive aspects of mental health. As a short and psychometrically robust scale, with no ceiling effects in a population sample, it offers promise as a tool for monitoring mental well-being at a population level. Whilst WEMWBS should appeal to those evaluating mental health promotion initiatives, it is important that the scale's sensitivity to change is established before it is recommended in this context.

Rates and risk of postpartum depression-a meta-analysis

Article

Jan 1996

Symptom features of postpartum depression: Are they distinct?

Article

Jan 2006

Manual for the State-Trait Anxiety Inventory (STAI : Form Y)

Article

Jan 1983

C.D. Spielberger

Predicators of postpartum depression: an update

Article

Jan 2001

C.T. Beck

Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale

Article

Jan 1987

Biofeedback Applications: A Survey of Clinical Research

Article

Dec 2006

Sala Horowitz

Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes Summary

Article

Jan 2005

Postpartum and nonpostpartum depression: Differences in presentation and response to pharmacologic treatment

Article

Jan 2000
DEPRESS ANXIETY

Following childbirth, major depression (postpartum depression) affects approximately 8–12% of new mothers. However, little is known about the pharmacological management of postpartum depression, and no studies to date have assessed differences in treatment response between women with postpartum and nonpostpartum major depressionThe authors reviewed the records of 26 women with postpartum major depression and 25 women with major depression unrelated to childbearing (nonpostpartum depression) who presented to them for treatment over a 4-year period. Compared with the nonpostpartum depressed patients, the postpartum depressed women were significantly more likely to present with anxious features. Also, cases of postpartum depression were more severe than cases of nonpostpartum depression. While the postpartum patients were equally as likely to recover (as defined by a Clinical Global Impression score of 1 or 2) compared to the nonpostpartum-depressed patients, their time to response was significantly longer. By 3 weeks of pharmacotherapy, 75% of the nonpostpartum cases had recovered, in contrast to only 36% of the postpartum cases. Further, postpartum patients were significantly more likely to be receiving more than one antidepressant agent at the time of response to treatment. Length of depression prior to treatment did not explain the difference in treatment response. Presence of depressive symptoms during pregnancy and timing of onset of the depression (before vs. after 4 weeks of delivery) did not affect likelihood of treatment response in this sampleWomen with postpartum depression appear to be significantly more likely than the nonpostpartum women to present with anxious features, take longer to respond to pharmacotherapy for depression, and require more antidepressant agents at the time of response to treatment. Depression and Anxiety 11:66–72, 2000. © 2000 Wiley-Liss, Inc

Mind-body interventions during pregnancy for preventing or treating women's anxiety

Article

Jul 2011

Background: Anxiety during pregnancy is a common problem. Anxiety and stress could have consequences on the course of the pregnancy and the later development of the child. Anxiety responds well to treatments such as cognitive behavioral therapy and/or medication. Non-pharmacological interventions such as mind-body interventions, known to decrease anxiety in several clinical situations, might be offered for treating and preventing anxiety during pregnancy. Objectives: To assess the benefits of mind-body interventions during pregnancy in preventing or treating women's anxiety and in influencing perinatal outcomes. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2010), MEDLINE (1950 to 30 November 2010), EMBASE (1974 to 30 November 2010), the National Center for Complementary and Alternative Medicine (NCCAM) (1 December 2010), ClinicalTrials.gov (December 2010) and Current Controlled Trials (1 December 2010), searched the reference lists of selected studies and contacted professionals and authors in the field. Selection criteria: Randomized controlled trials, involving pregnant women of any age at any time from conception to one month after birth, comparing mind-body interventions with a control group. Mind-body interventions include: autogenic training, biofeedback, hypnotherapy, imagery, meditation, prayer, auto-suggestion, tai-chi and yoga. Control group includes: standard care, other pharmacological or non-pharmacological interventions, other types of mind-body interventions or no treatment at all. Data collection and analysis: Three review authors independently assessed trials for inclusion all assessed risk of bias for each included study. We extracted data independently using an agreed form and checked it for accuracy. Main results: We included eight trials (556 participants), evaluating hypnotherapy (one trial), imagery (five trials), autogenic training (one trial) and yoga (one trial). Due to the small number of studies per intervention and to the diversity of outcome measurements, we performed no meta-analysis, and have reported results individually for each study. Compared with usual care, in one study (133 women), imagery may have a positive effect on anxiety during labor decreasing anxiety at the early and middle stages of labor (MD -1.46; 95% CI -2.43 to -0.49; one study, 133 women) and (MD -1.24; 95% CI -2.18 to -0.30). Another study showed that imagery had a positive effect on anxiety and depression in the immediate postpartum period. Autogenic training might be effective for decreasing women's anxiety before delivering. Authors' conclusions: Mind-body interventions might benefit women's anxiety during pregnancy. Based on individual studies, there is some but no strong evidence for the effectiveness of mind-body interventions for the management of anxiety during pregnancy. The main limitations of the studies were the lack of blinding and insufficient details on the methods used for randomization.

Does maternal postpartum depressive symptomatology influence infant feeding outcomes?

Article

Apr 2007

To examine the relationship between diverse infant feeding outcomes, e.g. infant feeding method, maternal satisfaction, infant feeding plans, breastfeeding progress and breastfeeding self-efficacy) and postpartum depressive symptomatology using a time-sequenced analysis. As part of a population-based study, 594 participants completed questionnaires at 1, 4 and 8 weeks postpartum. No relationship was found between diverse infant feeding outcomes at 1-week postpartum and the development of depressive symptomatology at 4 or 8 weeks. Conversely, mothers with an Edinburgh Postnatal Depression Score>12 at 1 week postpartum were significantly more likely at 4 and/or 8 weeks to discontinue breastfeeding, be unsatisfied with their infant feeding method, experience significant breastfeeding problems and report lower levels of breastfeeding self-efficacy. The findings from this study suggest that early identification of breastfeeding mothers with depressive symptomatology is needed not only to reduce the morbidity associated with postpartum depression but also in attempt to promote increased rates of breastfeeding duration.

Biofeedback for pain management during labour

Article

Jun 2011

Background: Labour is often associated with pain and discomfort caused by a complex and subjective interaction of multiple factors, and should be understood within a multi-dimensional and multi-disciplinary framework. Within the non-pharmacological approach, biofeedback has focused on the acquisition of control over some physiological responses with the aid of electronic devices, allowing individuals to regulate some physical processes (such as pain) which are not usually under conscious control. The role of this behavioural approach for the management of pain during labour, as an addition to the standard prenatal care, has been never assessed systematically. This review is one in a series of Cochrane reviews examining pain relief in labour, which will contribute to an overview of systematic reviews of pain relief for women in labour (in preparation). Objectives: To examine the effectiveness of the use of biofeedback in prenatal lessons for managing pain during labour. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2011), CENTRAL (The Cochrane Library 2011, Issue 1), PubMed (1950 to 20 March 2011), EMBASE (via OVID) (1980 to 24 March 2011), CINAHL (EBSCOhost) (1982 to 24 March 2011), and PsycINFO (via Ovid) (1806 to 24 March 2011). We searched for further studies in the reference lists of identified articles. Selection criteria: Randomised controlled trials of any form of prenatal classes which included biofeedback, in any modality, in women with low-risk pregnancies. Data collection and analysis: Two authors independently assessed trial quality and extracted data. Main results: The review included four trials (186 women) that hugely differed in terms of the diversity of the intervention modalities and outcomes measured. Most trials assessed the effects of electromyographic biofeedback in women who were pregnant for the first time. The trials were judged to be at a high risk of bias due to the lack of data describing the sources of bias assessed. There was no significant evidence of a difference between biofeedback and control groups in terms of assisted vaginal birth, caesarean section, augmentation of labour and the use of pharmacological pain relief. The results of the included trials showed that the use of biofeedback to reduce the pain in women during labour is unproven. Electromyographic biofeedback may have some positive effects early in labour, but as labour progresses there is a need for additional pharmacological analgesia. Authors' conclusions: Despite some positive results shown in the included trials, there is insufficient evidence that biofeedback is effective for the management of pain during labour.

Postpartum depression effects on early interactions, parenting, and safety practices: A review

Article

Dec 2009

Tiffany Field

In this paper studies are reviewed from the last decade on postpartum depression effects on early interactions, parenting, safety practices and on early interventions. The interaction disturbances of depressed mothers and their infants appear to be universal, across different cultures and socioeconomic status groups and, include less sensitivity of the mothers and responsivity of the infants. Several caregiving activities also appear to be compromised by postpartum depression including feeding practices, most especially breastfeeding, sleep routines and well-child visits, vaccinations and safety practices. These data highlight the need for universal screening of maternal and paternal depression during the postpartum period. Early interventions reviewed here include psychotherapy and interaction coaching for the mothers, and infant massage for their infants.

A Pilot Study on the Effects of Heart Rate Variability Biofeedback in Patients with Depression and in Healthy Subjects

Article

Sep 2008
APPL PSYCHOPHYS BIOF

Decreased vagal activity and increased sympathetic arousal have been proposed as major contributors to the increased risk of cardiovascular mortality in patients with depression. It was aim of the present study to assess the feasibility of using heart rate variability (HRV) biofeedback to treat moderate to severe depression. This was an open-label study in which 14 patients with different degrees of depression (13 f, 1 m) aged 30 years (18-47; median; range) and 12 healthy volunteers attended 6 sessions of HRV biofeedback over two weeks. Another 12 healthy subjects were observed under an active control condition. At follow up BDI was found significantly decreased (BDI 6; 2-20; median 25%-75% quartile) as compared to baseline conditions (BDI 22;15-29) in patients with depression. In addition, depressed patients had reduced anxiety, decreased heart rate and increased HRV after conduction of biofeedback (p < 0.05). By contrast, no changes were noted in healthy subjects receiving biofeedback nor in normal controls. In conclusion, HRV biofeedback appears to be a useful adjunct for the treatment of depression, associated with increases in HRV.

Detection of postnatal depression — development of the 10 item Edinburgh Postnatal Depression Scale (EPDS)

Article

Jul 1987

The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.

Increases in heart rate variability with successful treatment in patients with major depression

Article

Feb 1993
Psychopharmacol Bull

We obtained Hamilton Rating Scale for Depression (HAM-D) scores and recorded 5 minutes of rhythm strip both before and after a therapeutic trial of antidepressant medications in 17 patients diagnosed with major depressive disorder (MDD). We calculated the standard deviation (SD) of interbeat intervals and the mean squared successive difference (MSSD) as measures of heart-rate variability (HRV). We then calculated Spearman rank-ordered correlation coefficients between the HRV measures and the HAM-D scores. Changes in SD and MSSD correlated with post-treatment HAM-D scores and with changes in HAM-D scores. These relationships were strongest in patients who responded positively to nontricyclic antidepressant medications. HRV before treatment was not predictive of treatment response, nor did HRV reliably reflect the severity of depressive symptoms. These findings indicate that pharmacologic treatment leading to improvement in MDD is associated with increased HRV. Hence, brief measures of HRV could be developed as a useful adjunctive, physiologic measure of treatment response to pharmacotherapy in clinical trials and other settings. Further, increased HRV associated with successful treatment of MDD may reflect improved autonomic function, decreasing the risk of cardiovascular mortality found in patients with MDD.

Hendrick V, Altshuler L, Strouse T, Grosser S. Postpartum and nonpostpartum depression: Differences in presentation and response to pharmacologic treatment. Depress Anxiety 11: 66-72

Article

Feb 2000

Following childbirth, major depression (postpartum depression) affects approximately 8-12% of new mothers. However, little is known about the pharmacological management of postpartum depression, and no studies to date have assessed differences in treatment response between women with postpartum and nonpostpartum major depression. The authors reviewed the records of 26 women with postpartum major depression and 25 women with major depression unrelated to childbearing (nonpostpartum depression) who presented to them for treatment over a 4-year period. Compared with the nonpostpartum depressed patients, the postpartum depressed women were significantly more likely to present with anxious features. Also, cases of postpartum depression were more severe than cases of nonpostpartum depression. While the postpartum patients were equally as likely to recover (as defined by a Clinical Global Impression score of 1 or 2) compared to the nonpostpartum-depressed patients, their time to response was significantly longer. By 3 weeks of pharmacotherapy, 75% of the nonpostpartum cases had recovered, in contrast to only 36% of the postpartum cases. Further, postpartum patients were significantly more likely to be receiving more than one antidepressant agent at the time of response to treatment. Length of depression prior to treatment did not explain the difference in treatment response. Presence of depressive symptoms during pregnancy and timing of onset of the depression (before vs. after 4 weeks of delivery) did not affect likelihood of treatment response in this sample. Women with postpartum depression appear to be significantly more likely than the nonpostpartum women to present with anxious features, take longer to respond to pharmacotherapy for depression, and require more antidepressant agents at the time of response to treatment.

Maternal Depression and Parenting Behavior: A Meta-Analytic Review

Article

Sep 2000
CLIN PSYCHOL REV

The results of 46 observational studies were analyzed to assess the strength of the association between depression and parenting behavior and to identify variables that moderated the effects. The association between depression and parenting was manifest most strongly for negative maternal behavior and was evident to a somewhat lesser degree in disengagement from the child. The association between depression and positive maternal behavior was relatively weak, albeit significant. Effects for negative maternal behavior were moderated by timing of the depression: Current depression was associated with the largest effects. However, residual effects of prior depression were apparent for all behaviors. Socioeconomic status, child age, and methodological variables moderated the effects for positive behavior: Effects were strongest for studies of disadvantaged women and mothers of infants. Studies using diagnostic interviews and self-report measures yielded similar effects, suggesting that deficits are not specific to depressive disorder. Research is needed to identify factors that affect the magnitude of parenting deficits among women who are experiencing depression and other psychological difficulties.

Infant Sleep Problems and Postnatal Depression: A Community-Based Study

Article

Jun 2001
Pediatrics

To describe infant sleep patterns and investigate relationships between infant sleep problems and maternal well-being in the community setting. Cross-sectional community survey. Setting. Maternal and Child Health Centers in 3 middle-class local government areas in Melbourne, Australia. Mothers of infants 6 to 12 months of age. Maternal well-being (Edinburgh Postnatal Depression Scale) and infant sleep problems (standardized maternal questionnaire). The survey was completed by 738 mothers (94% response rate), of whom 46% reported their infant's sleep as a problem. In the univariate analyses, sleep patterns characterizing a sleep problem included the infant sleeping in the parent's bed, being nursed to sleep, taking longer to fall asleep, waking more often and for longer periods overnight, and taking shorter naps. The same sleep patterns were associated with high depression scores and tended to increase as depression scores increased. Because of positive skew, the Edinburgh Postnatal Depression Score was analyzed in 3 categories (<10, 10-12, and >12) using validated cutoff scores from community and clinical studies. Fifteen percent of mothers scored above 12 on the depression scale, indicating probable clinical depression, and 18% scored between 10 and 12, indicating possible clinical depression. After adjusting for potential confounders and factors significant in the univariate analyses, maternal report of an infant sleep problem remained a significant predictor of a depression score >12 (odds ratio: 2.13; 95% confidence interval: 1.27,3.56) and >10 (odds ratio: 2.88; 95% confidence interval: 1.93,4.31). However, mothers reporting good sleep quality, despite an infant sleep problem, were not more likely to suffer depression. Maternal report of infant sleep problems and depression symptoms are common in middle-class Australian communities. There is a strong association between the 2, even when known depression risk factors are taken into account. Maternal report of good sleep quality attenuates this relationship. Appropriate anticipatory guidance addressing infant sleep could potentially decrease maternal report of depressive symptoms.

Predictors of Postpartum Depression

Article

Sep 2001

Cheryl Tatano Beck

Approximately 13% of women experience postpartum depression. Early recognition is one of the most difficult challenges with this mood disorder because of how covertly it is suffered. The purpose of this meta-analysis was to update the findings of an earlier meta-analysis of postpartum depression predictors that had synthesized the results of studies conducted mostly in the 1980s. A meta-analysis of 84 studies published in the decade of the 1990s was conducted to determine the magnitude of the relationships between postpartum depression and various risk factors. Using the software system Advanced Basic Meta-Analysis, effect sizes were calculated three ways: unweighted, weighted by sample size, and weighted by quality index score. Thirteen significant predictors of postpartum depression were revealed. Ten of the 13 risk factors had moderate effect sizes while three predictors had small effect sizes. The mean effect size indicator ranges for each risk factor were as follows: prenatal depression (.44 to .46), self esteem (.45 to. 47), childcare stress (.45 to .46), prenatal anxiety (.41 to .45), life stress (.38 to .40), social support (.36 to .41), marital relationship (.38 to .39), history of previous depression (.38 to .39), infant temperament (.33 to .34), maternity blues (.25 to .31), marital status (.21 to .35), socioeconomic status (.19 to .22), and unplanned/unwanted pregnancy (.14 to .17). Results confirmed findings of an earlier meta-analysis and in addition revealed four new predictors of postpartum depression: self-esteem, marital status, socioeconomic status, and unplanned/unwanted pregnancy.

Measurement issues in postpartum depression part 1: Anxiety as a feature of postpartum depression

Article

Mar 2003

We investigated the contribution of anxiety symptoms to scores on the Edinburgh Postnatal Depression Scale (EPDS) between 36 weeks gestation and 16 weeks postpartum in 150 women. The 3-item anxiety subscale of the EPDS accounted for 47% of the total score in late pregnancy, and 38% of the total score in the postpartum period. Two categories of anxiety were common in the perinatal period: subsyndromal, situational anxiety (in particular during the last weeks of pregnancy); and clinically significant comorbid anxiety, which was experienced by nearly 50% of clinically depressed pregnant and postpartum women. The close relationship between anxiety and depression raises questions about whether symptoms of anxiety might be more common in the perinatal period than in other depressions. A strong role for anxiety symptoms in postpartum depression, and implications for its etiology and treatment, are discussed.

Antenatal risk factors for postpartum depression: A synthesis of recent literature

Article

Jul 2004
GEN HOSP PSYCHIAT

Postpartum nonpsychotic depression is the most common complication of childbearing, affecting approximately 10-15% of women and, as such, represents a considerable health problem affecting women and their families. This systematic review provides a synthesis of the recent literature pertaining to antenatal risk factors associated with developing this condition. Databases relating to the medical, psychological, and social science literature were searched using specific inclusion criteria and search terms, in order to identify studies examining antenatal risk factors for postpartum depression. Studies were identified and critically appraised in order to synthesize the current findings. The search resulted in the identification of two major meta-analyses conducted on over 14,000 subjects, as well as newer subsequent large-scale clinical studies. The results of these studies were then summarized in terms of effect sizes as defined by Cohen. The findings from the meta-analyses of over 14,000 subjects, and subsequent studies of nearly 10,000 additional subjects found that the following factors were the strongest predictors of postpartum depression: depression during pregnancy, anxiety during pregnancy, experiencing stressful life events during pregnancy or the early puerperium, low levels of social support, and a previous history of depression. Critical appraisal of the literature revealed a number of methodological and knowledge gaps that need to be addressed in future research. These include examining specific risk factors in women of lower socioeconomic status, risk factors pertaining to teenage mothers, and the use of appropriate instruments assessing postpartum depression for use within different cultural groups.

The course of maternal depressive symptoms and maternal sensitivity as predictors of attachment security at 36 months

Article

Feb 2004

We examined the course of maternal depressive symptoms and children's attachment security at 36 months in a large sample of mother-child pairs from 10 sites across the country participating in the NICHD Study of Early Child Care (N = 1077). Maternal depressive symptoms predicted higher rates of insecure attachment. Women who reported intermittent symptoms across the first 36 months had preschoolers who were more likely to be classified as insecure C or D; women with chronic symptoms were more likely to have preschoolers who were classified as insecure D. Symptoms reported only during the first 15 months were not associated with elevated rates of later insecurity. After controlling for potentially confounding demographic variables, maternal sensitivity (observed at 6, 15, 24, and 36 months) did not meaningfully account for links between attachment security and patterns of depressive symptoms. However, the course and timing of maternal depressive symptoms interacted with maternal sensitivity to predict insecurity. Women with late, intermittent, or chronic symptoms who were also low in sensitivity were more likely to have preschoolers who were insecure, in contrast to symptomatic women who were high in sensitivity. These data have implications for understanding the combined impact of maternal depressive symptoms and maternal sensitivity on children's socioemotional development.

Newer antidepressants in pregnancy and rates of major malformations: A meta-analysis of prospective comparative studies

Article

Dec 2005

A substantial number of women of childbearing age suffer from depression. Despite this, relatively little is known about the safety of antidepressant use during pregnancy. We conducted a meta-analysis of prospective comparative cohort studies to quantify the relationship between maternal exposure to the newer antidepressants and major malformations. We searched Medline, Embase and Reprotox from 1996 to the present for studies comparing outcomes in first trimester exposures to citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, reboxetine, venlafaxine, nefazodone, trazodone, mirtazapine and bupropion to those of non-exposed mothers. Data were combined using a random effects model; heterogeneity was tested with chi2, and publication bias with a funnel plot and the Begg-Mazumdar statistic. Twenty-two studies were identified, 15 were rejected (4 reviews, 4 without comparison groups, 2 third trimester exposures, 2 retrospective database studies, 2 case reports and 1 duplicate); 7 studies (n = 1774) met inclusion criteria. Effects were not heterogeneous (chi2 = 2.04, p = 0.92); funnel plot and test (tau = -0.24, p = 0.45) indicated no publication bias. The summary relative risk was 1.01 (95%CI: 0.57-1.80). As a group, the newer antidepressants are not associated with an increased risk of major malformations above the baseline of 1-3% in the population.

The Many Faces of Postpartum Depression

Article

Sep 2005

To provide a profile of women suffering from major postpartum depression as assessed by the Postpartum Depression Screening Scale (PDSS). A secondary analysis conducted on a portion of the data collected from an earlier psychometric testing of the PDSS. Private practice in the San Francisco Bay Area of a marriage and family therapist specializing in perinatal mood disorders. One hundred thirty-three women who were diagnosed with major postpartum depression. Each mother completed the PDSS followed by a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnostic interview. Seven dimensions of postpartum depression: sleeping/eating disturbances, anxiety/insecurity, emotional lability, mental confusion, loss of self, guilt/shame, and suicidal thoughts as measured by the PDSS. Scores on all seven dimensions of the PDSS were elevated. The three top dimensions were emotional lability, mental confusion, and anxiety/insecurity. The mean total PDSS score of 120 was well beyond the recommended cutoff score of 80 for a positive screen for major postpartum depression. Clinicians who come in contact with new mothers need to be alert to the range of possible symptoms that postpartum depressed mothers may experience so that these women are not left to suffer in silence.

Perinatal Depression: A Systematic Review of Prevalence and Incidence

Article

Dec 2005
OBSTET GYNECOL

We systematically review evidence on the prevalence and incidence of perinatal depression and compare these rates with those of depression in women at non-childbearing times. We searched MEDLINE, CINAHL, PsycINFO, and Sociofile for English-language articles published from 1980 through March 2004, conducted hand searches of bibliographies, and consulted with experts. We included cross-sectional, cohort, and case-control studies from developed countries that assessed women for depression during pregnancy or the first year postpartum with a structured clinical interview. Of the 109 articles reviewed, 28 met our inclusion criteria. For major and minor depression (major depression alone), the combined point prevalence estimates from meta-analyses ranged from 6.5% to 12.9% (1.0-5.6%) at different trimesters of pregnancy and months in the first postpartum year. The combined period prevalence shows that as many as 19.2% (7.1%) of women have a depressive episode (major depressive episode) during the first 3 months postpartum; most of these episodes have onset following delivery. All estimates have wide 95% confidence intervals, showing significant uncertainty in their true levels. No conclusions could be made regarding the relative incidence of depression among pregnant and postpartum women compared with women at non-childbearing times. To better delineate periods of peak prevalence and incidence for perinatal depression and identify high risk subpopulations, we need studies with larger and more representative samples.

Risks Associated With Selective Serotonin Reuptake Inhibitors in Pregnancy

Article

Dec 2005
OBSTET GYNECOL

To study the effects of selective serotonin reuptake inhibitors (SSRIs) on pregnancy outcome. We performed a population-based study of women exposed to SSRIs during pregnancy (n = 1782). Data were derived from a national project in Finland, established by 3 governmental organizations. In that project, the Drug Reimbursement Register, the Medical Birth Register, the Register of Congenital Malformations, and the Register of Induced Abortions have been linked. Comparisons were made between women with SSRI purchases to matched controls and between women with purchases in different trimesters. Only singleton pregnancies were included. Primary outcomes were major malformations, preterm birth, small for gestational age, low birth weight, and treatment in neonatal special or intensive care unit. Analyses were based on logistic models. Major malformations were not more common in infants or fetuses of women with first trimester SSRI purchases (n = 1,398) when compared with controls with no drug purchases (P = .4). Of infants born to mothers with SSRI purchases in the 3rd trimester, 15.7% were treated in special or intensive care unit compared with 11.2% of infants exposed only during the 1st trimester (P = .009, adjusted odds ratio 1.6, 95% confidence interval 1.1-2.2). We found no increased risk of preterm birth (< 37 weeks), birth 32 weeks of gestation or less, small for gestational age, or low birth weight in women with purchases in each trimester or during the 2nd and 3rd trimesters when compared with women with only 1st trimester purchases. Use of SSRIs during pregnancy is not independently associated with increased risk of adverse perinatal outcome other than need for treatment in neonatal special or intensive care unit.

Maternal Depressive Symptoms at 2 to 4 Months Post Partum and Early Parenting Practices

Article

Apr 2006
Arch Pediatr Adolesc Med

To determine whether maternal depressive symptoms, reported when infants are 2 to 4 months old, are associated with mothers' early parenting practices. Secondary data analyses collected from the National Evaluation of Healthy Steps for Young Children. Data sources included newborn enrollment questionnaires and parent interviews when infants were 2 to 4 months old. Maternal depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. Twenty-four pediatric practices across the United States. A total of 5565 families enrolled in Healthy Steps; 4874 mothers (88%) completed 2- to 4-month interviews and provided Center for Epidemiologic Studies Depression Scale data; 17.8% of mothers reported having depressive symptoms. Ten parenting practices assessed in 3 domains: safety (sleep position and lowering water temperature), feeding (cereal, water, or juice; continuing breastfeeding), and practices to promote child development (showing books, playing with infant, talking to infant, and following 2 or more routines). Mothers with and without depressive symptoms reported similar uses of safety and feeding practices. Mothers with depressive symptoms had reduced odds of continuing breastfeeding (adjusted odds ratio [AOR], 0.73; 95% confidence interval [CI], 0.61-0.88), showing books (AOR, 0.81; 95% CI, 0.68-0.97), playing with the infant (AOR, 0.70; 95% CI, 0.54-0.90), talking to the infant (AOR, 0.74; 95% CI, 0.63-0.86), and following routines (AOR, 0.61; 95% CI, 0.52-0.72). Maternal depressive symptoms are common in early infancy and contribute to unfavorable parenting practices.

Selective serotonin reuptake inhibitors and adverse pregnancy outcomes

Article

May 2006

The purpose of this study was to assess the safety of the use of selective serotonin reuptake inhibitors in pregnancy. We carried out a retrospective cohort study of 972 pregnant women who had been given at least 1 selective serotonin reuptake inhibitor prescription in the year before delivery and 3878 pregnant women who did not receive selective serotonin reuptake inhibitors and who were matched by the year of the infant's birth, the type of institute at birth, and the mother's postal code from 1990 to 2000 in the Canadian province of Saskatchewan. The risks of low birth weight (adjusted odds ratio, 1.58; 95% CI, 1.19, 2.11), preterm birth (adjusted odds ratio, 1.57; 95% CI, 1.28, 1.92), fetal death (adjusted odds ratio, 2.23; 95% CI, 1.01, 4.93), and seizures (adjusted odds ratio, 3.87; 95% CI, 1.00, 14.99) were increased in infants who were born to mothers who had received selective serotonin reuptake inhibitor therapy. The use of selective serotonin reuptake inhibitors in pregnancy may increase the risks of low birth weight, preterm birth, fetal death, and seizures.

Power spectrum analysis and cardiovascular morbidity in anxiety disorders

Article

Aug 2006
AUTON NEUROSCI-BASIC

Spectral analysis of heart rate variability (HRV) and related measures has been shown to be a reliable noninvasive technique enabling quantitative assessment of cardiovascular autonomic regulatory responses to autonomic regulatory mechanisms; it provides a dynamic probe of sympathetic and parasympathetic tone, reflecting the interactions between the two. Over 20 studies reported abnormalities of HRV in anxiety, and patients with heart disease and anxiety are at increased risk for morbidity and mortality. Psychiatric drugs partly correct abnormalities of HRV and, recently, autonomic drugs (beta-blockers) have been studied in anxiety disorders. The authors call for further studies, especially in patients with co-existing anxiety disorders and heart disease, incorporating assessment of HRV.

The Timing of Maternal Depressive Symptoms and Mothers' Parenting Practices With Young Children: Implications for Pediatric Practice

Article

Aug 2006
Pediatrics

The prevalence of maternal depressive symptoms and its associated consequences on parental behaviors, child health, and development are well documented. Researchers have called for additional work to investigate the effects of the timing of maternal depressive symptoms at various stages in the development of the young child on the emergence of developmentally appropriate parenting practices. For clinicians, data are limited about when or how often to screen for maternal depressive symptoms or how to target anticipatory guidance to address parental needs. We sought to determine whether concurrent maternal depressive symptoms have a greater effect than earlier depressive symptoms on the emergence of maternal parenting practices at 30 to 33 months in 3 important domains of child safety, development, and discipline. Secondary analyses from the Healthy Steps National Evaluation were conducted for this study. Data sources included a self-administered enrollment questionnaire and computer-assisted telephone interviews with the mother when the Healthy Steps children were 2 to 4 and 30 to 33 months of age. The 30- to 33-month interview provided information about 4 safety practices (ie, always uses car seat, has electric outlet covers, has safety latches on cabinets, and lowered temperature on the water heater), 6 child development practices (ie, talks daily to child while working, plays daily with child, reads daily to child, limits child television and video watching to <2 hours a day, follows > or = 3 daily routines, and being more nurturing), and 3 discipline practices (ie, uses more reasoning, uses more harsh punishment, and ever slapped child on the face or spanked the child with an object). The parenting practices were selected based on evidence of their importance for child health and development, near complete data, and sample variability. The discipline practices were constructed from the Parental Response to Misbehavior Scale. Maternal depressive symptoms were assessed using a 14-item modified version of the Center for Epidemiologic Studies-Depression Scale. Multiple logistic regression models estimated the effect of depressive symptoms on parenting practices, adjusted for baseline demographic characteristics, Healthy Steps participation, and site. No significant interactions were found when testing analytic models with dummy variables for depressive symptoms at 2 to 4 months only, 30 to 33 months only, and at both times; reported models do not include interaction terms. We report main effects of depressive symptoms at 2 to 4 and 30 to 33 months when both are included in the model. Of 5565 families, 3412 mothers (61%) completed 2- to 4- and 30- to 33-month interviews and provided Center for Epidemiologic Studies-Depression Scale data at both times. Mothers with depressive symptoms at 2 to 4 months had reduced odds of using car seats, lowering the water heater temperature, and playing with the child at 30 to 33 months. Mothers with concurrent depressive symptoms had reduced odds of using electric outlet covers, using safety latches, talking with the child, limiting television or video watching, following daily routines, and being more nurturing. Mothers with concurrent depressive symptoms had increased odds of using harsh punishment and of slapping the child on the face or spanking with an object. The study findings suggest that concurrent maternal depressive symptoms have stronger relations than earlier depressive symptoms, with mothers not initiating recommended age-appropriate safety and child development practices and also using harsh discipline practices for toddlers. Our findings, however, also suggest that for parenting practices that are likely to be established early in the life of the child, it may be reasonable that mothers with early depressive symptoms may continue to affect use of those practices by mothers. The results of our study underscore the importance of clinicians screening for maternal depressive symptoms during the toddler period, as well as the early postpartum period, because these symptoms can appear later independent of earlier screening results. Providing periodic depressive symptom screening of the mothers of young patients has the potential to improve clinician capacity to provide timely and tailored anticipatory guidance about important parenting practices, as well as to make appropriate referrals.

Individual and Combined Effects of Postpartum Depression in Mothers and Fathers on Parenting Behavior

Article

Sep 2006
Pediatrics

Pediatric anticipatory guidance has been associated with parenting behaviors that promote positive infant development. Maternal postpartum depression is known to negatively affect parenting and may prevent mothers from following anticipatory guidance. The effects of postpartum depression in fathers on parenting is understudied. Our purpose with this work was to examine the effects of maternal and paternal depression on parenting behaviors consistent with anticipatory guidance recommendations. The 9-month-old wave of data from a national study of children and their families, the Early Childhood Longitudinal Study, provided data on 5089 2-parent families. Depressive symptoms were measured with a short form of the Center for Epidemiologic Studies Depression Scale. Interviews with both parents provided data on parent health behaviors and parent-infant interactions. Logistic and linear regression models were used to estimate the association between depression in each parent and the parenting behaviors of interest. These models were adjusted for demographic and socioeconomic status indicators. In this national sample, 14% of mothers and 10% of fathers exhibited levels of depressive symptoms on the Center for Epidemiologic Studies Depression Scale that have been associated with clinical diagnoses, confirming other findings of a high prevalence of postpartum maternal depression but highlighting that postpartum depression is a significant issue for fathers as well. Mothers who were depressed were approximately 1.5 times more likely to engage in less healthy feeding and sleep practices with their infant. In both mothers and fathers, depressive symptoms were negatively associated with positive enrichment activity with the child (reading, singing songs, and telling stories). Postpartum depression is a significant problem in both mothers and fathers in the United States. It is associated with undesirable parent health behaviors and fewer positive parent-infant interactions.

An autonomic flexibility-neurovisceral integration model of anxiety and cardiac vagal tone

Article

Mar 2007
BIOL PSYCHOL

Bruce Howard Friedman

A Pilot Study of Heart Rate Variability Biofeedback Therapy in the Treatment of Perinatal Depression on a Specialized Perinatal Psychiatry Inpatient Unit

Abstract

No full-text available