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Perinatal depression in (pregnant) mothers: 'From prevalence to prevention' – A precision medicine approach within a public health perspective

Perinatal Depression (PD) is one of the most common complications (10-20%) during the perinatal period. Although studies clearly suggest that PD may has a considerable negative impact both in the short term and in the long run on (expectant) parents, their offspring and their environment, there is a clear need for longitudinal analytical epidemiological studies in this area given the large heterogeneity in developmental trajectories associated with PD.This research proposal aims to fill these gaps in our current knowledge by combining a longitudinal analytic epidemiological approach with a preventative intervention approach which will yield unprecedented knowledge in the field of psychiatric epidemiology. In the first part of this project, we will conduct a longitudinal epidemiological study of PD in all (pregnant) mothers referred to the outpatient clinic of the university hospital of Leuven (n=about 2,000 mothers/year).Based on a multivariate risk prediction algorithm, developed in previous research, will divide this sample into four groups: (1) not at risk for PD; (2) mild risk, (3) moderate risk and (4) high risk. We will (a) investigate the psychosocial profile of these mothers and (b) investigate whether these features predict the longitudinal course of PD in these mothers. This study will also lay the foundation for a longer-term follow-up study of mothers at risk for PD and their offspring.The second part of this project focuses on the group of pregnant mothers with moderate risk to develop PD. The aim of this part is to study whether early online self-help intervention that has been developed in the context of www.depressiehulp.be may prevent the actual onset of PD in these mothers. To this end, we will conduct a combined superiority and non-inferiority randomized controlled trial, we will investigate whether a cognitive-behaviorally-based preventative online self-help (+ usual care) is non-inferior compared to a brief 5 session FTF solution-based intervention (+ usual care) and superior to usual care. Effectiveness and cost-effectiveness will be studied. The primary outcome will be PD symptoms. Secondary outcomes will include general psychiatric symptoms, social and relational functioning, attachment to the newborn child, and child psychosocial functioning.The current research proposal is innovative in at least four ways. First, it will identify sociodemographic and clinical features of (pregnant) mothers at risk for PD based on an analytical epidemiological approach. Second, we will develop multivariate models containing risk and protective factors in the longitudinal course of PD. Third, this will be the first study to examine the efficacy and cost-effectiveness of an online self-help intervention for PD in a sample of pregnant mothers identified to be at risk for PD based on an analytical epidemiological approach. This promises to contribute to the emergence of precision medicine in this area. Finally, results of this study promise to contribute to the development and implementation of a prognostic screening tool for PD.
Date:1 Oct 2022 →  Today
Keywords:Perinatal depression, Risk prevention, Epidemiology, Preventative intervention, e-health, Short Solution Focused Therapy, cost-effectiveness
Disciplines:Health economy, Neurosciences not elsewhere classified, Preventive medicine, Health management, Epidemiology