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Open Access 01-12-2020 | Mood Disorders | Study protocol

Effectiveness of a guided ACT-based self-help resilience training for depressive symptoms during pregnancy: Study protocol of a randomized controlled trial embedded in a prospective cohort

Authors: Anke B. Witteveen, Jens Henrichs, Annika L. Walker, Ernst T. Bohlmeijer, Huibert Burger, Yvonne Fontein-Kuipers, Francois G. Schellevis, Claire A.I. Stramrood, Miranda Olff, Corine J. Verhoeven, Ank de Jonge

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Abstract

Background

During pregnancy, about 10 to 20% of women experience depressive symptoms. Subclinical depression increases the risk of peripartum depression, maternal neuro-endocrine dysregulations, and adverse birth and infant outcomes. Current treatments often comprise face-to-face psychological or pharmacological treatments that may be too intensive for women with subclinical depression leading to drop-out and moderate effectiveness. Therefore, easily accessible, resilience enhancing and less stigmatizing interventions are needed to prevent the development of clinical depression. This paper describes the protocol of a prospective cohort study with an embedded randomized controlled trial (RCT) that aims to improve mental resilience in a sample of pregnant women through a self-help program based on the principles of Acceptance and Commitment Therapy (ACT). Maternal and offspring correlates of the trajectories of peripartum depressive symptoms will also be studied.

Methods

Pregnant women (≥ 18 years) receiving care in Dutch midwifery practices will participate in a prospective cohort study (n ~ 3500). Between 12 and 18 weeks of pregnancy, all women will be screened for depression with the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS score ≥ 11 will be evaluated with a structured clinical interview. Participants with subclinical depression (n = 290) will be randomized to a 9-week guided self-help ACT-training or to care as usual (CAU). Primary outcomes (depressive symptoms and resilience) and secondary outcomes (e.g. anxiety and PTSD, bonding, infant development) will be collected via online questionnaires at four prospective assessments around 20 weeks and 30 weeks gestation and at 6 weeks and 4 months postpartum. Maternal hair cortisol concentrations will be assessed in a subsample of women with a range of depressive symptoms (n = 300). The intervention’s feasibility will be assessed through qualitative interviews in a subsample of participants (n = 20).

Discussion

This is the first study to assess the effectiveness of an easy to administer intervention strategy to prevent adverse mental health effects through enhancing resilience in pregnant women with antepartum depressive symptomatology. This longitudinal study will provide insights into trajectories of peripartum depressive symptoms in relation to resilience, maternal cortisol, psychological outcomes, and infant developmental milestones.

Trial registration

Netherlands Trial Register (NTR), NL7499. Registered 5 February 2019.

Truijens SEM, Spek V, van Son MJM, Guid Oei S, Pop VJM. Different patterns of depressive symptoms during pregnancy. Arch Womens Ment Health. 2017;20:539–46. https://doi.org/10.1007/s00737-017-0738-5.CrossRefPubMedPubMedCentral

Lambregtse-van den Berg MP, van Kamo I, Wennink H. Handboek Psychiatrie en Zwangerschap. Utrecht: de Tijdstroom; 2015.

Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Depression during pregnancy: Overview of clinical factors. Clin Drug Investig. 2004;24:157–79. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L38445264.

Beijers C, Verbeek T, Van Pampus MG, Meijer JL, Burger H, Bockting CLH, et al. Cognitive behavioral therapy for treatment of antenatal anxiety and depressive symptoms: A randomized controlled trial. Arch Womens Ment Health. 2015;18:373. https://doi.org/10.1007/s00737-014-0488-6.CrossRef

de Cock ESA, Henrichs J, Vreeswijk CMJM, Maas AJBM, Rijk CHAM, van Bakel HJA. Continuous feelings of love? The parental bond from pregnancy to toddlerhood. J Fam Psychol. 2016;30:125–34. https://doi.org/10.1037/fam0000138.CrossRefPubMed

Velders FP, Dieleman G, Henrichs J, Jaddoe VWV, Hofman A, Verhulst FC, et al. Prenatal and postnatal psychological symptoms of parents and family functioning: the impact on child emotional and behavioural problems. Eur Child Adolesc Psychiatry. 2011;20:341–50. https://doi.org/10.1007/s00787-011-0178-0.CrossRefPubMedPubMedCentral

Accortt EE, Wong MS. It is time for routine screening for perinatal mood and anxiety disorders in obstetrics and gynecology settings. Obstet Gynecol Surv. 2017;72:553–68. https://doi.org/10.1097/OGX.0000000000000477.CrossRefPubMed

Talge NM, Neal C, Glover V. Antenatal maternal stress and long-term effects on child neurodevelopment: how and why? J Child Psychol Psychiatry. 2007;48:245–61. https://doi.org/10.1111/j.1469-7610.2006.01714.x.CrossRefPubMed

Van den Bergh BRH, van den Heuvel MI, Lahti M, Braeken M, de Rooij SR, Entringer S, et al. Prenatal developmental origins of behavior and mental health: The influence of maternal stress in pregnancy. Neurosci Biobehav Rev. 2017. https://doi.org/10.1016/j.neubiorev.2017.07.003.CrossRefPubMed

10.

Meijer JL, Bockting CLH, Beijers C, Verbeek T, Stant AD, Ormel J, et al. PRegnancy Outcomes after a Maternity Intervention for Stressful EmotionS (PROMISES): study protocol for a randomised controlled trial. Trials. 2011;12:157.CrossRefPubMedPubMedCentral

11.

Xiong F, Zhang L. Role of the hypothalamic–pituitary–adrenal axis in developmental programming of health and disease. Front Neuroendocrinol. 2013;34:27–46. 10.1016/J.YFRNE.2012.11.002.

12.

Waugh CE, Koster EHW. A resilience framework for promoting stable remission from depression. Clin Psychol Rev. 2015;41:49–60. https://doi.org/10.1016/j.cpr.2014.05.004.CrossRefPubMed

13.

Herrman H, Saxena S, Moodie R. Promoting mental health: concepts, emerging evidence, practice. A WHO report in collaboration with the Victorian Health Promotion Foundation and the University of Melbourne. Geneva: World Health Organization; 2005. http://www.who.int/mental_health/evidence/MH_Promotion_Book.pdf.

14.

Johnson KM, Paley FM, Modest AM, Hacker MR, Shaughnessy S, Ricciotti HA, et al. An assessment of depression, psychosocial factors, and resilience among women seeking prenatal care at an urban community health center. Int J Gynecol Obstet. 2018;140:153–8. https://doi.org/10.1002/ijgo.12358.CrossRef

15.

van den Heuvel MI, Johannes MA, Henrichs J, Van den Bergh BRH. Maternal mindfulness during pregnancy and infant socio-emotional development and temperament: The mediating role of maternal anxiety. Early Hum Dev. 2015;91:103–8. https://doi.org/10.1016/j.earlhumdev.2014.12.003.CrossRefPubMed

16.

Bellido-González M, Robles-Ortega H, Castelar-Ríos MJ, Díaz-López M, Gallo-Vallejo JL, Moreno-Galdó MF, et al. Psychological distress and resilience of mothers and fathers with respect to the neurobehavioral performance of small-for-gestational-age newborns. Health Qual Life Outcomes. 2019;17:54. https://doi.org/10.1186/s12955-019-1119-8.CrossRefPubMedPubMedCentral

17.

Wikman A, Axfors C, Iliadis SI, Cox J, Fransson E, Skalkidou A. Characteristics of women with different perinatal depression trajectories. J Neurosci Res. 2019:jnr.24390. https://doi.org/10.1002/jnr.24390.

18.

NICE-Guideline, editor. Antenatal and postnatal mental health: clinical management and service guidance |. NICE; 2014. https://www.nice.org.uk/guidance/cg192. Accessed 31 May 2017.

19.

Reynolds CF, Frank E. US preventive services task force recommendation statement on screening for depression in adults: Not good enough. JAMA Psychiatry. 2016;73:189–90. https://doi.org/10.1001/jamapsychiatry.2015.3281.CrossRefPubMed

20.

Sockol LE. A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. J Affect Disord. 2015;177:7–21.CrossRefPubMed

21.

Burger H, Verbeek T, Aris-Meijer JL, Beijers C, Mol BW, Hollon SD, et al. Effects of psychological treatment of mental health problems in pregnant women to protect their offspring: Randomised controlled trial. Br J Psychiatry. 2020;216:182–8. https://doi.org/10.1192/bjp.2019.260.CrossRefPubMed

22.

Ravesteyn LM, Van, Berg MPL, Van Den, Hoogendijk WJG, Kamperman AM. Interventions to treat mental disorders during pregnancy: A systematic review and multiple treatment meta-Analysis. PLoS One. 2017;12. https://doi.org/10.1371/journal.pone.0173397.

23.

Werner E, Miller M, Osborne LM, Kuzava S, Monk C. Preventing postpartum depression: Review and recommendations. Arch Womens Ment Health. 2015;18:41–60. https://doi.org/10.1007/s00737-014-0475-y.CrossRefPubMed

24.

Fontein-Kuipers YJ, Nieuwenhuijze MJ, Ausems M, Bude L, de Vries R. Antenatal interventions to reduce maternal distress: a systematic review and meta-analysis of randomised trials. BJOG. 2014;121:389–97.CrossRefPubMed

25.

Milgrom J, Schembri C, Ericksen J, Ross J, Gemmill AW. Towards parenthood: An antenatal intervention to reduce depression, anxiety and parenting difficulties [ACTRN012606000263594]. J Affect Disord. 2011;130:385–94. https://doi.org/10.1016/j.jad.2010.10.045.CrossRefPubMed

26.

Hain S, Oddo-Sommerfeld S, Bahlmann F, Louwen F, Schermelleh-Engel K. Risk and protective factors for antepartum and postpartum depression: a prospective study. J Psychosom Obstet Gynaecol. 2016;37:119–29.CrossRefPubMed

27.

Dikmen-Yildiz P, Ayers S, Phillips L. Longitudinal trajectories of posttraumatic stress disorder (PTSD) after birth and associated risk factors. J Affect Disord. 2018;229:377–85.CrossRefPubMed

28.

Bohlmeijer ET, Fledderus M, Rokx TAJJ, Pieterse ME. Efficacy of an early intervention based on acceptance and commitment therapy for adults with depressive symptomatology: Evaluation in a randomized controlled trial. Behav Res Ther. 2011;49:62–7. https://doi.org/10.1016/j.brat.2010.10.003.CrossRefPubMed

29.

Forman EM, Shaw JA, Goetter EM, Herbert JD, Park JA, Yuen EK. Long-term follow-up of a randomized controlled trial comparing acceptance and commitment therapy and standard cognitive behavior therapy for anxiety and depression. Behav Ther. 2012;43:801–11. https://doi.org/10.1016/j.beth.2012.04.004.CrossRefPubMed

30.

Ruiz FJ. Acceptance and commitment therapy versus traditional cognitive behavioral therapy: A systematic review and meta-analysis of current empirical evidence. Int J Psychol Psychol Ther. 2012;12:333–57 (http://www.ijpsy.com/volumen12/num3/334/acceptance-and-commitment-therapy-versus-EN.pdf. Accessed 31 May 2017).

31.

Bonacquisti A, Cohen MJ, Schiller CE. Acceptance and commitment therapy for perinatal mood and anxiety disorders: development of an inpatient group intervention. Arch Women’s Mental Health. 2017:1–10. https://doi.org/10.1007/s00737-017-0735-8.

32.

Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, Mccallum M, et al. Perinatal mental health 3: Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384:1800–19. https://doi.org/10.1016/S0140-6736(14)61277-0.CrossRefPubMed

33.

Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol. 2010;202:5–14.CrossRefPubMedPubMedCentral

34.

Ghosn F, Almansa B, Moreno-Giménez A, Sahuquillo-Leal R, Serrano-Lozano E, Hervás D, et al. Trajectories of stress biomarkers and anxious-depressive symptoms from pregnancy to postpartum period in women with a trauma history. Eur J Psychotraumatol. 2019;10:1601990. https://doi.org/10.1080/20008198.2019.1601990.CrossRefPubMedPubMedCentral

35.

King S, Dancause K, Turcotte-Tremblay A-M, Veru F, Laplante DP. Using Natural Disasters to Study the Effects of Prenatal Maternal Stress on Child Health and Development. Birth Defects Res Part C Embryo Today Rev. 2012;96:273–88. https://doi.org/10.1002/bdrc.21026.CrossRef

36.

Cao-Lei L, Elgbeili G, Massart R, Laplante DP, Szyf M, King S. Pregnant women’s cognitive appraisal of a natural disaster affects DNA methylation in their children 13 years later: Project Ice Storm. Transl Psychiatry. 2015;5:e515.CrossRefPubMedPubMedCentral

37.

Perined. Perinatale zorg in Nederland anno 2018: landelijke perinatale cijfers en duiding. Utrecht: Perined; 2019.

38.

Bergink V, Kooistra L, Lambregtse-van den Berg MP, Wijnen H, Bunevicius R, van Baar A, et al. Validation of the Edinburgh Depression Scale during pregnancy. J Psychosom Res. 2011;70:385–9. https://doi.org/10.1016/j.jpsychores.2010.07.008.CrossRefPubMed

39.

Vliet IM, de Beurs E. Het Mini Internationaal Neuropsychiatrisch Interview (MINI). Ned Tijdschrijft Voor Psychiatr. 2007;49:393–7.

40.

Sheehan DV, Lecrubier Y, Harnett Sheehan K, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): The Development and Validation of a Structured Diagnostic Psychiatric Interview for DSM-IV and ICD-10. J Clin Psychiatry J Clin Psychiatry. 1998;5959:22–33 (http://www.psychiatrist.com/JCP/article/%7B_%7Dlayouts/ppp.psych.controls/BinaryViewer.ashx?Article=/jcp/article/Pages/1998/v59s20/v59s2005.aspx%7B&%7DType=Article).

41.

Leon AC, Olfson M, Portera L, Farber L, Sheehan DV. Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. Int J Psychiatry Med. 1997;27:93–105.CrossRefPubMed

42.

Staufenbiel SM, Penninx BWJH, de Rijke YB, van den Akker ELT, van Rossum EFC. Determinants of hair cortisol and hair cortisone concentrations in adults. Psychoneuroendocrinology. 2015;60:182–94. https://doi.org/10.1016/j.psyneuen.2015.06.011.CrossRefPubMed

43.

Bohlmeijer ET, Hulsbergen M. Voluit leven. Mindfulness of de kunst van het aanvaarden, nu als praktisch hulpboek. Amsterdam: Boom; 2008.

44.

Hayes SC, Hayes SC, Luoma JB, Luoma JB, Bond FW, Bond FW, et al. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44:1–25. https://doi.org/10.1016/j.brat.2005.06.006.CrossRefPubMed

45.

Fledderus M, Bohlmeijer ET, Pieterse ME, Schreurs KM. Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: a randomized controlled trial. Psychol Med. 2012;42:485–95. https://doi.org/10.1017/s0033291711001206.CrossRefPubMed

46.

Guy W. Clinical Global Impression Scale. In: The ECDEU Assessment Manual for Psychopharmacology-Revised 338. 1976. p. 218–22.

47.

Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry. 1987;150. http://bjp.rcpsych.org/content/150/6/782. Accessed 18 May 2017.

48.

Pop VJ, Komproe IH, van Son MJ. Characteristics of the Edinburgh post natal depression scale in The Netherlands. J Affect Disord. 1992;26:105–10. https://doi.org/10.1016/0165-0327(92)90041-4.CrossRefPubMed

49.

Bowen A, Muhajarine N. Prevalence of antenatal depression in women enrolled in an outreach program in Canada. J Obstet Gynecol Neonatal Nurs. 2006;35:491–8. http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L44334161.

50.

Underwood L, Waldie KE, D’Souza S, Peterson ER, Morton SMB. A Longitudinal Study of Pre-pregnancy and Pregnancy Risk Factors Associated with Antenatal and Postnatal Symptoms of Depression: Evidence from Growing Up in New Zealand. Matern Child Health J. 2017;21:915–31. https://doi.org/10.1007/s10995-016-2191-x.CrossRefPubMed

51.

Lamers SMA, Westerhof GJ, Bohlmeijer ET, Ten Klooster PM, Keyes CLM. Evaluating the Psychometric Properties of the Mental Health Continuum-Short Form (MHC-SF). J Clin Psychol. 2011;67:99–110. https://doi.org/10.1002/jclp.20741.CrossRefPubMed

52.

Keyes CLM. Mental Illness and/or Mental Health? Investigating Axioms of the Complete State Model of Health. J Consult Clin Psychol. 2005;73:539–48. https://doi.org/10.1037/0022-006X.73.3.539.CrossRefPubMed

53.

Mols F, Pelle AJ, Kupper N. Normative data of the SF-12 health survey with validation using postmyocardial infarction patients in the Dutch population. Qual Life Res. 2009;18:403–14. https://doi.org/10.1007/s11136-009-9455-5.CrossRefPubMed

54.

Bouwmans C, De Jong K, Timman R, Zijstra-Vlasveld M, Cornelis C, Swan T, et al. Feasibility, reliability and validity of a questionnaire on healthcare consumption and productivity loss in patients with a psychiatric disorder (TiC-P). BMC Health Serv Res. 2013;13. https://doi.org/10.1186/1472-6963-13-217.

55.

Spielberger CD, Gorsuch RL, Lushene RE. Manual for the State-Trait Anxiety Inventory. 1970. https://ubir.buffalo.edu/xmlui/handle/10477/2895?show=full. Accessed 18 Jun 2017.

56.

Marteau TM, Bekker H. The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). Br J Clin Psychol. 1992;31:301–6. https://doi.org/10.1111/j.2044-8260.1992.tb00997.x.CrossRefPubMed

57.

van der Ploeg HM. De Zelf-Beoordelings Vragenlijst angst Tijdschr Psychiatr. 1982;24:576–88 (http://www.tijdschriftvoorpsychiatrie.nl/assets/articles/articles_2438pdf.pdf. Accessed 18 Jun 2017).

58.

Huizink AC, Delforterie MJ, Scheinin NM, Tolvanen M, Karlsson L, Karlsson H. Adaption of pregnancy anxiety questionnaire–revised for all pregnant women regardless of parity: PRAQ-R2. Arch Womens Ment Health. 2016;19:125–32. https://doi.org/10.1007/s00737-015-0531-2.CrossRefPubMed

59.

Wijma K, Söderquist J, Wijma B. Posttraumatic stress disorder after childbirth: a cross sectional study. J Anxiety Disord. 1997;11:587–97 (http://www.ncbi.nlm.nih.gov/pubmed/9455721. Accessed 14 Feb 2018).CrossRefPubMed

60.

Cuijlits I, Wetering van de A, Potharst E, Truijens S, Baar van AL, Pop V. Development of a Pre- and Postnatal Bonding Scale (PPBS). J Psychol Psychother. 2016;6:1–7. https://doi.org/10.4172/2161-0487.1000282.

61.

Dencker A, Taft C, Bergqvist L, Lilja H, Berg M. Childbirth experience questionnaire (CEQ): development and evaluation of a multidimensional instrument. BMC Pregnancy Childbirth. 2010;10:81. https://doi.org/10.1186/1471-2393-10-81.CrossRefPubMedPubMedCentral

62.

Manniën J, Klomp T, Wiegers T, Pereboom M, Brug J, de Jonge A, et al. Evaluation of primary care midwifery in the Netherlands: design and rationale of a dynamic cohort study (DELIVER). BMC Health Serv Res. 2012;12:69. https://doi.org/10.1186/1472-6963-12-69.CrossRefPubMedPubMedCentral

63.

Squires J, Bricker D, Potter L. Revision of a parent-completed development screening tool: Ages and stages questionnaires. J Pediatr Psychol. 1997;22:313–28 (http://www.ncbi.nlm.nih.gov/pubmed/9212550. Accessed 18 Jun 2017).CrossRefPubMed

64.

Steenis LJP, Verhoeven M, Hessen DJ, van Baar AL. Parental and professional assessment of early child development: the ASQ-3 and the Bayley-III-NL. Early Hum Dev. 2015;91:217–25. https://doi.org/10.1016/j.earlhumdev.2015.01.008.CrossRefPubMed

65.

Gartstein MA, Rothbart MK. Studying infant temperament via the revised infant behavior questionnaire. Infant Behav Dev. 2003;26:64–86 (https://research.bowdoin.edu/rothbart-temperament-questionnaires/files/2016/09/2003-ibq-studying-infant-behavior.pdf. Accessed 18 Jun 2017).CrossRef

66.

Worobey J, Blajda VM. Temperament Ratings at 2 Weeks, 2 Months, and 1 Year: Differential Stability of Activity and Emotionality. Dev Psychol. 1989;25:257–63.CrossRef

67.

Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary Psychometric Properties of the Acceptance and Action Questionnaire–II: A Revised Measure of Psychological Inflexibility and Experiential Avoidance. Behav Ther. 2011;42:676–88. https://doi.org/10.1016/j.beth.2011.03.007.CrossRefPubMed

68.

Klaassen K, Nyklíček I, Traa S, De Nijs R. Distressed personality is associated with lower psychological well-being and life satisfaction, but not disability or disease activity in rheumatoid arthritis patients. Clin Rheumatol. 2012;31:661–7.CrossRefPubMed

69.

Garnefski N, Kraaij V, Spinhoven P. Negative life events, cognitive emotion regulation and emotional problems. Pers Individ Dif. 2001;30:1311–27. https://doi.org/10.1016/S0191-8869(00)00113-6.CrossRef

70.

Bakker A, van der Meer C, Olff M Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). Amsterdam: Academisch Medisch Centrum; 2014.

71.

Prins A, Bovin MJ, Smolenski DJ, Marx BP, Kimerling R, Jenkins-Guarnieri MA, et al. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample. J Gen Intern Med. 2016;31:1206–11. https://doi.org/10.1007/s11606-016-3703-5.CrossRefPubMedPubMedCentral

72.

Truijens SEM, Pommer AM, van Runnard Heimel PJ, Verhoeven CJM, Oei SG, Pop VJM. Development of the Pregnancy and Childbirth Questionnaire (PCQ): evaluating quality of care as perceived by women who recently gave birth. Eur J Obstet Gynecol Reprod Biol. 2014;174:35–40. https://doi.org/10.1016/j.ejogrb.2013.11.019.CrossRefPubMed

73.

Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-Country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–95.CrossRefPubMed

74.

Nguyen TD, Attkisson CC, Stegner BL. Assessment of patient satisfaction: development and refinement of a service evaluation questionnaire. Eval Program Plann. 1983;6:299–313 ( http://www.ncbi.nlm.nih.gov/pubmed/10267258. Accessed 14 Mar 2019).CrossRefPubMed

75.

Attkisson CC, Zwick R. The client satisfaction questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome. Eval Program Plann. 1982;5:233–7 (http://www.ncbi.nlm.nih.gov/pubmed/10259963. Accessed 14 Feb 2018).CrossRefPubMed

76.

de Brey H. A cross-national validation of the client satisfaction questionnaire: the Dutch experience. Eval Program Plann. 1983;6:395–400 (http://www.ncbi.nlm.nih.gov/pubmed/10267266. Accessed 14 Feb 2018).CrossRefPubMed

77.

Noppe G, de Rijke YB, Dorst K, van den Akker ELT, van Rossum EFC. LC-MS/MS-based method for long-term steroid profiling in human scalp hair. Clin Endocrinol (Oxf). 2015;83:162–6. https://doi.org/10.1111/cen.12781.CrossRef

78.

Utens E, van Rijen EHM, Erdman RAM, Verhulst FC. Rotterdam’s Kwaliteit van Leven – Interview. Rotterdam: Department of Child & Adolescent Psychiatry/Psychology; 2000.

79.

A-Tjak JGL, Davis ML, Morina N, Powers MB, Smits JAJ, Emmelkamp PMG. A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychother Psychosom. 2015;84:30–6. https://doi.org/10.1159/000365764.CrossRefPubMed

80.

Pots WTM, Fledderus M, Meulenbeek PAM, ten Klooster PM, Schreurs KMG, Bohlmeijer ET. Acceptance and commitment therapy as a web-based intervention for depressive symptoms: randomised controlled trial. Br J Psychiatry. 2016;208:69–77. https://doi.org/10.1192/bjp.bp.114.146068.CrossRefPubMed

81.

Rompala KS, Cirino N, Rosenberg KD, Fu R, Lambert WE. Prenatal Depression Screening by Certified Nurse-Midwives, Oregon. J Midwifery Womens Health. 2016;61:599–605. https://doi.org/10.1111/jmwh.12491.CrossRefPubMed

82.

Evans J, Heron J, Patel RR, Wiles N. Depressive symptoms during pregnancy and low birth weight at term: longitudinal study. Br J Psychiatry. 2007;191:84–5. https://doi.org/10.1192/bjp.bp.105.016568.CrossRefPubMed

83.

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillside: Lawrence Erlbaum Associates; 1988.

84.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77–101. https://doi.org/10.1191/1478088706qp063oa.CrossRef

85.

Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Interventions to Prevent Perinatal Depression: US Preventive Services Task Force Recommendation Statement. JAMA - Journal of the American Medical Association. 2019;321:580–7. https://doi.org/10.1001/jama.2019.0007.CrossRefPubMed

86.

Wikenius E, Moe V, Kjellevold M, Smith L, Lyle R, Waagbø R, et al. The Association between Hair Cortisol and Self-Reported Symptoms of Depression in Pregnant Women. PLoS One. 2016;11:e0161804. https://doi.org/10.1371/journal.pone.0161804.CrossRefPubMedPubMedCentral

87.

Garcia-Leon MA, Peralta-Ramirez MI, Arco-Garcia L, Romero-Gonzalez B, Caparros-Gonzalez RA, Saez-Sanz N, et al. Hair cortisol concentrations in a Spanish sample of healthy adults. PLoS One. 2018;13:e0204807. https://doi.org/10.1371/journal.pone.0204807.CrossRefPubMedPubMedCentral

Title: Effectiveness of a guided ACT-based self-help resilience training for depressive symptoms during pregnancy: Study protocol of a randomized controlled trial embedded in a prospective cohort
Authors: Anke B. Witteveen
Jens Henrichs
Annika L. Walker
Ernst T. Bohlmeijer
Huibert Burger
Yvonne Fontein-Kuipers
Francois G. Schellevis
Claire A.I. Stramrood
Miranda Olff
Corine J. Verhoeven
Ank de Jonge
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Mood Disorders
Affective Disorder
Published in: BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-020-03395-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effectiveness of a guided ACT-based self-help resilience training for depressive symptoms during pregnancy: Study protocol of a randomized controlled trial embedded in a prospective cohort

Abstract

Background

Methods

Discussion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Discussion

Trial registration

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Anthropometrical measurements and maternal visceral fat during first half of pregnancy: a cross-sectional survey