Effectiveness Of Sbt For Prevent Postpartum Depression.pdf

Journal of Reproductive and Infant Psychology

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The effect of cognitive-behavioural and solutionfocused counselling on prevention of postpartum depression in nulliparous pregnant women Somayeh Ramezani, Ahmad Khosravi, Zahra Motaghi, Azam Hamidzadeh & Seyed Abbas Mousavi To cite this article: Somayeh Ramezani, Ahmad Khosravi, Zahra Motaghi, Azam Hamidzadeh & Seyed Abbas Mousavi (2016): The effect of cognitive-behavioural and solution-focused counselling on prevention of postpartum depression in nulliparous pregnant women, Journal of Reproductive and Infant Psychology, DOI: 10.1080/02646838.2016.1266470 To link to this article: http://dx.doi.org/10.1080/02646838.2016.1266470

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Date: 01 January 2017, At: 01:22

Journal of Reproductive and Infant Psychology, 2016 http://dx.doi.org/10.1080/02646838.2016.1266470

The effect of cognitive-behavioural and solution-focused counselling on prevention of postpartum depression in nulliparous pregnant women Somayeh Ramezania, Ahmad Khosravib, Zahra Motaghic, Azam Hamidzadehd and Seyed Abbas Mousavie a

Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran; bCenter for Health Related Social and Behavioural Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran; cDepartment of Midwifery, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran; dFatemieh Center for Education, Research and Treatment, Shahroud University of Medical Sciences, Shahroud, Iran; eResearch Centre of Psychiatry, Golestan University of Medical Sciences, Gorgan, Iran

ABSTRACT

Objective: The aim of this study was to evaluate the effect of cognitive-behavioural approach and solution-focused counselling on prevention of postpartum depression in nulliparous pregnant women. Background: Maternity blues is a common disorder and postpartum depression is a serious disorder. Therefore, the use of preventive measures and timely intervention is of particular importance. Methods: In this randomised clinical trial, 85 nulliparous pregnant women at 30–35 weeks were randomly divided into three groups: cognitive-behavioural counselling (n = 25), solution-focused counselling (n = 25) and control (n = 35). Counselling meetings were held on a weekly basis. The cognitive-behavioural group received four sessions of counselling and the solution-focused group received three sessions of counselling. The control group received only routine pregnancy healthcare services. Maternity blues and postpartum depression were, respectively, measured on postpartum days 5 and 15 through the Austin Inventory and Edinburgh Postnatal Depression Scale. The mean scores of the three groups were compared using one-way ANOVA. Results: The results of this study showed that the maternity blues mean scores of the three groups of cognitivebehavioural counselling, solution-focused counselling and control groups were 6.1 ± 4.6, 4.2 ± 3.6 and 6.7 ± 4.9, respectively, and the difference between the scores was significant. The mean scores of postnatal depression on the 15th postpartum day in the three groups were 6.7  ±  5.3, 4.4  ±  4.4 and 10.4  ±  5.9, respectively. The results showed that cognitive-behavioural and solution-focused counselling significantly reduced the maternity blues and postpartum depression scores compared with the control group and no difference was observed between the scores of these two counselling methods. The odds ratio of being depressed in women with maternity blues was 7.6 (95% CI: 2.1–27.5). Conclusion: Integration of solution-focused and cognitive-behavioural counselling programmes in prenatal care can be effective for improving the mental health of pregnant women. CONTACT  Seyed Abbas Mousavi 

[email protected], [email protected]

© 2016 Society for Reproductive and Infant Psychology

ARTICLE HISTORY

Received 11 July 2016 Accepted 3 October 2016 KEYWORDS

Solution-focused counselling; cognitivebehavioural counselling; postpartum depression; maternity blues

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Background Although childbirth is an emotionally challenging experience, pregnancy and childbirth can be stressful for some women and it can be associated with extensive negative effects of physical, mental and social costs (Wilkins, Baker, Bick, & Thomas, 2009). Postpartum mood disorder includes postpartum blues, postpartum depression and postpartum psychosis, disorders that have overlap in symptomatology but also unique differentiating features. Postpartum blues is one of the most common postpartum mood disorders and its prevalence is 50–80% in new mothers. It occurs in the first 10 days postpartum (Perfetti, Clark, & Fillmore, 2004). Postpartum blues (‘baby blues’) refers to a transient condition characterized by mild depressive symptoms such as dysphoria (i.e. sadness, tearfulness, irritability, and anxiety), insomnia and decreased concentration (O’Hara, Schlechte, Lewis, & Wright, 1991). These symptoms develop in 40–80% of women within 2–3 days of delivery (Cohen et al., 2010; O’Hara et al., 1991). Symptoms typically peak over the next few days and resolve within two weeks (Wisner, Parry, & Piontek, 2002). This condition is usually mild and becomes limited spontaneously. Its peak incidence is during 4–5 days postpartum, but sometimes it stays up to 10 days. If maternity blues lasts more than two weeks, it can lead to postpartum depression (PPD) (RutaNonacs & Cohen, 1998). Maternity blues symptoms include anxiety, fatigue, insomnia, nervousness and irritability (Perfetti et al., 2004). Maternity blues exerts two important effects on postpartum health. It can lead to postpartum depression as well as debilitating the bond between the mother and the baby (Ferber & Makhoul, 2004). Evidence shows a higher incidence of postpartum depression in people who experience maternity blues (Adewuya, 2005). In various studies, the prevalence of postpartum depression has been reported to be between 7% and 20% (Gavin et al., 2005), and the result of a systematic review article on 41 studies in Iran showed the pooled prevalence of PPD was 25.3%. The prevalence of PPD was more predominant among subgroups of women who were illiterate, had an unwanted pregnancy or had a history of depression (Veisani, Delpisheh, Sayehmiri, & Rezaeian, 2013). Postpartum depression leaves adverse effects on the mother, child and the family (Stein et al., 2010). As a result, the mother is not able to play her roles as a mother and a spouse and if untreated, in severe cases, it can lead to suicide or infanticide (Sit, Seltman, & Wisner, 2011). The results of some studies, among non-pharmacological interventions to reduce or prevent PPD, showed that a cognitive-behavioural approach has had the best results in the reduction of postnatal depression. A cognitive-behavioural approach focuses on correcting distorted cognition and negative beliefs that perpetuate depressive symptoms (Beck, 2005). In fact, learning to identify and correct mistaken beliefs reduces patient stress and increases her adjustment power (Beck, 2011). Another effective intervention for shortterm treatment of depression is solution-focused counselling. Despite its relatively short history, in recent years, solution-focused counselling has gained popularity among counsellors and mental health professionals (Kim, 2008). It is a future-oriented and goal-oriented approach and focuses on solutions and on building scales for measuring the patient’s progress (Trepper, Dolan, McCollum, & Nelson, 2006). Instead of focusing on the defects and disabilities of people, this approach concentrates on highlighting the capabilities and achievements of people. In fact, solution-focused counselling, instead of dealing with difficult and unchangeable issues, focuses on issues that are likely to change. For this reason, it is named as hope counselling (Shakarami, Davarniya, & Zahrakar, 2014). This study was designed to improve mothers’ and newborns’ health and it aimed to help mothers acquire

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coping skills to prevent or relieve the symptoms of maternity blues and PPD by using cognitive-behavioural and solution-focused counselling models. Therefore, the aim of this study was to evaluate the effect of a cognitive-behavioural counselling approach and solutionfocused counselling on the prevention of PPD compared with routine care services in nulliparous pregnant women.

Materials and methods This is a randomised clinical trial that was conducted as a pilot study. Figure 1 shows the flowchart of the trial. For recruitment of women with inclusion and exclusion criteria, we reviewed the medical records of pregnant women that were under routine care in healthcare centres. In Shahroud (northeast of Iran) there are 11 urban healthcare centres that provide the healthcare services for the target population. All pregnant women in these centres receive routine health and prenatal care. In our study 120 eligible pregnant women were selected and invited for participation. After explanation of the goals and protocol of study, 35 women refused to participate. The main refusal reasons given by the women included unwillingness to participate, prenatal problems that limited the participation (such as bleeding, complete bed rest, high risk for preterm labour) and the high number of cognitivebehavioural and solution-focused counselling sessions. After obtaining written informed consents from 85 Iranian pregnant women who were referred to Shahroud city’s healthcare centres during 30–35 weeks of gestation, the researcher completed the entry checklist and then the participants were randomly divided into three groups: a cognitive-behavioural counselling, a solution-focused counselling group and a control group. We hypothesised that the difference between the mean PPD scores at 15 days after delivery in the intervention and control groups would be at least 4.5. This effect size was estimated

120 eligible participants

35 people refused to particiapte in the study.

35 people in the control group

3 people failed to complete the quetsionnaire 32 people in control group

85 people were randomized.

25 people in solution-focused group

25 people in cognitive behavioral group

2 people failed to complete the questionnaire.

2 people left becasue of perinatal problems

23 people in solution-focued group

Figure 1. Participant flow chart of the trial.

23 people in cognitive behavioral group

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from pilot data for the cognitive-behavioural counselling compared with the control. Using a significance level of .05 and a power of 80%, a sample size of 25 per group was needed to test this hypothesis. Because the study had three arms, the size of the control group was estimated to be 40% larger than the size of the intervention groups. We used a permuted block random allocation method. Random assignment of participant was performed based on blocks of six. The research methodology of this study was approved by the Research Council of Shahroud University of Medical Sciences and by the Ethics Committee of Shahroud University of Medical Sciences with the code IR.SHMU.REC.1394.67.

Inclusion and exclusion criteria Inclusion criteria were nulliparous pregnant women, who had at least a primary education, and did not participate in childbirth preparation classes. Exclusion criteria included having chronic diseases and addiction, history of mental illnesses such as schizophrenia, depression, anxiety in the past and in this pregnancy.

Intervention The cognitive-behavioural counselling group received four 1.5-h counselling sessions and the solution-focused counselling received three 1.5-h counselling sessions, which were held weekly. The control group received no counselling and only routine pregnancy healthcare services were provided for them. The routine pregnancy care consists of prenatal care such as control of blood pressure, weight, fundal height measures, auscultation of fetal heart rate and laboratory test. The intervention groups also received the routine pregnancy healthcare services in addition to the designed interventions. At the start of the meetings, demographic and obstetric history questionnaires were completed for the participants. Table 1 displays the structure of the cognitive-behavioural counselling adopted from treatment protocol of Muñoz and Miranda (2000) and Table 2 displays the structure of the solution-focused counselling. The counselling was conducted by a midwife who had been trained in counselling for two years. The structure of interventions and counselling sessions were reviewed and approved by the supervisors of the study. To maintain the blindness in the study, the outcomes (maternity blues and PPD) on 4–5 and 15 days after delivery were measured by another midwife who was unaware of the allocation and participation of the people in the study groups. Table 1. Structure of cognitive-behavioural counselling sessions. 1. Welcome and introduction of group members and a description of the number of sessions and the procedures for following up the participants to complete the questionnaires after delivery 2. Explaining the purpose of counselling sessions 3. Introducing maternity blues and postpartum depression and explaining their causes and symptoms 1. Introduction to the cognitive-behavioural counselling approach 2. Introducing cognitive and behavioural concepts 3. Explaining the role of thoughts on emotions 4. Providing homework to record thoughts and feelings 1. Checking homework 2. Explaining the impact of people’s thoughts on mood, body and actions 3. Explaining the thoughts of depressed people (cognitive errors) 4. Providing homework 1. Checking homework 2. Training on depression-prevention activities such as relaxation and mother and baby skin-to-skin contacts 3. Summing up meetings

Session 1

Session 2

Session 3

Session 4

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Table 2. Structure of solution-focused counselling. 1. Welcome and introduction of group members and a description of the number of sessions and the procedures for following up the participants to complete the questionnaires after delivery 2. Explaining the purpose of counselling sessions 3. Introducing maternity blues and postpartum depression and explaining their causes and symptoms 1. The exact definition of the problem by the client in the form of a sentence and a word 2. Setting objective and operational goals 3. Reviewing the solutions to the problem 4. Providing homework 1. Checking homework 2. Finding exceptions 3. Summing up meeting

Session 1

Session 2

Session 3

Outcome measure To investigate maternity blues, the validated Persian version of the Austin inventory (Abbasyan Azar, Ahmadi, Shams, & Abadi, 2013) was used. It consists of 13 items. The first eight items were on a five-point Likert-type scale ranging from 0 to 4 and the last five items were yes/no questions. The yes answers were scored 1 and no answers were scored 0. The total score on the scale ranged from 0 to 26. The questionnaire was completed 4–5 days after delivery for the three groups. To investigate the effect of intervention methods on PPD which follows maternity blues, the Edinburgh Postnatal Depression Scale (EPDS) was used. This questionnaire includes 10 items which are scored on a four-point Likert-type scale which ranges from 0 to 3. Questions one, two and four are coded from 0 to 3 and the rest of the items are reversed. Scores higher than 13 indicate high symptoms level of depression (Kheirabadi, Maracy, Akbaripour, & Masaeli, 2012). This questionnaire was completed 15 days after delivery in the three groups. The reliability of these questionnaires was evaluated using Cronbach’s alpha, reaching .73 for the Persian Austin Inventory and .81 for the EPDS.

Data analysis Using SPSS software, the comparison of the mean scores between the three groups were analysed through one-way ANOVA, and the Tukey post-hoc test was used for comparison between two groups. Frequency distribution of categorical variables in three groups was evaluated using a chi-square test. A logistic regression was used for assessing the relationship between PPD and maternity blues. The significance level was less than 0.05.

Results In this study, the mean age of the cognitive-behavioural counselling, solution-focused and control groups were 25.17 ± 5.2, 26.14 ± 4.8 and 26.2 ± 3.9, respectively, and no significant difference was observed between the groups. Other characteristics of the participants in three groups are listed in Table 3. The results in Table 3 show no significant differences between education, gestational age, job, pregnancy acceptance and economic status in the two intervention groups and the control group. The table also indicates that the groups have been well randomised. According to the results of this study, the mean score of maternity blues in three groups of cognitive-behavioural counselling, solution-focused counselling and control were 6.1 ± 4.6, 4.2 ± 3.6 and 6.7 ± 4.9, respectively. A significant difference was observed between

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Table 3. Comparison of demographic and obstetric variables in the three groups. Variable Age (years) Education Gestational age (weeks) Job Pregnancy acceptance Economic status

House wife Working Wanted Unwanted Poor Moderate Good

CBC (n=23) 25.17 ± 5.2 13.2 ± 2.7 36.6 ± 10.3 19 (82.6%) 4 (17.4%) 23 (100%) 0 (0%) 4 (17.4%) 10 (43.5%) 9 (39.1%)

Solution-focused (n=23) 26.14 ± 4.8 13.3 ± 3.1 34.0 ± 2.7 21 (91.3%) 2 (8.7%) 22 (95.7%) 1 (4.3%) 1 (4.3%) 14 (60.9%) 8 (34.8%)

Control (n=32) 26.2 ± 2.9 11.8 ± 3 35.0 ± 1.4 31 (6.6%) 1 (3.1%) 31 (96.9%) 1 (3.1%) 10 (31.3%) 17 (53.1%) 5 (15.6%)

P value .66 .31 .3 . 19 .6 .064

Note: Quantitative variables are mean and standard deviation and qualitative variables are presented as frequencies and percentages.

Table 4. Comparison of sadness and depression scores in the three groups. Groups CBT Solution-focused Control Test

No 23 23 32

Postpartum blues score 6.1 ± 4.6 4.2 ± 3.6 6.71 ± 4.9 F = 7.20.002 = P

Depression score 6.7 ± 5.3 4.42 ± 4.4 10.4 ± 5.9 F = 8.8 .001 > P

the groups. The mean PPD scores at 15 day after delivery in the three groups were 6.7 ± 5.3, 4.4 ± 4.4 and 10.4 ± 5.9 and there are a significant difference between scores (Table 4). The results of post-hoc tests showed that the maternity blues scores were not significantly different between the solution-focused and cognitive-behavioural counselling groups, or between the cognitive-behavioural group and the control group. There was only a significant difference between the solution-focused group and the control group. Comparison of the PPD scores showed a significant difference between intervention groups and the control group; however, the difference between the two intervention groups was not significant. In the cognitive-behaviour counselling group, four (17.4%) women had EPDS scores > 13 after the intervention, in comparison to two (8.7%) in the solution-focused group and 13 (40.6%) in the control group and the using a pearson chi square test differences between groups are statistically significant (chi-sq=8.3, p=0.016). A logistic regression model with depression as the dependent variable and maternity blues as a predictor variable showed an odds ratio equal to 7.6 (95% CI: 2.1–27.5).

Conclusion Because many research projects have been conducted on the effect of psychological treatment on PPD, this study was designed at the first level to prevent and also to reduce the postpartum mood disorders through counselling as well as providing perinatal healthcare services. The results of this study suggest that in the cognitive-behavioural and solutionfocused groups, the PPD scores decreased compared to the PPD scores in the control group. In line with the results of this study, Dashti-Zadeh and colleagues concluded in their study that a short-term, solution-focused approach is effective in reducing depressive symptoms in women (Dashtizadeh, Sajedi, Nazari, Davarniya, & Shakaram, 2015). The results of other

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studies also showed that short-term, solution-focused intervention reduces symptoms of depression and anxiety (Dahl, Bathel, & Carreon, 2000; Spilsbury, 2012). Lee and colleagues used the solution-focused approach for the treatment of depressed people and the results demonstrated the effectiveness of this intervention in reducing depression (Lee, Greene, Mentzer, Pinnell, & Niles, 2001). Moreover, the results of this study are consistent with the results of Reddy et al. (2015), Murphy (1993), Maljanen et al. (2012), Estrada and Beyebach (2007) and Gruninger (2005). The solution-focused approach shows different ways of thinking about the process (Kim, 2007). The main advantage of the solution-focused approach compared with traditional methods is that instead of analysing the problem, it focuses on discovering solutions (Chaudhry & Li, 2011). A solution-focused approach encourages people to express the beneficial experiences with the aim of determining their ability to benefit from their past experiences that have repeatability in their future life (Laaksonen, Knekt, Sares-Jäske, & Lindfors, 2013). In this study, the participating women were encouraged to discover their abilities in confronting past problems and complexities and they could use these abilities to face future problems after childbirth. They learned not to focus on unchangeable issues in their lives and instead to seek practical and efficient solutions for dealing with issues. Also in line with our study, Lau showed that different types of cognitive-behavioural counselling are effective in reducing perinatal depression (Lau, 2013). Nardi’s study also showed that the use of cognitive-behavioural counselling in depressed pregnant women reduced PPD (Nardi, Laurenzi, Di Nicolò, & Bellantuono, 2012). Among non-pharmacological treatments, psychotherapy, especially interpersonal therapy, cognitive-behavioural therapy and psychosocial counselling such as indirect counselling have been recommended for the treatment of depression. Also, stress management skills, light therapy, massage therapy, relaxation and yoga, mother’s proper nutrition, exercise, improved sleep and supporting mothers in breastfeeding the babies play an important role in this regard (Field et al., 2012; Ko, Yang, Fang, Lee, & Lin, 2013). In their research on depressed pregnant women, Cho and colleagues used cognitive-behavioural counselling techniques and concluded that this intervention could be a preventive treatment for PPD (Cho, Kwon, & Lee, 2008). The main aim of this study was to compare the mean scores of maternity blues and PPD in the two intervention groups, i.e. cognitive-behavioural and solution-focused groups showed that both counselling types had influenced maternity blues, but the two groups showed no significant difference. A few studies have been conducted to compare these two counselling methods. For example, Mofid and colleagues, in a study which was conducted in 2013, compared the effect of cognitive-behavioural counselling and solution-focused counselling on the sexual satisfaction of women in Isfahan (Iran) and reported that cognitive-behavioural counselling was more effective (Mofid, Ahmadi, & Etemadi, 2014). Studies on solutionfocused approach confirm its efficiency and effectiveness in a wide range of problems. In this study, it was found that using solution-focused techniques, pregnant women can focus on their capabilities and noticing the exceptions, they could change their views toward life issues and ultimately suffered less from mood disorders, maternity blues and PPD. A cognitive-behavioural approach is also a realistic and effective intervention for prevention of behavioural disorders in pregnant women, including PPD. This method emphasises the interplay between the events, thoughts, opinions, moods and emotions (Maracy & Kheirabadi, 2012). In this study, the participants were helped to identify their false beliefs and thoughts, such as inability to take care of the baby, fear from childbirth, worrying about lack of family

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support, etc., and in these sessions the role of thoughts in creating negative feelings which can predispose individuals to PPD was emphasised. Then, behavioural techniques such as relaxation and skin-to-skin contact, the effectiveness of which has been proven in numerous studies, were taught. The supports provided for mothers such as relaxation during pregnancy helps the person to adapt with the postpartum condition and with the emotional status and role as a mother and in this way they reduce stress, create calmness and increase the mother’s attachment (Saisto, Toivanen, Salmela-Aro, & Halmesmäki, 2006). Skin contact relaxes the mother, lengthens breastfeeding, increases the ability of a person to take care of the baby, increases the energy of the mother, improves coordination and happiness, and reduces anxiety, maternity blues and PPD (Anderson et al., 2003; Burkhammer, Anderson, & Chiu, 2004). Therefore, the results can be explained by factors such as the use of behavioural techniques such as relaxation and skin contact that were used in this study, the efficacy of which in reducing anxiety, maternity blues and PPD have been supported in previous research (Burkhammer et al., 2004). Maternity blues is a common disorder and PPD is a serious disorder of women’s health. Therefore, using preventive measures and timely interventions that are particularly important in reducing vulnerability, eliminating or minimising the behaviours and environmental conditions, the impact of these conditions must be taken into account. The results of previous studies have shown the effectiveness of methods such as cognitive-behavioural and solution-oriented counselling in the treatment of people suffering from different disorders. The results of this study showed that cognitive-behavioural and solution-focused counselling had an effective impact in preventing maternity blues and PPD. The results of this study also showed the effectiveness of these methods in healthy people during the sensitive period of pregnancy. It is recommended to use midwifery counselling techniques along with prenatal care and childbirth preparation classes to promote the mental health of women during pregnancy and after delivery. According to the results of this study, cognitive-behavioural and solution-oriented counselling have been effective in reducing maternity blues and PPD. Among the strengths of this study was the conducting of a three-arm randomized clinical trial in which the size of the control group was larger than the intervention groups for achieving higher statistical power. However, due to the nature of the provided counselling, the blinding of patients was not done well. The power of this study is low because of the low number of women in the intervention groups for comparison between cognitive-behavioural consulting and solution-focused interventions. With regards to exclusion criteria, excluding women with psychological problems and the refusal of women with pregnancy problems can limit the application of this study. We did not gather any obstetric data after delivery as an outcome of study and experiences around the time of birth may have impacted on maternal mood. However, we used a fully trained midwife to conduct the interventions, but the same midwife conducted both types of intervention, which could lead to cross-contamination effects and decreases internal validity. Due to a limited number of similar studies, further large-scale, rigorously designed studies are recommended for the generalisation of the results of this study.

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Acknowledgements This paper presents the results of an MSc thesis in counselling in midwifery which was sponsored by Shahroud University of Medical Sciences. It is registered in the Iranian Clinical Trial Registry Center with the code IRcT201505252204. The researchers are grateful to the Deputy of Research of Shahroud University of Medical Sciences and to the School of Nursing and Midwifery for their support.

Disclosure statement No potential conflict of interest was reported by the authors.

References Abbasyan Azar, F., Ahmadi, M., Shams, J., & Abadi, A. (2013). Effect of kangaroo mother care on postpartum depression. Journal of Nursing and Midwifery (sbmu), 23, 74–83 Adewuya, A. O. (2005). The maternity blues in Western Nigerian women: Prevalence and risk factors. Am J Obstet Gynecol, 193, 1522–1525. doi:10.1016/j.ajog.2005.02.085 Anderson, G. C., Chiu, S. H., Dombrowski, M. A., Swinth, J. Y., Albert, J. M., & Wada, N. (2003). Mothernewborn contact in a randomized trial of kangaroo (skin-to-skin) care. Journal of Obstetric, Gynecologic & Neonatal Nursing, 32, 604–611. Beck, A. T. (2005). The current state of cognitive therapy: A 40-year retrospective. Archives of General Psychiatry, 62, 953–959. Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond. New York, NY: Guilford Press. Burkhammer, M. D., Anderson, G. C., & Chiu, S. H. (2004). Grief, anxiety, stillbirth, and perinatal problems: Healing with kangaroo care. Journal of Obstetric, Gynecologic & Neonatal Nursing, 33, 774–782. doi:10.1177/0884217504270594 Chaudhry, S., & Li, C. (2011). Is solution-focused brief therapy culturally appropriate for muslim American counselees? Journal of Contemporary Psychotherapy, 41, 109–113. Cho, H. J., Kwon, J. H., & Lee, J. J. (2008). Antenatal Cognitive-behavioral therapy for prevention of postpartum depression: A pilot study. Yonsei Medical Journal, 49, 553–562. Cohen, L. S., Wang, B., Nonacs, R., Viguera, A. C., Lemon, E. L., & Freeman, M. P. (2010). Treatment of mood disorders during pregnancy and postpartum. Psychiatric Clinics of North America, 33, 273–293. doi:10.1016/j.psc.2010.02.001 Dahl, R., Bathel, D., & Carreon, C. (2000). The use of solution-focused therapy with an elderly population. Journal of Systemic Therapies, 19, 45. Dashtizadeh, N., Sajedi, H., Nazari, A., Davarniya, R., & Shakaram, M. (2015). Effectiveness of SolutionFocused Brief Therapy (SFBT) on reducing symptoms of depression in women. Journal of Clinical Nursing and Midwifery, 4, 67–78. Estrada, B., & Beyebach, M. (2007). Solution-focused therapy with depressed deaf persons. Journal of family psychotherapy, 18, 45–63. Ferber, S. G., & Makhoul, I. R. (2004). The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: A randomized, controlled trial. PEDIATRICS, 113, 858–865. Field, T., Diego, M., Hernandez-Reif, M., Medina, L., Delgado, J., & Hernandez, A. (2012). Yoga and massage therapy reduce prenatal depression and prematurity. Journal of Bodywork and Movement Therapies, 16, 204–209. Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstet Gynecol, 106, 1071–1083. doi:10.1097/01.AOG.0000183597.31630.db Gruninger, B. (2005). Solution focused breif therapy: Its uses, application, and efficacy (Master of counselling). Alberta: University of Calgary.

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 S. RAMEZANI ET AL.

Kheirabadi, G. R., Maracy, M. R., Akbaripour, S., & Masaeli, N. (2012). Psychometric properties and diagnostic accuracy of the edinburgh postnatal depression scale in a sample of Iranian women. Iranian Journal of Medical Sciences, 37, 32–38. Kim, J. S. (2007). Examining the effectiveness of solution-focused brief therapy: A meta-analysis using random effects modeling. National Symposium on Doctoral Research in Social Work, Austin, Texas. Kim, J. S. (2008). Examining the effectiveness of solution-focused brief therapy: A meta-analysis. Research on Social Work Practice,18, 107–116. doi:10.1177/1049731507307807 Ko, Y. L., Yang, C. L., Fang, C. L., Lee, M. Y., & Lin, P. C. (2013). Community-based postpartum exercise program. Journal of Clinical Nursing, 22, 2122–2131. Laaksonen, M., Knekt, P., Sares-Jäske, L., & Lindfors, O. (2013). Psychological predictors on the outcome of short-term psychodynamic psychotherapy and solution-focused therapy in the treatment of mood and anxiety disorder. European Psychiatry, 28, 117–124. Lau, Y. (2013). Efficacy of cognitive-behavioral therapy to prevent the perinatal depressive symptoms. Macau Journal of Nursing, 12, 48–57. Lee, M., Greene, G., Mentzer, R., Pinnell, S., & Niles, D. (2001). Solution-focused brief therapy and the treatment of depression: A pilot study. Journal of Brief Therapy, 1, 33–49. Maljanen, T., Paltta, P., Harkanen, T., Virtala, E., Lindfors, O., Laaksonen, M. A., & Knekt, P. (2012). The cost-effectiveness of short-term psychodynamic psychotherapy and solution-focused therapy in the treatment of depressive and anxiety disorders during a one-year follow-up. The Journal of Mental Health Policy and Economics, 15, 13–23. Maracy, M. R., & Kheirabadi, G. R. (2012). Development and validation of a postpartum depression risk score in delivered women, Iran. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences, 17, 1067. Mofid, W., Ahmadi, A., & Etemadi, O. (2014). The Comparison of cognitive-behavioral counseling and solution-oriented counseling on women’s sexual satisfaction in Isfahan. Women and Community, 5, 67–83 Muñoz, R. F., & Miranda, J. (2000). Group therapy manual for cognitive-behavioral treatment of depression. Arlington, TX: Rand Corporation. Murphy, S. (1993). Single-session psychotherapy for depression: Is it better to focus on problems or solutions? Retrospective Theses and Dissertations. Iowa: Iowa State University. Nardi, B., Laurenzi, S., Di Nicolò, M., & Bellantuono, C. (2012). Is the cognitive-behavioral therapy an effective intervention to prevent the postnatal depression? A critical review. International Journal of Psychiatry in Medicine, 43, 211–225. O’Hara, M. W., Schlechte, J. A., Lewis, D. A., & Wright, E. J. (1991). Prospective study of postpartum blues. Biologic and psychosocial factors. Archives of General Psychiatry, 48, 801–806. Perfetti, J., Clark, R., & Fillmore, C. M. (2004). Postpartum depression: Identification, screening, and treatment. Wisconsin Medical Society Journal, 103, 56–63. Reddy, P. D., Thirumoorthy, A., Vijayalakshmi, P., & Hamza, M. A. (2015). Effectiveness of solution-focused brief therapy for an adolescent girl with moderate depression. Indian Journal of Psychological Medicine, 37, 87–89. doi:10.4103/0253-7176.150849 RutaNonacs, M., & Cohen, L. S. (1998). Postpartum mood disorders: Diagnosis and treatment guidelines. J Clin Psychiatry, 59, 2134–2140. Saisto, T., Toivanen, R., Salmela-Aro, K., & Halmesmäki, E. (2006). Therapeutic group psychoeducation and relaxation in treating fear of childbirth. Acta Obstetricia et Gynecologica Scandinavica, 85, 1315–1319. Shakarami, M., Davarniya, R., & Zahrakar, K. (2014). The effectiveness of solution-focused brief therapy (SFBT) on reducing marital stress in women. Scientific Journal of Ilam University of Medical Sciences, 22, 18–26. Sit, D., Seltman, H., & Wisner, K. L. (2011). Seasonal effects on depression risk and suicidal symptoms in postpartum women. Depress Anxiety, 28, 400–405. doi:10.1002/da.20807 Spilsbury, G. (2012). Solution-focused brief therapy for depression and alcohol dependence: A case study. Clinical Case Studies, 11, 263–275. Stein, A., Arteche, A., Lehtonen, A., Craske, M., Harvey, A., Counsell, N., & Murray, L. (2010). Interpretation of infant facial expression in the context of maternal postnatal depression. Infant Behavior & Development, 33, 273–278. doi:10.1016/j.infbeh.2010.03.002

JOURNAL OF REPRODUCTIVE AND INFANT PSYCHOLOGY 

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Trepper, T. S., Dolan, Y., McCollum, E. E., & Nelson, T. (2006). Steve de Shazer and the future of solutionfocused therapy. Journal of Marital & Family Therapy, 32, 133–139. Veisani, Y., Delpisheh, A., Sayehmiri, K., & Rezaeian, S. (2013). Trends of postpartum depression in iran: A systematic review and meta-analysis. Depression Research and Treatment, 2013, 291029. doi:10.1155/2013/291029 Wilkins, C., Baker, R., Bick, D., & Thomas, P. (2009). Emotional processing in childbirth: A predictor of postnatal depression? British Journal of Midwifery, 17, 154–159. Wisner, K. L., Parry, B. L., & Piontek, C. M. (2002). Clinical practice. Postpartum depression. New England Journal of Medicine, 347, 194–199. doi:10.1056/NEJMcp011542