***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE This project aim ed to evaluate the impact of a home visiting programme that targeted families where the child , for environmental reasons , was at great risk of poor health and developmental outcomes . METHODOLOGY Women in the immediate postpartum period were recruited to a r and omized double-blind controlled trial on the basis of self-reported vulnerability factors and were r and omly assigned to receive either a structured programme of nurse home visiting , supported by a social worker and paediatrician ( n = 90 ) , or assigned to a comparison group receiving st and ard community child health services ( n = 91 ) . Parenting stress and maternal depression were measured at enrollment and at 6 weeks . Preventive health behaviour , service satisfaction and home environment outcomes were tested at 6 weeks , as were child health outcomes . RESULTS At six weeks , women receiving the home-based programme had significant reductions in postnatal depression screening scores as well as improvements in their experience of the parental role and improvement in the ability to maintain their own identity . Maternal-infant interactions were more likely to be positive , with significantly higher ( better ) scores in aspects of the home environment related to optimal development in children , particularly maternal-infant secure attachment . Intervention group mothers were significantly more satisfied with the community child health service . CONCLUSIONS This form of intervention for families is effective in promoting secure maternal-infant attachment , preventing maternal mood disorder and is welcomed by the families receiving it . These findings may predict long-term benefits for the healthy development of children otherwise at risk of a range of poor health and development outcomes BACKGROUND Women who have suffered one episode of postpartum-onset major depression ( PPMD ) comprise a high-risk group for subsequent episodes . We conducted a double-blind , r and omized clinical trial to test the efficacy of nortriptyline in the prevention of recurrent PPMD . METHOD Nondepressed women who had at least one past episode of PPMD ( Research Diagnostic Criteria ) were recruited during pregnancy . Subjects were r and omly assigned to nortriptyline or placebo . Treatment began immediately postpartum . Each subject was assessed for 20 sequential weeks with the Hamilton Rating Scale for Depression and Research Diagnostic Criteria for recurrence of major depression . RESULTS No difference was found in the rate of recurrence in women treated with nortriptyline compared with those treated with placebo . Of 26 subjects who took nortriptyline preventively , 6 ( 0.23 , 95 % exact confidence interval [ CI ] = 0.09 to 0.44 ) suffered recurrences . Of 25 subjects who took placebo  , 6 ( 0.24 , 95 % exact CI = 0.09 to 0.45 ) suffered recurrence ( Fisher exact p = 1.00 ) . CONCLUSION Nortriptyline did not confer additional preventive efficacy beyond that of placebo . The rate of recurrence of PPMD ( one fourth of women ) was unacceptably high OBJECTIVE Postpartum depression affects between 10 and 15 percent of new mothers . These mothers are apprehensive about recurrence after later births . This study tested the efficacy of antidepressant medication administered during the postpartum period to prevent a recurrence of postpartum depression  among women who had suffered a previous episode . METHODS An open clinical trial was conducted at a university-based outpatient clinic treating pregnant and postpartum women with mood disorders . Study participants were 23 pregnant women who had at least one previous postpartum episode that fit DSM-III-R criteria for nonbipolar major depression without psychotic features . Postpartum monitoring for recurrence of depressive symptoms was compared with postpartum monitoring plus postbirth treatment with either the medication that had been effective for the previous episode or nortriptyline . The first dose was given within 24 hours of birth . The authors assessed recurrence of postpartum major depression by psychiatric examination and use of the Inventory to Diagnose Depression , a reliable self-report instrument . RESULTS A significantly greater proportion of the women who elected monitoring alone ( 62.5 percent ) suffered recurrence of major depression compared with the women who received monitoring plus medication ( 6.7 percent ) ( p = .0086 ) . CONCLUSIONS Prophylactic antidepressant treatment reduced the recurrence of postpartum major depression BACKGROUND : Postnatal depression is a common disorder , which can have profound short and long term effects on maternal morbidity , the new infant and the family as a whole . Social factors appear to be particularly important in the aetiology and prognosis of postnatal depression and treatment is often largely social support and psychological interventions . It is not known whether antidepressants are an effective and safe choice for treatment of this disorder . OBJECTIVES : To evaluate the effectiveness of different antidepressant drugs  and compare their effectiveness with other forms of treatment . To assess any adverse effects of antidepressants in the mother or the nursing baby . SEARCH STRATEGY : The registers of clinical trials maintained and up date d by the Cochrane Depression , Anxiety and Neurosis Group and the Cochrane Pregnancy and Childbirth Group were search ed . Other data bases ( outlined below ) were also search ed and contacts were made with pharmaceutical companies and experts in the field . SELECTION CRITERIA : All trials were considered in which women with depression in the first six months postpartum were r and omised to receive antidepressants alone or in combination with another treatment , or to receive any other treatment including placebo . DATA COLLECTION AND ANALYSIS : Data was extracted independently from the trial reports by the review ers . Missing information was requested from investigators wherever possible . Data was sought to allow an " intention to treat " analysis . MAIN RESULTS : Only one trial could be included in this review , leaving most of the objectives of the review unfulfilled . Appleby et al ( 1997 ) reported that Fluoxetine was significantly more effective than placebo and , after an initial session of counselling , as effective as a full course of cognitive-behavioural counselling in the treatment of postnatal depression . There was no interaction between medication and counselling . REVIEW ER 'S CONCLUSIONS : Women with postnatal depression can be effectively treated with fluoxetine , which is as effective as a course of cognitive-behavioural counselling in the short-term . However , more trials with a longer follow-up period are needed to compare different antidepressants in the treatment of postnatal depression , and to compare antidepressant treatment with psychosocial interventions .  This is an area that has been neglected despite the large public health impact described above BACKGROUND Postpartum depression causes women great suffering and has negative consequences for their social relationships and for the development of their infants . Research is needed to evaluate the efficacy of psychotherapy for postpartum depression . METHODS A total of 120 postpartum women meeting DSM-IV criteria for major depression were recruited from the community and r and omly assigned to 12 weeks of interpersonal psychotherapy ( IPT ) or to a  waiting list condition ( WLC ) control group .  Subjects completed interview and self-report assessment s of depressive symptoms and social adjustment every 4 weeks . RESULTS Ninety-nine of the 120 patients completed the protocol .  Hamilton Rating Scale for Depression ( HRSD ) scores of women receiving IPT declined from 19.4 to 8.3 , a significantly greater decrease than occurred in the WLC group ( 19.8 to 16.8 ) . The Beck Depression Inventory ( BDI ) scores of women who received IPT declined from 23.6 to 10.6 over 12 weeks , a significantly greater decrease than occurred in the WLC group ( 23.0 to 19.2 ) . A significantly greater proportion of women who received IPT recovered from their depressive episode based on HRSD scores of 6 or lower ( 37 . 5 % ) and BDI scores of 9 or lower ( 43.8 % ) compared with women in the WLC group ( 13.7 % and 13.7 % , respectively ) . Women receiving IPT also had significant improvement on the Postpartum Adjustment Question naire and the Social Adjustment Scale-Self-Report relative to women in the WLC group . CONCLUSIONS These findings suggest that IPT is an efficacious treatment for postpartum depression . Interpersonal psychotherapy reduced depressive symptoms and improved social adjustment , and represents an alternative to pharmacotherapy , particularly for women who are breastfeeding BACKGROUND Social support theory and observational risk factor studies suggest that increased antenatal psychosocial support could prevent post-natal depression . We used empirical knowledge of risk and protective factors for post-natal depression not employed previously in order to develop and evaluate an antenatal preventive intervention . METHODS We conducted a pragmatic r and omized controlled trial in antenatal clinics . We screened 1300 primiparous women and 400 screened positive , 69 screen-positive women were untraceable or not eligible . Of 292 women who completed baseline assessment , 209 consented to r and omization , of these 190 provided outcome data 3 months post-natally . ' Preparing for Parenthood ' , a structured antenatal risk factor reducing intervention design ed to increase social support and problem-solving skills , was compared with routine antenatal care only . We compared the percentage depressed at 3 months after childbirth using the self-completion General Health Question naire Depression scale and Edinburgh Post-natal Depression Scale ( EPDS ) , and the Schedules for Clinical Assessment in Neuropsychiatry a systematic clinical interview . RESULTS Assignment to the intervention group did not significantly impact on post-natal depression ( odds ratio for GHQ-Depression 1.22 ( 95 % CI 0.63 - 2.39 ) , P = 0.55 ) or on risk factors for depression . Forty-five per cent of the intervention group women attended sufficient sessions to be likely to benefit from intervention if effective . Attenders benefited no more than non-attenders . CONCLUSIONS Prevention services targeting post-natal depression should not implement antenatal support programmes on these lines until further research has demonstrated the feasibility and effectiveness of such methods . The development of novel , low cost interventions effective in reducing risk factors should be completed before further trial evaluation OBJECTIVES To investigate the effectiveness of a psychosocial intervention for the prevention of postnatal depression . DESIGN A controlled trial . METHOD Women expecting their first or second child and design ated as ' more vulnerable ' by the Leverton Question naire ( LQ ) or Crown Crisp Experiential Index ( CCEI ) were allocated to a  preventive intervention ( N = 47 ) or  control group ( N = 52 ) by expected date of delivery to provide groups expecting their babies around the same time . Women were assessed at 3 months postnatal . An additional group of women design ated as ' less vulnerable ' ( N = 88 ) were assessed to confirm the validity of the LQ as a vulnerability measure . RESULTS Question naire measures of mood in first-time mothers invited to the Preparation for Parenthood groups revealed significantly more positive mood than in the group receiving routine care . The median Edinburgh Postnatal Depression Scale ( EPDS ) score for those invited was 3 , compared to 8 for those not invited ( p < .005 ) . The diagnosis of depression using the Present State Examination revealed differences for both groups , though it reached statistical significance only with the first-time mothers . Only 19 % of the ' more vulnerable ' invited first-time mothers were ' borderline ' or ' cases ' at any time in the first 3 months postnatally compared to 39 % of those not invited . The Surviving Parenthood groups for second-time mothers were not successful . CONCLUSION Some depressions following childbirth can be prevented by brief interventions that can be incorporated with existing systems of antenatal classes and postnatal support groups Abstract Objective : To compare the effect of a behavioural sleep intervention with written information about normal sleep on infant sleep problems and maternal depression . Design : R and omised controlled trial . Setting : Well child clinics , Melbourne , Australia Participants : 156 mothers of infants aged 6 - 12 months with severe sleep problems according to the parents . Main outcome measures : Maternal report of infant sleep problem ; scores on Edinburgh postnatal depression scale at two and four months . Intervention : Discussion on behavioural infant sleep intervention ( controlled crying ) delivered over three consultations . Results : At two months more sleep problems had resolved in the intervention group than in the control group ( 53/76 v 36/76 , P=0.005 ) . Overall depression scores fell further in the intervention group than in the control group ( mean change 3.7 , 95 % confidence interval 4.7 to 2.7 , v 2.5 , 1.7 to 3.4 , P=0.06 ) . For the subgroup of mothers with depression scores of 10 and over more sleep problems had resolved in the intervention group than in the control group ( 26/33 v 13/33 , P=0.001 ) . In this subgroup depression scores also fell further for intervention mothers than control mothers at two months ( 6.0 , 7.5 to 4.0 , v 3.7 , 4.9 to 2.6 , P=0.01 ) and at four months ( 6.5 , 7.9 to 5.1 v −4.2 , −5.9 to 2.5 , P=0.04 ) . By four months , changes in sleep problems and depression scores were similar . Conclusions : Behavioural intervention significantly reduces infant sleep problems at two but not four months . Maternal report of symptoms of depression decreased significantly at two months , and this was sustained at four months for mothers with high depression scores . What is already known on this topic Infant sleep problems and postnatal depression are both common potentially serious problems Women whose infants have sleep problems are more likely to report symptoms of depression Uncontrolled studies in clinical population s suggest that reducing infant sleep problems improves postnatal depression , but there is no good quality evidence in the community for such effect 
    Output:
    
The onset of postpartum psychosis is usually acute , within the first 2 weeks of delivery , and appears to be more common in women with a strong family history of bipolar or schizoaffective disorder .