***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: BACKGROUND Postnatal and antenatal depression are a focus of considerable clinical and research attention , but little is known about the patterns of anxiety across this period . METHODS  Self-reported anxiety and depression were assessed at 18 and 32 weeks gestation and 8 weeks and 8 months postnatally in a prospect i ve longitudinal study of a community sample of women in Engl and ( n=8323 ) . RESULTS The majority of cases of postnatal depression were preceded by antenatal depression ; similarly , postnatal anxiety was preceded by antenatal anxiety . Despite the stability of anxiety and depression across this period , there was a mean decrease in both anxiety and depression . Finally , antenatal anxiety predicted postnatal depression at 8 weeks and 8 months , even after controlling for antenatal depression ( OR=3.22 , p<0.001 ) . LIMITATIONS Data were based on self-report only and there was evidence of selective attrition . CONCLUSION The findings confirm that antenatal anxiety occurs frequently , overlaps with depression and increases the likelihood of postnatal depression Background To test whether receiving care from a health visitor ( HV ) trained in identification and psychological intervention methods prevents depression 6–18 months postnatally in women who are not depressed 6 weeks postnatally . Method The study was a prospect i ve cluster trial , r and omized by GP practice , with follow-up for 18 months in 101 primary care teams in the Trent area of Engl and . The participants were women scoring < 12 on the postal Edinburgh Postnatal Depression Scale ( EPDS ) at 6 weeks postnatally ( 1474 intervention and 767 control women ) . Intervention HVs ( n=89 , 63 clusters ) were trained in identifying depressive symptoms using the EPDS and face-to-face clinical assessment and in providing psychologically orientated sessions based on cognitive behavioral or person-centered principles . The control group comprised HVs ( n=49 , 37 clusters ) providing care as usual ( CAU ) . The primary outcome measure was the proportion of women scoring ⩾12 on the EPDS at 6 months postnatally . Secondary outcomes were mean EPDS score , Clinical Outcomes in Routine Evaluation – Outcome Measure ( CORE-OM ) score , State – Trait Anxiety Inventory ( STAI ) , 12-item Short Form Health Survey ( SF-12 ) and Parenting Stress Index Short Form ( PSI-SF ) scores at 6 , 12 and 18 months . Results After adjusting for individual-level covariates , living alone , previous postnatal depression ( PND ) , the presence of one or more adverse life events and the 6-week EPDS score , the odds ratio ( OR ) for EPDS ⩾12 at 6 months was 0.71 [ 95 % confidence interval ( CI ) 0.53–0.97 , p=0.031 ] for the intervention group ( IG ) women compared with the control ( CAU ) group women . Two subgroups were formed by baseline severity : a ‘ subthreshold ’ subgroup with a 6-week EPDS score of 6–11 ( n=999 ) and a ‘ lowest severity ’ subgroup with a 6-week EPDS score of 0–5 ( n=1242 ) . There was no difference in psychological effectiveness by subgroup ( interaction term : z=−0.28 , p=0.782 ) . Conclusions This study provides new evidence of a universal , enduring preventive effect for depression in women who screen negative for depression postnatally BACKGROUND Postnatal depression can have a significant impact on both maternal and child health . There have been very few studies undertaken in the developing world to identify women at risk of postnatal depression .  The present study aim ed to investigate risk factors for the occurrence of postnatal depression in urban South African women . METHOD A large prospect i ve population cohort study identified antenatal risk factors for postnatal depression in Soweto , Johannesburg , South Africa . One thous and and thirty-five women were interviewed in the antenatal period and subsequently completed the Pitt Depression Question naire in the postnatal period . RESULTS 170/1035 ( 16.4 % ) women were probable cases of postnatal depression . The strongest independent predictors of postnatal depression were exposure to extreme societal stressors ( witnessing a violent crime/danger of being killed ) ( adjusted Odds Ratio 2.468 ( 95 % Confidence Interval 1.509 , 4.037 ) ) and reporting difficulties with their partner ( adjusted OR 1.645 ( 1.088 , 2.488 ) ) . LIMITATIONS There was some loss of the sample during follow-up ( 35.1 % ) , which was to be expected given the turbulent nature of the study setting . The measures were question naires administered by interview . CONCLUSION Postnatal depression is common in women in developing world setting s , such as this part of Southern Africa . Although some of the risk factors for postnatal depression were similar to those identified in studies in developed nations , some important differences exist , most notably antenatal exposure to extreme societal stressors . This study shows that it is possible to identify women at risk during pregnancy in a developing world setting Research has indicated that social support is a major buffer of postpartum depression . Yet little is known concerning women ’s perceptions on social support during the postpartum period . The objective of this study was to explore postpartum women ’s views and experiences with social support following childbirth . Four focus groups were conducted with an ethnically diverse sample of women ( n = 33 ) in a large urban teaching hospital in New York City . Participants had completed participation in a postpartum depression r and omized trial and were 6–12 months postpartum . Data transcripts were review ed and analyzed for themes . The main themes identified in the focus group discussion s were mother ’s major needs and challenges postpartum , social support expectations and providers of support , how mothers mobilize support , and barriers to mobilizing support . Women across all groups identified receipt of instrumental support as essential to their physical and emotional recovery . Support from partners and families was expected and many women believed this support should be provided without asking . Racial/ethnic differences existed in the way women from different groups mobilized support from their support networks . Instrumental support plays a significant role in meeting women ’s basic needs during the postpartum period . In addition , women ’s expectations surrounding support can have an impact on their ability to mobilize support among their social networks . The results of this study suggest that identifying support needs and expectations of new mothers is important for mothers ’ recovery after childbirth . Future postpartum depression prevention efforts should integrate a strong focus on social support OBJECTIVE The aim of this study was to measure the impact of two middle-trimester parenting communication classes on postpartum anxiety , marital adjustment , and postpartum adjustment . METHODS Seventy primiparous , low-risk couples enrolled in prenatal classes in a large urban hospital were r and omized to experimental and control groups . An educational intervention consisting of two second-trimester classes was facilitated by two social workers . The classes were based on a previous assessment of the educational needs of postpartum couples and contained didactic sessions , role-playing sessions , and values clarification exercises . The Spielberger State-Trait Anxiety Inventory and the Dyadic Adjustment Scale were administered to both groups prenatally in the second trimester and at 6 weeks and 6 months postpartum . A modified version of the O'Hara Postpartum Adjustment Question naire was administered at 6 weeks and 6 months postpartum . RESULTS Both groups scored comparably in the prenatal period . The experimental group scored significantly lower on anxiety and higher on dyadic adjustment at both postpartum time periods than the control group . The experimental group also indicated a higher degree of postpartum adjustment . CONCLUSION Prenatal parenting communication classes had a significant impact on postpartum anxiety , postpartum marital satisfaction , and postpartum adjustment This article is Part 1 of a two-part series , in which we report on our evaluation of a mindfulness-based relationship enhancement program for couples who are expecting their first child . In this mixed- methods r and omized clinical trial , we assigned 33 couples to the 4-week Mindful Transition to Parenthood Program treatment group ( n = 16 couples ) or to a waitlist control condition ( n = 17 couples ) . Men in the treatment group significantly improved in relationship satisfaction , mindfulness , and negative affect ; women had no significant treatment effects . Small to large effect sizes were present for treatment group men and women in multiple areas . Mixed- methods analyses demonstrated that this intervention may be especially helpful for men because of differences in social support needs , effects of program enrollment , and relational processes in the prenatal period A sample of 99 women was studied prospect ively from the second trimester of pregnancy until nine weeks post partum . Depressed and nondepressed women identified at the second-trimester assessment and the postpartum assessment were compared on measures of  stressful life events and social support provided by their spouses and close confidants . Nine percent of women during pregnancy and 12 % of women after delivery were depressed . Women experiencing postpartum depression reported more stressful life events and less support from their spouses after delivery than the women not experiencing postpartum depression . Women experiencing depression during pregnancy reported somewhat less support from their spouses and more support from their confidants than nondepressed women . The results of the study suggest that different causes may be responsible for prepartum and postpartum depression BACKGROUND The aim of this study was to explore the prospect i ve relationship between depressive symptoms and anxiety across pregnancy and the early postpartum . METHODS Participants ( N=207 ) completed the  State-Trait Anxiety Inventory Trait subscale , Beck Depression Inventory , and social support and sleep quality measures  at two time points during pregnancy and once in the early postpartum period . RESULTS After accounting for the relative stability of anxiety and depression over time , depressive symptoms earlier in pregnancy predicted higher levels of anxiety in late pregnancy and anxiety in late pregnancy predicted higher depressive symptomatology in the early postpartum . A bi-directional model of depression and anxiety in pregnancy was supported . LIMITATIONS Data were based on self-reports and participating women were predominantly tertiary educated with high family incomes . CONCLUSION Our findings suggest that depressive symptoms precede the development of higher levels of anxiety and that anxiety , even at non- clinical levels , can predict higher depressive symptoms . Clinicians are advised to screen for anxiety and depression concurrently during pregnancy OBJECTIVES To determine the effectiveness of a psychosocial intervention , provided to expectant couples in routine antenatal classes , on the  postpartum psychosocial adjustment of women and men . DESIGN A 3 * 3 between subjects r and omised control design was utilised . The two factors were condition and self-esteem . Preparation for Parenthood programs were r and omly allocated to one of three conditions : usual service ( ' control ' ) , experimental ( ' empathy ' ) , or non-specific control ( ' baby-play ' ) . The latter condition controlled for the non-specific effects of the intervention , these being : the provision of an extra class ; asking couples to consider the early postpartum weeks ; and receiving booster information after the antenatal class , and again shortly after the birth . Women and men were categorised into three levels of self-esteem , as measured antenatally : low , medium and high . METHODS 268 participants were recruited antenatally . Interview data and self-report information was collected from 202 of these women at 6 weeks postpartum , and 180 women at 6 months postpartum . The intervention consisted of a session focusing on psychosocial issues related to becoming first-time parents . Participants discussed possible postpartum concerns in separate gender groups for part of the session , and then discussed these issues with their partners . Hypothetical scenarios depicting stressful situations in the early postpartum weeks for women and men were discussed , with solutions that parents have found useful given to the participants . In the non-specific control condition , the session focused on the importance of play with a baby , with videotapes and discussion around how parents can play with infants . RESULTS At 6 weeks postpartum there was a significant interaction effect between condition and self-esteem on maternal adjustment .  Women with low self-esteem , who had received the intervention , were significantly better adjusted on measures of mood and sense of competence than low-self-esteem women in either of the two control conditions . There were no main or interaction effects by 6 months postpartum . The beneficial effect at 6 weeks was related to partners of these women being more aware of how the mother was feeling , and with women reporting greater satisfaction with the sharing of home and baby tasks . There were no significant main or interaction effects for men at either time point , other than men with low self-esteem reporting poorer adjustment . CONCLUSIONS This brief and inexpensive intervention was effective in reducing postpartum distress in some first-time mothers at 6 weeks postpartum . The effectiveness of this intervention was related to an increased level of awareness in the men as to how their partners were experiencing the early postpartum weeks . That the effect was only evident for women who , antenatally , reported being low in self-esteem , is an important advance in our knowledge of the effectiveness of such prevention programs . No previous studies have investigated the differential effectiveness of such programs depending upon the woman 's level of self-esteem , and this finding indicates that future work should measure this variable . These findings should be understood in the context that the population sample d were those attending preparation for parenthood classes , and thus different interventions will be needed for couples who do not attend such classes . This brief psychosocial intervention can be readily applied to antenatal classes routinely conducted in hospitals or the community The purpose of this study was to test a theoretical model of confirmation of expectations for mutual support after childbirth and to evaluate an intervention given in prenatal classes during which prospect i ve parents clarified their expectations . Results provided support for the proposed model in that parents with greater confirmation of expectations were found to have more positive relationship satisfaction , emotional affect , and parenting attitudes . Differences in men and women emerged that demonstrated that confirmation of support expectations was more important to women , while the level of support 
    Output:
    
Partner factors with sound evidence that they protect against both perinatal depression and anxiety are : emotional closeness and global support .
Partner factors with a sound evidence base for depression only are communication , conflict , emotional and instrumental support , and relationship satisfaction .