***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 : To determine the impact of partner support in the treatment of mothers suffering from postpartum depression ( PPD ) . Method Patients underwent a comprehensive psychiatric assessment and were enrolled in the study only if they met the DSM-IV criteria for major depressive disorder with postpartum onset . Patients with PPD ( n = 29 ) were assigned r and omly to 2 treatment groups : group 1 ( control group ) consisted of patients only ( n = 13 )  , while group 2 ( support group ) consisted of patients ( n = 16 ) and their partners .  The patients in both groups were seen for 7 psychoeducational visits each . In group 2 , partners participated in 4 of the 7 visits . Patients in both groups were administered a set of question naires that included the Edinburgh Postnatal Depression Scale ( EPDS ) , the Kellner Symptom Question naire , the Dyadic Adjustment Scale ( DAS ) , and the Parental Bonding Instrument ( PBI ) .  In addition , during visits 1 and 7 , all patients underwent assessment using the Mini International Neuropsychiatric Instrument ( MINI ) , section A ( major depressive episode ) . The partners in both groups completed the DAS and the General Health Question naire ( GHQ ) . Results Relative to the control-group patients , the support-group patients displayed a significant decrease in depressive symptoms and other psychiatric conditions . Relative to the support group , the general health of the partners in the control group deteriorated . Conclusion Partner support has a measurable effect on women experiencing PPD BACKGROUND Over 50 percent of women have one or more risk factors for postnatal depression during pregnancy or in the perinatal period , but only 10 to 15 percent become clinical ly depressed . The objective of this study was to prospect ively test the Brisbane Postnatal Depression Index ( referred to here as Index ) , to vali date a theoretical index that was developed earlier , and to establish whether the index could be introduced as a clinical ly useful method to detect women who may be at risk for developing postnatal depression . METHODS Antenatally , women were asked about social support and about personal and family history of mental illness , including postnatal depression . Responses were scored according to predefined ratings on the Index . In the postnatal wards , 353 women were recruited and their scores for " blues , " social support , feelings about the baby , and satisfaction with the birth process were added . Sixteen weeks after hospital discharge , women were asked to complete the  Edinburgh Postnatal Depression Scale .  The Brisbane Index was vali date d by the number of women scoring more than 12 on the Edinburgh Postnatal Depression Scale at 16 weeks postpartum who were correctly predicted by a score of more than 6 on the Index . Sensitivity , specificity , positive predictive value , and negative predictive value for the Index , using > 6 as a cutoff point , were calculated . " Ease of use " was assessed informally with participants and staff responsible for administration and scoring the instrument . RESULTS Compared with results from the derivation study , prospect i ve testing of the index showed an improvement in sensitivity from 36.3 to 47.5 percent and a small decrease in specificity , but no improvement on the positive predictive value from 39.8 to 39.6 percent . CONCLUSION The Brisbane Postnatal Depression Index was vali date d in a prospect i ve sample , but its sensitivity and specificity require improvement before introduction as a measure of prediction 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 This study aim ed to assess the prevalence and incidence of  postpartum depression ( PPD ) and to identify risk factors in a community cohort of Israeli-born , as well as new and veteran immigrant women . A r and om sample of 288 registrants at a community clinic was assessed for depressive symptoms at 26 weeks ' pregnancy using the  Beck Depression Inventory ( BDI ) and at 6 weeks postpartum using the  Edinburgh Postnatal Depression Scale ( EPDS ) .  Information regarding risk factors was gathered through interviews and medical record abstract ing . The prevalence of PPD was 22.6 % . Two-thirds of the women had scored ' depressed ' during pregnancy , and one-third ( 6.9 % ) were new incident cases . Immigrant status was the only significant demographic predictor of PPD identified by either univariate or multivariate analysis , with Russian new immigrants having over twice the risk for PPD as Israeli-born subjects . The rate of PPD in this Israeli cohort was comparable to that found in other countries . The finding that immigrant status was the most potent demographic predictor may support the role of stressful life events in the etiology of PPD . The use of the EPDS for PPD screening was found acceptable and feasible in the primary health setting Background : A pregnant woman 's psychological health is a significant predictor of postpartum outcomes . The Antenatal Psychosocial Health Assessment ( ALPHA ) form incorporates 15 risk factors associated with poor postpartum outcomes of woman abuse , child abuse , postpartum depression and couple dysfunction . We sought to determine whether health care providers using the ALPHA form detected more antenatal psychosocial concerns among pregnant women than providers practising usual prenatal care . Methods : A r and omized controlled trial was conducted in 4 communities in Ontario . Family physicians , obstetricians and midwives who see at least 10 prenatal patients a year enrolled 5 eligible women each . Providers in the intervention group attended an educational workshop on using the ALPHA form and completed the form with enrolled women . The control group provided usual care . After the women delivered , both groups of providers identified concerns related to the 15 risk factors on the ALPHA form for each patient and rated the level of concern . The primary outcome was the number of psychosocial concerns identified . Results were controlled for clustering . Results : There were 21 ( 44 % ) providers r and omly assigned to the ALPHA group and 27 ( 56 % ) to the control group . A total of 227 patients participated : 98 ( 43 % ) in the ALPHA group and 129 ( 57 % ) in the control group . ALPHA group providers were more likely than control group providers to identify psychosocial concerns ( odds ratio [ OR ] 1.8 , 95 % confidence interval [ CI ] 1.1–3.0 ; p = 0.02 ) and to rate the level of concern as “ high ” ( OR 4.8 , 95 % CI 1.1–20.2 ; p = 0.03 ) . ALPHA group providers were also more likely to detect concerns related to family violence ( OR 4.8 , 95 % CI 1.9–12.3 ; p = 0.001 ) . Interpretation : Using the ALPHA form helped health care providers detect more psychosocial risk factors for poor postpartum outcomes , especially those related to family violence . It is a useful prenatal tool , identifying women who would benefit from additional support and interventions BACKGROUND Psychological morbidity , and especially depression and anxiety arising antenatally , are as common as that seen postnatally . Approximately one-third of women will remain depressed postpartum , sometimes for prolonged periods -- with the attendant morbidity for mother and infant that this brings . Morbidity is greatest where there is associated drug and alcohol use , domestic violence and personality disorder . OBJECTIVE This article aims to provide an overview of  psychosocial assessment  and the detection and management of  depression and anxiety disorders in pregnancy . DISCUSSION Psychosocial assessment of all pregnant women is an integral part of good antenatal care . The Edinburgh Postnatal Depression Scale is a useful adjunct in the detection and monitoring of anxiety and depression antenatally . Many women will decline medication and thus psychological interventions will often be first line treatments . Where medication is required , prospect i ve controlled studies suggest antidepressants are not associated with increased rates of teratogenicity and are thus relatively ' safe ' . Management of more severe and /or complex cases needs to be in association with a psychiatrist and a mental health or drug and alcohol team and may require antenatal notification of an ' at risk ' offspring 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 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 OBJECTIVE To develop and evaluate a question naire used antepartum to screen for postpartum depression . STUDY DESIGN Demographic and clinical data , based on previously identified variables , were obtained from 106 second-trimester gravidas ( sample I ) by interview , self-administered question naire and medical record review . The Beck Depression Inventory ( BDI ) was administered at 1 , 6 and 12 weeks postpartum ( PP ) . Statistical analysis , including stepwise linear regression with maximum r-squared improvement , identified a subset of the 24 most predictive variables . This antepartum question naire ( APQ ) was vali date d retrospectively in the original sample and prospect ively in a second group of 99 women ( sample II ) . RESULTS In both sample population s the APQ had acceptable sensitivity ( 80 -  
    Output:
    
While the use of an antenatal psychosocial assessment may increase the clinician 's awareness of psychosocial risk , neither of these small studies provides sufficient evidence that routine antenatal psychosocial assessment by itself leads to improved perinatal mental health outcomes .