***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: This study utilizes video feedback to improve maternal parenting behavior in clinical ly depressed mothers admitted to a perinatal inpatient psychiatric unit . Depressed mothers ( n = 74 ) were r and omized to “ video ” ( n = 25 ) , “ verbal ” ( n = 26 ) , or “ st and ard care ” ( n = 23 ) . “ Video ” mothers were taped playing with their infant ; interaction was review ed with a mental health specialist . “ Verbal ” mothers only discussed interaction with their infant . “ St and ard care ”  mothers received only routine inpatient care . Mothers were assessed for mental health status , perceptions of baby behavior , and parenting competence . There was significant improvement in mental health status of all participants , regardless of intervention . Neither intervention had an advantage , compared to st and ard care , in improving parenting confidence or perceptions of infant behavior . Video mothers were more likely to report no change in their parenting confidence the more feedback sessions completed . The number of intervention sessions for each participant was limited by the duration of their inpatient admission . Most participants were on simultaneous pharmacotherapy and psychotherapy , as well as receiving intensive mothercraft assistance ; this may have influenced intervention effectiveness . Results suggest that this type of intervention may be beneficial , but in the current format does not add sufficiently to st and ard care to be detected by the measures used Background Despite the high prevalence of postnatal depression ( PND ) , few women seek help . Internet interventions may overcome many of the barriers to PND treatment use . We report a phase II evaluation of a 12-session , modular , guided Internet behavioural activation ( BA ) treatment modified to address postnatal-specific concerns [ Netmums Helping With Depression ( NetmumsHWD ) ] . Method To assess feasibility , we measured recruitment and attrition to the trial and examined telephone session support and treatment adherence . We investigated sociodemographic and psychological predictors of treatment adherence . Effectiveness outcomes were estimated with the Edinburgh Postnatal Depression Scale ( EPDS ) , Generalized Anxiety Disorder-7 , Work and Social Adjustment Scale , Postnatal Bonding Question naire , and Social Provisions Scale . Results A total of 249 women were recruited via a UK parenting site , Netmums.com . A total of 83 women meeting DSM-IV criteria for major depressive disorder were r and omized to NetmumsHWD ( n = 41 ) or treatment-as-usual ( TAU ; n = 42 ) . Of the 83 women , 71 ( 86 % ) completed the EPDS at post-treatment , and 71 % ( 59/83 ) at the 6-month follow-up . Women completed an average of eight out of 12 telephone support sessions and five out of 12 modules . Working women and those with less support completed fewer modules . There was a large effect size favouring women who received NetmumsHWD on depression , work and social impairment , and anxiety scores at post-treatment compared with women in the TAU group , and a large effect size on depression at 6 months post-treatment . There were small effect sizes for postnatal bonding and perceived social support . Conclusions A supported , modular , Internet BA programme can be feasibly delivered to postpartum women , offering promise to improve depression , anxiety and functioning OBJECTIVE To test the efficacy of the relationship-focused behavioral coaching intervention Communicating and Relating Effectively ( CARE ) in increasing maternal/infant relational effectiveness between depressed mothers and their infants during the first 9 months postpartum . DESIGN R and omized clinical trial ( RCT ) with three phases . METHODS In this three-phase study , women were screened for postpartum depression ( PPD ) in Phase I at 6 weeks postpartum . In Phase II , women were r and omly assigned to treatment or control conditions and maternal/infant interaction was video recorded at four intervals postpartum : 6 weeks , 3 months , 6 months , and 9 months . Phase III involved focus group and individual interviews with study participants . SETTING Phase I mothers were recruited from obstetric units of two major medical centers . Phase II involved the RCT , a series of nurse-led home visits beginning at 6 weeks and ending at 9 months postpartum . Phase III focus groups were conducted at the university and personal interviews were conducted by telephone or in participants ' homes . PARTICIPANTS Postpartum mother/infant dyads ( 134 ) representative of southeastern New Engl and , United States participated in the RCT . One hundred and twenty-five mother/infant dyads were fully retained in the 9-month protocol . RESULTS Treatment and control groups had significant increases in quality of mother/infant interaction and decreases in depression severity . Qualitative findings indicated presence of the nurse , empathic listening , focused attention and self-reflection during data collection , directions for video-recorded interaction , and assistance with referrals likely contributed to improvements for both groups . CONCLUSIONS Efficacy of the CARE intervention was only partially supported . Nurse attention given to the control group and the data collection process likely confounded results and constituted an unintentional treatment . Results suggest that nurse-led home visits had a positive effect on outcomes for all participants This study examined the effect of a mother-baby intervention on the quality of mother-child interaction , infant-mother attachment security , and infant socioemotional functioning in a group of depressed mothers with infants aged 1 - 12 months . A r and omized controlled trial compared an experimental group ( n = 35 ) receiving the intervention ( 8 - 10 home visits )  with a  control group ( n = 36 ) receiving parenting support by telephone .  There were assessment s pre , post , and follow-up after 6 months . The intervention had positive effects on the quality of mother-infant interaction . Infants in the experimental group had higher scores for attachment security and for one aspect of socioemotional functioning , namely , competence . The intervention proved successful in preventing deterioration of the quality of mother-child interaction Maternal depression is prevalent , and puts children at risk . Little evidence addresses whether treatment for maternal depression is sufficient to improve child outcomes . An experiment was conducted testing whether psychotherapeutic treatment for mothers , suffering from major depression in the postpartum period , would result in improved parenting and child outcomes .  Participants included depressed women r and omly assigned to  interpersonal psychotherapy  ( n = 60 ) or to a waitlist ( n = 60 ) , and a nondepressed comparison group ( n = 56 ) . At 6 months , depressed mothers were less responsive to their infants , experienced more parenting stress , and viewed their infants more negatively than did nondepressed mothers . Treatment affected only parenting stress , which improved significantly but was still higher than that for nondepressed mothers . Eighteen months later , treated depressed mothers still rated their children lower in attachment security , higher in behavior problems , and more negative in temperament than nondepressed mothers . Initial response to treatment did not predict reduced risk for poor child outcomes . Early maternal negative perceptions of the child predicted negative temperament and behavior problems 18 months after treatment . Treatment for depression in the postpartum period should target the mother-infant relationship in addition to the mothers ' depressive symptoms Many prospect i ve studies have shown that if a mother is depressed , anxious or stressed while pregnant , this increases the risk for her child having a wide range of adverse outcomes including emotional problems , symptoms of attention deficit hyperactivity disorder ( ADHD ) or impaired cognitive development . Although genetics and postnatal care clearly affect these outcomes , evidence for a prenatal causal component also is substantial . Prenatal anxiety/depression may contribute 10 - 15 % of the attributable load for emotional/behavioural outcomes .The mechanisms underlying these changes are just starting to be explored . One possible mediating factor is increased exposure of the fetus to cortisol , as has been shown in animal studies . However , the human hypothalamic-pituitary-adrenal ( HPA ) axis which makes cortisol functions differently in human pregnancy from in most animals . The maternal HPA axis becomes gradually less responsive to stress as pregnancy progresses . And there is only a weak , if any , association between a mother 's  prenatal mood and her cortisol level , especially later in pregnancy . Cytokines are alternative possible mediators . An additional explanation is that stress or anxiety causes increased transfer of maternal cortisol across the placenta to the fetus . The placenta plays a crucial role in moderating fetal exposure to maternal factors and presumably in preparing the fetus for the environment in which it is going to find itself . There is some evidence in both rat models and in humans that prenatal stress can reduce placental 11β-HSD2 , the enzyme which metabolises cortisol to inactive cortisone . The level of cortisol in the amniotic fluid , surrounding the baby in the womb , has been shown to be inversely correlated with infant cognitive development . However , several other biological systems are likely to be involved . Serotonin is another possible mediator of prenatal stress induced programming effects on offspring neurocognitive and behavioural development . The role of epigenetic changes in mediating alterations in offspring outcome following prenatal stress is likely to be important and starting to be explored 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 This study is a r and omised controlled trial comparing outcomes from an 8-week Interpersonal Psychotherapy group ( IPT-G ) for postnatal depression  with ‘ treatment as usual ’ ( TAU ) , conducted in a routine community setting in the Australian Capital Territory ( ACT ) . Eligible women were recruited and r and omly assigned to either  IPT-G or TAU conditions . This study compared outcomes on such variables as depressive symptoms , marital adjustment , social support and mother – infant bond at baseline , mid-treatment , end-of-treatment and 3 months follow-up . Participants were also independently assessed using the Hamilton Depression Rating Scale ( HAM-D ) . 50 women completed baseline assessment s and were included in the analysis . Comparisons of treatment conditions showed that by end of treatment both the TAU and IPT-G groups significantly improved in terms of mean depression scores , however , the IPT-G women improved significantly more and had continued improvements at 3 months post therapy . Furthermore , women who received IPT-G displayed significant improvement in terms of marital functioning and perceptions of the mother-infant relationship compared to TAU participants . These findings highlight the potential benefits of an interpersonally based treatment , which not only improves outcomes for the mother but also potentially for the couple and the infant when compared to usual care Background Calgary , Alberta has the fourth highest immigrant population in Canada and ethnic minorities comprise 28 % of its total population . Previous studies have found correlations between minority status and poor pregnancy outcomes . One explanation for this phenomenon is that minority status increases the levels of stress experienced during pregnancy . The aim of the present study was to identify specific types of maternal psychosocial stress experienced by women of an ethnic minority ( Asian , Arab , Other Asian , African , First Nations and Latin American ) . Methods A secondary analysis of variables that may contribute to maternal psychosocial stress was conducted using data from the All Our Babies prospect i ve pregnancy cohort ( N = 3,552 ) where question naires were completed at < 24 weeks of gestation and between 34 and 36 weeks of gestation . Question naires included st and ardized measures of  perceived stress , anxiety , depression , physical and emotional health , and social support . Socio-demographic data included immigration status , language proficiency in English , ethnicity , age , and socio-economic status . Results Findings from this study indicate that women who identify with an ethnic minority were more likely to report symptoms of depression , anxiety , inadequate social support , and problems with emotional and physical health during pregnancy than women who identified with the White reference group . Conclusions This study has identified that women of an ethic minority experience greater psychosocial stress in pregnancy compared to the White reference group Objective To evaluate benefits for postnatal women of two  psychologically informed interventions  by health visitors . Design Prospect i ve cluster trial r and omised by general practice , with 18 month follow-up . Setting 101 general practice s in Trent , Engl and . Participants 2749 women allocated to intervention 
    Output:
    
For AD , IPT , CBT , and massage produced large effects on parenting ( e.g. adjustment and attention toward infant ) and child development ( e.g. behaviour ) .
For PPD , maternal-child interaction guidance and psychotherapeutic group support produced large effects on parenting ( e.g. sense of competence ) and child development ( e.g. cortisol ) .
However , meta- analysis revealed nonsignificant effects of IPT on maternal-child attachment and CBT on parenting stress .
Promising findings exist for IPT , CBT , maternal-child interaction guidance , massage , and psychotherapeutic group support for specific parenting and /or child development outcomes .