***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 OBJECTIVE Selective serotonin reuptake inhibitor ( SSRI ) use during pregnancy incurs a low absolute risk for major malformations ; however , other adverse outcomes have been reported . Major depression also affects reproductive outcomes . This study examined whether 1 ) minor physical anomalies , 2 ) maternal weight gain and infant birth weight , 3 ) preterm birth , and 4 ) neonatal adaptation are affected by SSRI or depression exposure . METHOD This prospect i ve observational investigation included maternal assessment s at 20 , 30 , and 36 weeks of gestation . Neonatal outcomes were obtained by blinded review of delivery records and infant examinations . Pregnant women ( N=238 ) were categorized into three mutually exclusive exposure groups : 1 ) no SSRI , no depression ( N=131 ) ; 2 ) SSRI exposure ( N=71 ) , either continuous ( N=48 ) or partial ( N=23 ) ; and 3 ) major depressive disorder ( N=36 ) , either continuous ( N=14 ) or partial ( N=22 ) . The mean depressive symptom level of the group with continuous depression and no SSRI exposure was significantly greater than for all other groups , demonstrating the expected treatment effect of SSRIs . Main outcomes were minor physical anomalies , maternal weight gain , infant birth weight , pregnancy duration , and neonatal characteristics . RESULTS Infants exposed to either SSRIs or depression continuously across gestation were more likely to be born preterm than infants with partial or no exposure . Neither SSRI nor depression exposure increased risk for minor physical anomalies or reduced maternal weight gain . Mean infant birth weights were equivalent . Other neonatal outcomes were similar , except 5-minute Apgar scores . CONCLUSIONS For depressed pregnant women , both continuous SSRI exposure and continuous untreated depression were associated with preterm birth rates exceeding 20 % A r and omized controlled trial evaluated the effect of telephone-based peer support ( mother-to-mother ) on preventing postpartum depression among high-risk mothers . This paper reports volunteers ' perceptions , which showed that peer support is an effective preventative intervention . Two-hundred and five ( 205 ) volunteers were recruited and trained to provide peer support to 349 mothers r and omized to the intervention group . Volunteers ' perceptions were measured at 12 weeks using the  Peer Volunteer Experience Question naire , completed by 69 % ( 121 ) of the 175 volunteers who provided support to at least one mother . Large majorities felt that the training session had prepared them for their role ( 94.2 % ) , that volunteering did not interfere with their lives ( 81.8 % ) and that providing support helped them grow as individuals ( 87.8 % ) . Over 90 % stated that they would become a peer volunteer again , given the opportunity . Recruitment and retention of effective volunteers is essential to the success of any peer-support intervention . Results from this study can assist clinicians and program planners to provide effective training , sufficient on-going support and evaluation and appropriate matching of volunteers to mothers who desire peer support and are at high risk of postpartum depression The military has recognized that health and quality of life for service members are closely tied to the re sources for their families , including how they are cared for during pregnancy and childbirth . However , there has been little examination of women 's experience with different models of prenatal care ( PNC ) in military setting s. The purpose of this article is to describe the results of a qualitative study of women 's experiences with the CenteringPregnancy model of group PNC compared to individual PNC in two military health care setting s. This clinical trial enrolled 322 women who were r and omized into group or individual PNC at two military treatment facilities . Qualitative interviews were completed with 234 women during the postpartum period . Interpretative narrative and thematic analysis was used to identify three themes : 1 ) " I was n't alone"-the experience with group PNC ; 2 ) " I liked it but ... "- recommendations to improve group PNC ; and 3 ) " They really need to listen"-general concerns across the sample about PNC . Greatest concerns of women in individual PNC included lack of continuity and time with the provider . Our military families must be assured that their health care system meets their needs through personal and family-centered care . Group PNC offers the potential for continuity of provider while also offering community with other women . In the process , women gain knowledge and power as a health care consumer BACKGROUND Postnatal depression is a public health problem requiring intervention . To provide effective care , information is needed on the experiences of those with high levels of depressive symptoms who are offered and accept , or decline , psychological intervention postnatally . AIM To provide the first integrated in-depth exploration of postnatal women 's experiences of the identification and management of symptoms of depression and the offer and acceptance of postnatal care by health visitors taking part in the PoNDER trial . SETTING General practice : primary care within the former Trent regional health authority , Engl and . METHOD Thirty women with 6-week Edinburgh Postnatal Depression Scale ( EPDS ) scores ≥ 18 and probable depression completed semi-structured interviews . All women had taken part in the Post-Natal Depression Economic Evaluation and R and omised controlled ( PoNDER ) trial where  intervention group health visitors received training in identification of depressive symptoms and provided psychologically informed sessions based on cognitive-behavioural therapy or person-centred counselling principles . RESULTS When accepted , psychological sessions were experienced as positive , effective , and ' ideal care ' . Women approved of using the EPDS but did not underst and the health visitor 's role in supporting women . Seeking help and accepting sessions depended on women 's perspectives of their health visitor as an individual . CONCLUSION Women 's experience of their health visitors providing psychological sessions to help with postnatal depressive symptoms is highly positive . Women will better accept support from health visitors if they recognise their role in postnatal depression and find them easy to relate to on personal matters . There is a case for specific enhancement of interpersonal skills in health visiting , or alternatively offering a choice of health visitors to women BACKGROUND Peer support in the early postpartum period is effective in the prevention of postpartum depression among women identified as high-risk . OBJECTIVES To describe maternal perceptions of peer support received while participating in a trial . DESIGN Cross-sectional survey of women participating in a r and omized controlled trial to evaluate the effect of peer support in the prevention of postpartum depression . SETTING Seven health regions across Ontario Canada . PARTICIPANTS 701 women were recruited between November 2004 and September 2006 . Women eligible for the study were all mothers with an Edinburgh Postnatal Depression Scale score > 9 who were within 2 weeks postpartum , at least 18 years of age , able to speak English , had a live birth , and had been discharged home from the hospital . Exclusion criteria included an infant not discharged home with the mother and current use of antidepressant or antipsychotic medication . Two hundred and twenty-one mothers completed the mailed question naire . METHODS Women were r and omly allocated to receive usual postpartum care ( control group ) or usual postpartum care plus telephone-based peer support ( intervention group ) . Maternal perceptions of peer support were evaluated at 12 weeks postpartum using the vali date d Peer Support Evaluation Inventory . RESULTS Interactions provided by the peer volunteer included the provision of emotional ( 92.7 % ) , informational ( 72.4 % ) , and appraisal ( 72.0 % ) support . Mothers reported high levels of positive relationship qualities such as trust ( 83.6 % ) and perceived acceptance ( 79.1 % ) . Most ( 80.5 % ) mothers indicated they were very satisfied with their peer support experience . Maternal satisfaction was associated with the number and duration of peer volunteer contacts . CONCLUSIONS The majority of mothers perceived their peer volunteer experience positively lending further support to telephone-based peer support as a preventative strategy for postpartum depression . The following program modifications were suggested : ( a ) adapt training to enhance the provision of appraisal support ; ( b ) improve matching of volunteers to participants based on age , number of children , and breastfeeding status ; and ( c ) ensure participating mothers want to receive peer support in order to facilitate the development of relationships with their assigned peers Summary ¶ Background : Poor compliance by participants consenting to be r and omised to receive both physical and mental health promotion interventions represents a potentially serious threat to external and internal validity of those interventions . Quantitative and qualitative investigation of possible predictors of engagement forms an appropriate basis for efforts to enhance it . Methods : Eight ‘ Preparing for Parenthood ’ intervention courses of a r and omized controlled trial ( RCT ) underpinned a quantitative study . One ‘ Preparing for Parenthood ’ ( PFP ) intervention course , run upon completion of the RCT , formed a qualitative study . All nine courses followed identical procedures to enable clear comparisons . The three factors quantitatively explored with respect to engagement in health promoting behaviours were : locus of control ( LOC ) , psychosocial support , and life events . The qualitative study utilised grounded theory analysis , the participants reflecting upon their experiences of the intervention and /or their reasons for not attending the course ; nine interviews were completed . Results : Participants in the quantitative and qualitative studies were divided into three sub-groups : compliant , non-compliant , and refusers . None of the three health promoting variables predicted compliance to a statistically significant degree . However , a variable from the trial analysis was found to reach significance ; those women who had had less contact with the National Health Service in the 12 months prior to the baseline assessment were more likely to refuse the invitation to PFP . The qualitative study produced nine main themes that had influenced participant engagement at both the initial recruitment stage and during the course itself . Conclusions : In combination these findings may contribute to the future design of both effective and acceptable interventions to prevent postnatal depression . One such modified intervention is described and its impact on engagement outlined 
    Output:
    
Support and empowerment through education were identified as particularly helpful to women as intervention components , across all intervention types .
Implication s for accessing the service , underst and ing the remit of the service and women 's preferences for group and individual care also emerged .