Background Postnatal depression (PND) has become a world-wide public health problem. Maternal Child Health Centers (MCHCs) provide maternal and child healthcare with community-based Comprehensive Child Development Services (CCDS) aimed for early identification for provision of appropriate referral for intervention. There were 13.8% suspected PND cases in 2011(Department of Health PND Report, 2011). Antenatal Interpersonal Psychotherapy (IPT) has found efficacious for high depression risk (HDR) pregnant women. Evidence-based practice (EBP) antenatal IPT guideline best suited for MCHCs implementation. Purpose This dissertation intends to develop an effective EBP antenatal IPT guideline for HDR pregnant women, and to offer plans for implementation and evaluation. Methods Six electronic databases searched for updated relevant studies. Randomized controlled trails (RCTs) with antenatal IPT intervention for HDR pregnant women targeted. Evidence data related to EBP guideline development were extracted for critical appraisal. Program implementation potentials assessed for transferability, feasibility and cost-benefit ratio. Guideline with level of evidence and recommendation grading developed. Communication plan for different stakeholders and potential users were developed. Pilot test planned for process evaluation. Impact evaluation, outcome evaluation and economic evaluation planned to verify empirical evidences to initial changes in MCHCs. Results Eight RCTs studies, which compare group receiving antenatal IPT intervention with routine antenatal education group, were reviewed. Target population was HDR pregnant women. Antenatal IPT intervention found effective for HDR pregnant women with PND. The studies suggest antenatal IPT intervention give0.89 reductions in EPDS, improved psychological well-being, 0.77 reductions in GHQ and improved role competence2.43 increases in PSOC-E. After critical appraisal of reviewed studies, antenatal IPT guideline developed. Pregnant women should be screened between 20 to 32 gestation weeks. Those with EPDS≥13 scores should enrolled into two 2-hour antenatal IPT program educated by trained nurse educators in class size ≤10. Those refusing to join the program receive routine education. Three-point measurements of EPDS, GHQ and PSOC-E at baseline, postnatal 6 to 8 weeks and 3 to 6 months of both groups are conducted. Postnatal EPDS ≥13 participants referred for psychiatric services upon their consent. Program will propose implementation in MCHCs. Steering Committee is established and communicates with various stakeholders. Pilot test implement in one MCHC and reviewed for clinical applicability, feasibility and to obtain process evaluation for quality improvement. Program should have quasi-experimental non- equivalent pretest-posttest control group and analyze data with ‘two-sample t-test’, ‘paired t-tests’ and ‘chi-square test’. Target achievement should be: i. Primary outcomes: EPDS score reduced to0.89, GHQ reduced to0.77 and PSOC-E score increased to2.43; ii. Secondary outcomes: Reduction of PND incidence and PND management caseloads by 20%. Participants’ gestation ages, program attendance and satisfactory rates recorded. Economic evaluation indicates for every $1invested, the return is $8.45, program is a sound investment suggested. Conclusions Eight RCT studies provide evidence that antenatal IPT program is effective for HDR pregnant women in reducing PND, and in promoting higher maternal role efficacy level and psychological well-being. Implementation of this EBP program guideline can potentially help PND prevention and ease antenatal depression management of HDR pregnant women in MCHCs. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Objective: To study the evidence on physical activity (PA) as an effective preventive strategy for depression. Methods: A search of electronic databases was performed for articles between 2007 and 2012, both original research and review articles, concerning the link between PA and depression on children, youth and adults. Three reviews, five longitudinal and two cross sectional studies were included. Results:  PA reduced the likelihood of depression in many studies and a sedentary or inactive lifestyle increased the risks for mental health symptoms such as depression. One study showed that low PA in childhood increased the odds of depression as an adult and other studies on teenagers saw a connection and mediation between PA and self-esteem whereas physical fitness showed no mediating effect. Many of the studies and reviews point out the insecurity regarding the dose-response association and the difficulties in defining causality. Conclusion: PA might have a preventive effect on depression. Some evidence exist to support that PA in childhood prevents depression in adults. The complex mechanism and causality need further attention and quality research is needed to determine the nature of the relationship and to verify the effectiveness of preventive programs. / Syfte: Att se huruvida belägg finns för fysisk aktivitet som effektiv förebyggande strategi mot depression. Metod: Sökning i elektroniska databaser gjordes efter både studier och litteraturgranskningar publicerade mellan 2007 och 2012 med avseende på kopplingen mellan fysisk aktivitet och depression hos barn, ungdomar och vuxna. Tre litteraturgranskningar, fem longitudinella och två tvärsnittsstudier inkluderades. Resultat: Fysisk aktivitet reducerade sannolikheten för att utveckla depression i många av de populationer som studerades och stillasittande eller inaktivt liv ökade risken för mental ohälsa såsom depression. En studie visade att låg fysisk aktivitet i barndomen ökade oddsen för depression som vuxen och andra studier såg en koppling och medlande funktion hos fysisk aktivitet och självkänsla hos tonåringar emedan fysisk kondition inte såg ha någon medlande effekt. Emellertid pekar många av författarna på en osäkerhet gällande dos-responssamband samt svårigheter i att bestämma kausalitet. Slutsatser: Fysisk aktivitet kan ha preventiv effekt mot depression. Viss evidens finns för att den i barndomen kan verka förebyggande mot depression i vuxen ålder. De komplexa sambanden och kausaliteten bör utforskas vidare och studier av hög kvalitet behövs för att bestämma orsaker och samband samt preventiva insatsers effektivitet.

Despite the growing need for depression prevention programming for university students, few programs exist and those that do are too resource-intensive for broad dissemination. Furthermore, limited research has been conducted on mechanisms of change in CBT-based prevention programs and similar research conducted on CBT for depression demonstrates mixed findings. Therefore, there is a need to incorporate a formal model of health-behaviour change in prevention (and intervention) programs to clarify mechanisms of change and improve outcomes, such as the theory of planned behaviour (TPB). This series of studies developed and tested a formal CBT-TPB “hybrid” model to predict intention to change thinking patterns and a brief depression prevention program for university students and to examine the program’s potential to change the hypothesized constructs in the hybrid model. Results indicated support for the hybrid model, in that TPB factors predict intention to change thinking patterns. In addition, across an open and randomized control trial, my “Start Making a Change” intervention promotes change in TPB factors, as well as improvement in relevant CBT and well-being outcomes. The implication of this work is that brief, easy-to-disseminate, programs, based on a formal model of change, can effectively, at least in the short term, target and change important risk factors for depression onset in university students.

School-based depression prevention programs are being implemented in schools across the world in efforts to inoculate children and adolescents from depressive symptoms. This meta-analysis examined 56 manuscripts with a total of 82 studies which focused on school-based programs to determine how they affect depression, anxiety, cognitive skills, self-esteem, coping, and internalizing behaviors. For these specific outcomes, effect sizes ranged from .08 to .25. All combined outcomes yielded a significant effect size of .15. Moderator analyses revealed key differences that identified characteristics of the most effective programs. Targeted programs servicing at-risk students yielded an effect size of .31, while universal programs produced a significant but small effect size of .07. However, the program facilitator seemed to impact the effectiveness of all types of programs. Non-school personnel produced a .39 effect size with targeted samples, and .17 with universal samples, while school personnel produced about one half to a third of the effect.

Zhang, Dexing = 階梯式治預防焦慮癥和抑鬱癥的效果和可性的研究 / 張德杏. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 181-205). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese; appendixes includes Chinese. / Zhang, Dexing = Jie ti shi zhi yu fang jiao lü zheng he yi yu zheng de xiao guo he ke xing de yan jiu / Zhang Dexing.

There are significant mental health disparities in Aboriginal communities in Canada as a result of historical assimilation policies (Health Canada, 2012). One approach to mitigating these mental health concerns is through prevention programs that include a wilderness component. Wilderness based programs for Aboriginal youth are informed by cultural wisdom and empirical research that connects immersion in nature with psychological well-being. The goal of this study was to collaborate with two community partners (Nala Winds canoe family from the Heiltsuk First Nation, and Victoria Native Friendship Centre) to develop an evaluation tool that will satisfy mainstream funding standards as well as community, cultural standards. This tool-kit was designed to reflect the youth experience and mental health consequences of Tribal Journeys, an annual canoe journey program for Coastal First Nations peoples. The findings were shared with community partners and may be helpful in facilitating the creation, maintenance, and evaluation of other Aboriginal youth programs. / Graduate / 0620 / 0347 / 0621 / tansmethurst@gmail.com