Study Findings of Mind-Body Interventions
for Perinatal Depression
Patricia Kinser PhD, RN, WHNP-BC
and Nancy Jallo PhD, RN, FNP-BC, WHNP-BC
Funding Acknowledgements
Study #1: Experience of Stress & Depression in Pregnant, Urban,
African-American Adolescents
Study #2: Perceptions of Women regarding Mind-Body Interventions
for Symptom Self-Management
Study #3: Guided Imagery for Stress in African American Pregnant
Women
Supported through VCU School of Nursing intramural funds by P30
NR011403 (Grap, PI), Center of Excellence for Biobehavioral
Approaches to Symptom Management; National Institute of Nursing
Research, NIH
and
VCU’s CTSA (UL1TR000058 from the National Institutes of Health's
National Center for Advancing Translational Science) and the CCTR
Endowment Fund of the Virginia Commonwealth University
Perinatal Depression
• Depressive symptoms are projected to be a
leading cause of illness and disability in the
world by 2030
• Nearly 20% of pregnant women experience
depressive symptoms during their pregnancy
Institute of Medicine (IOM). Living well with chronic illness: A call for public health action. Washington, DC:
National Academies Press. 2012.
Davalos DB, Yadon CA, Tregellas HC. Untreated prenatal maternal depression and the potential risks to
offspring: A review. Arch Womens Ment Health. 2012;15(1):1-14.
Depression Risk Factors
• Pregnancy is often a time of multiple stressors
• Stress & anxiety have potential to impact
physical and emotional health
• Other Risk factors:
– Ethnicity/race (African American>Caucasian,
Hispanic pregnant women)
– Socioeconomic & insurance status
Jallo, N., Svikis, D., Price, S., Kinser, P., Elswick, R., Masho, S. (2015, in press). Prevalence and predictors
of depressive symptoms in pregnant African American women. Issues in Mental Health Nursing.
Research Aims
Study #1
• Community-based
qualitative study using focus
groups to explore
adolescents’ perceptions of
stress and depression and
their interest in mind-body
therapies
– Study sample: n=17 currently
pregnant adolescents, age 1421
Study #2
• Community-based
qualitative study using focus
groups to explore womens’
experiences with mind-body
therapies for stress &
depression symptom
management
– Study sample: n=14 currently
or recently pregnant women,
age ≥18 and above who
participated in prenatal yoga
in some form within the past
6 months
Findings- Study #1
Experience of adolescent
pregnancy
Perception of stress/
depression management
Any intervention must:
Pervasive stress and depression
symptoms
•be group-based & interactive
•include others of similar age and background
•be facilitated by someone who "understands"
•provide information about managing difficult
emotions
Yoga and guided imagery are perceived to be
appealing because it may:
Sense of isolation
•decrease stress
•prevent isolation
•decrease physical discomforts of pregnancy
•enhance relationship-building with others
Kinser, P., Masho, S. (2015). “I just start crying for no reason”: The experience of stress and depression in
pregnant urban African American adolescents. Women’s Health Issues. 25(2): 142-8.
Findings- Study #2
Lived Experience of a Mind-Body Therapy
(Prenatal Yoga)
Theme #1:
attracted to
mind-body
practices
because of
stress and
depressive
symptoms
Theme #2: Psychological & Physical
Benefits
Psychological
Benefit:
self-care
Psychological
Benefit:
communitybuilding
Physical Benefit:
ultimately
creates
psychological
strength
Theme #3:
Prenatal
yoga more
beneficial
than other
prenatal
groups
Kinser, P., Masho, S. (2015). “Yoga was my saving grace”: The experience of women who practice
prenatal yoga. Journal of the American Psychiatric Nurses Association, 21(5): 319-26.
Conclusion from Studies #1 and 2
• Women are interested in mind-body therapies
for symptom management
• Mind-body approaches may be useful in the
management of psychological distress and in
development of community among pregnant
women
Complementary Health Approaches
• Mind-body practices
– Physical activity
– Yoga
– Guided imagery
– Massage
– Acupuncture
– Mindfulness
Study #3: Aim
Test the effects of a guided imagery intervention
on maternal stress (perceived stress), related
symptoms (fatigue, anxiety) in pregnant African
American women beginning early in the second
trimester
Methods
• Study Design & Setting
– 12 week prospective longitudinal repeated
measures RCT with 2 groups (GI and usual care
– Community obstetrical practices
• Sample
– 72 pregnant African American women at 14-17
weeks gestation
– Inclusion criteria: > 18 yo, no major obstetrical or
medical complications
Perceived Stress Scale
40
GI
UC
22
PSS
20
18
16
14
12
10
1
p = <0.05 @ 8 weeks
2
visit
3
NRSS-GI Group
10
pre intervention
post intervention
5
stress scale
4
3
2
1
0
1
p = <0.0001
2
3
4
5
6
7
week
8
9
10
11
12
NRSS-GI and Usual Care
10
GI post intervention
Usual Care
5
stress scale
4
3
2
1
p = 0.0191
0
1
2
3
4
5
6
7
week
8
9
10
11
12
Anxiety
48
GI
UC
46
Trait Anxiety
44
42
40
38
36
34
baseline
p = <0.05 @ 8 weeks
week 8
week 12
Brief Fatigue
6
GI
UC
BFI Total
5
4
3
p = <0.05 @ 8 weeks
2
baseline
week 8
week 12
Jallo, N. Ruiz, R.J., Elswick, R.K., & French, E (2014). Guided Imagery for Stress and Symptom Management in Pregnant African
American Women, Evidenced Based Complementary and Alternate Medicine http://dx.doi.org/10.1155/2014/840923.
Conclusions
• Significant reduction in perceived stress scores in
GI group compared to UC group at 8 weeks
• In the GI group, significant reduction in the
weekly means of the post- GI compared to pre-GI
NRSS scores
• Significant reduction in the weekly means of the
post GI compared to UC NRSS scores
• Significant reduction of anxiety and fatigue
scores in GI group compared to UC
• Participants found in helpful in coping with their
stress and minimizing its negative effects
Future Studies
• Stress coping interventions can be delivered using
mobile technology
– Current Study: A Pocket Computer Delivered Stress Coping
Intervention for Hospitalized Pregnant Women at High Risk
for Preterm Birth (PI: Jallo; funded by VCU SON)
• Maternal stress is associated not only with negative
pregnancy and birth outcomes but also may have
negative consequences for fetal neurobehavioral
development, and consequently, child outcomes.
– Potential upcoming study: effects of Wellness mobile app
on maternal and infant outcomes (PI: Jallo; pending)
Future Studies (cont)
• Yoga may be integrated into prenatal care
programs
– Current Study: Centering Pregnancy Care + Yoga
(PI: Kinser; funded by STTI/SNRS)
• Women can be empowered to engage in selfmanagement of chronic depressive symptoms in
pregnancy
– Current Study: nurse-patient partnership for
enhancing awareness of symptoms and engagement
in mindful physical activity
(PI: Kinser; funded by National Institute of Child
Health & Human Development)
QUESTIONS?
Contact Information:
Patricia Kinser: [email protected]
Nancy Jallo: [email protected]
References
Evenson KR, Savitz DA, Huston SL. Lesure-time physical activity among pregnant women in the US. Paediatr Perinat
Epidemiol 2004; 18:400–407
Field T, Diego M, Hernandez-Reif M, Medina L, Delgado J, Hernandez A. Yoga and massage therapy reduce prenatal depression and
prematurity. J Bodyw Mov Ther. 2012 Apr;16(2):204-9. doi: 10.1016/j.jbmt.2011.08.002.
M.P. Freeman, J.R. Hibbeln, K.L. Wisner,et al. Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry J
Clin Psychiatry, 67 (2006), pp. 1954–1967
Freeman MP, Davis M, Sinha P, Wisner KL, Hibbeln JR, Gelenberg AJ. Omega-3 fatty acids and supportive psychotherapy for
perinatal depression: a randomized placebo-controlled study. Journal of Affective Disorders 2008;110(1-2):142–8.
Jallo N, Salyer J, Ruiz RJ, French E. Perceptions of guided imagery for stress management in pregnant African American woman.
Arch Psychiatr Nurs. 2015 Aug;29(4):249-54. doi: 10.1016/j.apnu.2015.04.004
Kinser, P., Elswick, R., Kornstein, S., (2014). Long-term effects of a mind-body intervention for women with major depressive
disorder: Sustained mental health improvements with yoga. Archives of Psychiatric Nursing.
Kinser, P., Masho, S. (2015). “I just start crying for no reason”: The experience of stress and depression in pregnant urban African
American adolescents. Women’s Health Issues. 25(2): 142-8.
Kinser, P., Masho, S. (in review). “It helps you be in the moment”: Prenatal yoga for stress and depression during pregnancy.
JAPNA.
Manber R, Schnyer RN, Lyell D, et al. Acupuncture for depression during pregnancy: a randomized controlled trial. Obstet Gynecol.
2010;115:511–520.
Robledo-Colonia AF, Sandoval-Restrepo N, Mosquera-Valderrama YF, et al. Aerobic exercise training during pregnancy reduces
depressive symptoms in nulliparous women: a randomized clinical trial. J Physiother 2012; 58:9–15.
Songøygard KM, Stafne SN, Evensen KA, Salvesen KA, Vik T, Mørkved S. Does exercise during pregnancy prevent postnatal
depression? A randomized controlled trial. Acta Obstet Gynecol Scand. 2012;91:62–67.
Su KP, Huang SY, Chiu TH, Huang KC, Huang CL, Chang HC, et al.Omega-3 fatty acids for major depressive disorder during
pregnancy: results from a randomized, double-blind, placebo-controlled trial. Journal of Clinical Psychiatry 2008; 69(4):644–51.
Wirz-Justice A, Bader A, Frisch U, Stieglitz RD, Alder J, Bitzer J, et al.A randomized, double-blind, placebo controlled study of light
therapy for antepartum depression. Journal of Clinical Psychiatry 2011;72(7):986–93