Brief Psychotherapy for the Treatment of Postpartum Depression: a systematic review and meta-analysis

Colleen Huml, MD; Loh Emi; Xue Geng, MS; Kean J. Hsu, PhD

Medstar Georgetown Psychiatry

Category: Research

Purpose: Postpartum depression (PPD) is a prevalent mental health challenge, yet existing treatment options fall short in meeting the needs of new mothers. The purpose of this study was to examine the effectiveness of brief psychotherapeutic interventions for PPD through meta-analysis of the existing literature.

Methods: This meta-analysis explored the effectiveness of brief psychotherapeutic interventions (defined as 8 sessions or fewer) for the treatment of PPD. Studies were assessed for change between pretreatment and post-treatment symptoms.

Results: 144 studies were originally identified, of which 14 were included in this review. Brief psychotherapeutic interventions were associated with significant decrease in depressive symptoms as measured by standardized mean change scores in Beck Depression Inventory (BDI) (SMCC=-2.6335, p<.0001) and Edinburgh Postnatal Depression Scale (EPDS) (SMCC=-2.5082, p<.0001), both with significant between-study heterogeneity. For BDI, between-study heterogeneity resolved after meta-regression analysis, with number of sessions as the most significant moderator. For outcome measures Beck Anxiety Inventory (BAI), State-Trait Anxiety Inventory (STAI), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Rating Scale for Depression (HRSD), sample size was insufficient to conduct meaningful analysis.

Conclusion: Overall, this meta-analysis finds that brief psychotherapeutic interventions hold promise in reducing symptoms of PPD. Future research should clarify the minimum number of sessions required and the type of psychotherapy most suitable for achieving this effect.

Pseudo-Wellens’ Syndrome in Substance Use: A Scoping Review

Usman Bakshi, MS4; Ayyub Imtiaz, MD; Asmeret Berhane, MD; Nicholas Mahan, MD

American University of Antigua

Category: Research

Introduction: Pseudo-Wellens’ Syndrome (PWS), characterized by ECG changes resembling Wellens’ Syndrome without associated critical coronary artery stenosis, has diverse causes, including substance use. Amid the increase in drug decriminalization and legalization, this scoping review aims to identify specific drugs associated with PWS due to a notable absence of any such literature.

Methods: A systematic search on PubMed and Google Scholar yielded 67 articles, of which 24 duplicates were removed. Of the 43 articles remaining, 31 were excluded for not meeting inclusion criteria and 1 was not found. The final analysis included 11 articles spanning 2006 to 2023, where PWS cases, confirmed through ECG change reversal or catheterization, involving substance use were assessed based on specific substances mentioned.

Results: The study focused on 11 cases involving individuals aged 22 to 59 with a history of substance use. Nine cases had confirmed urine drug screening (UDS), two were reported, and all exhibited abnormal ECGs consistent with Wellens’ Syndrome. Cardiac catheterization in 9 cases revealed no coronary artery obstruction, confirming PWS diagnosis and two cases showed symptom resolution without further intervention. Six cases involved marijuana, five cocaine, one PCP, two opiates, and one methamphetamine. Polysubstance use was common, and although marijuana and cocaine exhibited stronger associations, the study suggests considering any substance, illustrated by cases solely involving PCP and methamphetamine.

Conclusion: A notable absence of large-scale studies on the correlation between substance use and PWS underscores the importance of this scoping review. While marijuana and cocaine presented stronger associations, polysubstance use challenges attributing PWS to specific drugs. Tailored clinical approaches informed by substance-specific associations are crucial to guide decision-making, prevent unnecessary interventions, and mitigate harm. Two cases had favorable outcomes without catheterization, exemplifying the practical application of these insights thus emphasizing the need for further research in this area.

Exploring the Association between Depression Severity and Outdoor Exposure
Anh Le; Katrina K Le, MPH

George Washington University School of Medicine and Health Sciences

Category: Public Health

Depression is a prevalent mental health disorder globally, with various factors contributing to its onset and severity. Recent research suggests that environmental factors, particularly outdoor exposure, may play a significant role in influencing depressive symptoms. This study aims to investigate the association between depression severity and outdoor exposure among a diverse population sample. Using a collective American population data from 2017 to March 2020 from the National Health and Nutrition Examination Survey, we have employed standardized measures to assess depression and self-reported outdoor exposure frequency and duration. Both linear and logistic regression models controlled for confounding variables of age, gender/sex, race/ethnicity, income, education, smoking, and occupation. Adjusted regression analyses revealed outdoor exposure outside working hours was associated with PHQ-9 total numerical scores (β = -0.002, p-value = 0.0078) and with depression (OR = 0.993, p-value = 0.0329). Findings from this study supports and contributes to previous literature, shedding light on the role of outdoor exposure in mitigating or exacerbating depressive symptoms. Understanding this association may have implications for informing public health interventions and urban planning strategies aimed at promoting mental well-being. Furthermore, the study may contribute to the growing body of literature on ecotherapy and nature-based interventions for mental health treatment and prevention.

Exploring Imposter Phenomenon during Onboarding into a Military Medical School

Eungjae Kim, BS; Steven J. Durning, MD, PhD; Jezreelyn Bulaklak; Abigail Crosier; Jinbum Dupont, MS; Michael Soh, PhD

Uniformed Services University of the Health Sciences

Category: Research

Introduction: Impostor phenomenon (IP) is an experience where an individual believes that their success was because of chance or luck and was not associated with the mastery of skills. Prevention, or early intervention, of IP may reduce potential effects on a medical trainee’s confidence and competence in their profession, which may ultimately enhance health care team performance and impact patient outcomes. This study explores military medical students experience with IP during orientation into a military medical school.

Methods: The study participants were medical students at a military medical school. Researchers conducted semi-structured interviews to explore if and why students experienced IP and deployed the Clance IP Scale (CIPS) as a measure with validity evidence for ascertaining the presence and magnitude of IP. Researchers calculated scores from the CIPS and thematically analyzed interview transcripts.

Results: Researchers interviewed 29 matriculating military medical students. Twenty-one (75%) students reported frequent or intense IP experiences on the CIPS indicating that IP was present in our study sample. Thematic analysis identified six themes that drove one’s experience with IP: reevaluation of merit, individualized diversity and inclusion experiences, administrative and financial support, preconceived expectations, building relationships, and new community roles.

Discussion: Our identified themes provide us with a better understanding of if and why military medical students experience IP during onboarding. Our findings are also consistent with the situated learning theory, which places emphasis on the sense of belonging and may provide a unique and insightful lens through which IP can be further explored and studied, particularly at a military medical school where various identities, dynamics, and aspirations can converge simultaneously. Our findings suggest that existing practices may benefit from improvements on tailoring onboarding activities to entail more reflective discussion using small groups, reevaluating administrative and financial supports, and ensuring cultural coherence (organizational alignment of mission) among faculty, staff, and upperclassmen.