Depressive Symptoms Assessed Near the End of Pregnancy Predict Differential Response to Postpartum Smoking Relapse Prevention Intervention

Overview

Journal Ann Behav Med

Publisher Oxford University Press

Specialty Social Sciences

Date 2019 Jun 21

PMID 31219152

Authors

Michele D Levine

Rebecca L Emery

Rachel P Kolko Conlon

Marsha D Marcus

Lisa J Germeroth

Rachel H Salk

Yu Cheng

Affiliations

Soon will be listed here.

Abstract

Background: Depressive symptoms are prevalent during pregnancy and the postpartum period and affect risk for smoking relapse. Whether and how depression affects response to postpartum interventions designed to sustain smoking abstinence is unknown.

Purpose: We examined end-of-pregnancy depressive symptoms as a moderator of response to two postpartum-adapted smoking relapse prevention interventions.

Methods: Women (N = 300) who quit smoking during pregnancy were randomized to receive either a postpartum intervention focused on psychosocial factors linked to postpartum smoking (Strategies to Avoid Returning to Smoking [STARTS]) or an attention-controlled comparison intervention (SUPPORT). Women completed the Edinburgh Postnatal Depression Scale at the end of pregnancy. Smoking status was biochemically assessed at the end of pregnancy and at 12, 24, and 52 weeks postpartum.

Results: End-of-pregnancy depressive symptoms moderated response to postpartum smoking relapse prevention interventions (χ2 = 10.18, p = .001). After controlling for variables previously linked to postpartum smoking relapse, women with clinically significant end-of-pregnancy depressive symptoms (20%) were more likely to sustain abstinence through 52 weeks postpartum if they received STARTS. In contrast, women with few end-of-pregnancy depressive symptoms were more likely to sustain abstinence through 52 weeks postpartum if they received SUPPORT. Changes in the psychosocial factors addressed in the STARTS intervention did not mediate this moderation effect.

Conclusion: Assessment of end-of-pregnancy depressive symptoms may help determine success following postpartum smoking relapse prevention interventions. Women with elevated end-of-pregnancy depressive symptoms benefited from postpartum relapse prevention intervention tailored to their psychosocial needs, while those with few symptoms were more successful in postpartum intervention that used standard behavioral components.

Clinical Trial Registration: NCT00757068.

References

Pollak K, Fish L, Lyna P, Peterson B, Myers E, Gao X . Efficacy of a Nurse-Delivered Intervention to Prevent and Delay Postpartum Return to Smoking: The Quit for Two Trial. Nicotine Tob Res. 2016; 18(10):1960-6. PMC: 5016846. DOI: 10.1093/ntr/ntw108. View

Kraemer H, Wilson G, Fairburn C, Agras W . Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry. 2002; 59(10):877-83. DOI: 10.1001/archpsyc.59.10.877. View

Bennett H, Einarson A, Taddio A, Koren G, Einarson T . Prevalence of depression during pregnancy: systematic review. Obstet Gynecol. 2004; 103(4):698-709. DOI: 10.1097/01.AOG.0000116689.75396.5f. View

Cinciripini P, Blalock J, Minnix J, Robinson J, Brown V, Lam C . Effects of an intensive depression-focused intervention for smoking cessation in pregnancy. J Consult Clin Psychol. 2010; 78(1):44-54. PMC: 2881321. DOI: 10.1037/a0018168. View

Owora A, Carabin H, Reese J, Garwe T . Diagnostic performance of major depression disorder case-finding instruments used among mothers of young children in the United States: A systematic review. J Affect Disord. 2016; 201:185-93. PMC: 5578461. DOI: 10.1016/j.jad.2016.05.015. View

Heatherton T, Kozlowski L, Frecker R, Fagerstrom K . The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict. 1991; 86(9):1119-27. DOI: 10.1111/j.1360-0443.1991.tb01879.x. View

Reitzel L, Vidrine J, Businelle M, Kendzor D, Costello T, Li Y . Preventing postpartum smoking relapse among diverse low-income women: a randomized clinical trial. Nicotine Tob Res. 2010; 12(4):326-35. PMC: 2847071. DOI: 10.1093/ntr/ntq001. View

Condiotte M, Lichtenstein E . Self-efficacy and relapse in smoking cessation programs. J Consult Clin Psychol. 1981; 49(5):648-58. DOI: 10.1037//0022-006x.49.5.648. View

Niaura R, Britt D, Shadel W, Goldstein M, Abrams D, Brown R . Symptoms of depression and survival experience among three samples of smokers trying to quit. Psychol Addict Behav. 2001; 15(1):13-7. DOI: 10.1037/0893-164x.15.1.13. View

10.

Kapson H, Haaga D . Depression vulnerability moderates the effects of cognitive behavior therapy in a randomized controlled trial for smoking cessation. Behav Ther. 2010; 41(4):447-60. PMC: 7261491. DOI: 10.1016/j.beth.2009.10.001. View

11.

Muller D, Judd C, Yzerbyt V . When moderation is mediated and mediation is moderated. J Pers Soc Psychol. 2006; 89(6):852-63. DOI: 10.1037/0022-3514.89.6.852. View

12.

Brandon T, Simmons V, Meade C, Quinn G, Lopez Khoury E, Sutton S . Self-help booklets for preventing postpartum smoking relapse: a randomized trial. Am J Public Health. 2012; 102(11):2109-15. PMC: 3477952. DOI: 10.2105/AJPH.2012.300653. View

13.

Lee E . Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res (Korean Soc Nurs Sci). 2014; 6(4):121-7. DOI: 10.1016/j.anr.2012.08.004. View

14.

Allen A, Prince C, Dietz P . Postpartum depressive symptoms and smoking relapse. Am J Prev Med. 2008; 36(1):9-12. DOI: 10.1016/j.amepre.2008.09.020. View

15.

Cohen S, Kamarck T, Mermelstein R . A global measure of perceived stress. J Health Soc Behav. 1983; 24(4):385-96. View

16.

Correa J, Simmons V, Sutton S, Meltzer L, Brandon T . A content analysis of attributions for resuming smoking or maintaining abstinence in the post-partum period. Matern Child Health J. 2014; 19(3):664-74. PMC: 4284152. DOI: 10.1007/s10995-014-1556-2. View

17.

Levine M, Cheng Y, Marcus M, Kalarchian M, Emery R . Preventing Postpartum Smoking Relapse: A Randomized Clinical Trial. JAMA Intern Med. 2016; 176(4):443-52. PMC: 7333234. DOI: 10.1001/jamainternmed.2016.0248. View

18.

Matthey S, Henshaw C, Elliott S, Barnett B . Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale: implications for clinical and research practice. Arch Womens Ment Health. 2006; 9(6):309-15. DOI: 10.1007/s00737-006-0152-x. View

19.

Levine M, Marcus M, Kalarchian M, Houck P, Cheng Y . Weight concerns, mood, and postpartum smoking relapse. Am J Prev Med. 2010; 39(4):345-51. PMC: 2939865. DOI: 10.1016/j.amepre.2010.05.023. View

20.

Eberhard-Gran M, Eskild A, Tambs K, Opjordsmoen S, Samuelsen S . Review of validation studies of the Edinburgh Postnatal Depression Scale. Acta Psychiatr Scand. 2001; 104(4):243-9. DOI: 10.1034/j.1600-0447.2001.00187.x. View