Date of Degree
PhD (Doctor of Philosophy)
Michael W. O'Hara
Postpartum depression (PPD) is a significant public health issue. Up to 20% of women are affected by depression following childbirth. PPD is associated with anxiety, poor adjustment and health-related quality of life (HRQOL), and may lead to a woman's personal suffering, conflict with family members (especially in the relationship with partner) and developmental delays in children. Given the high prevalence of PPD and deleterious effects on both women and their families, adequate treatment is critical. While existing PPD treatments have strong efficacy data, the treatment literature suggests that many depressed postpartum women either do not receive treatment or receive suboptimal care. Further, barriers to care including medication side effects for breastfeeding women, stigma, and treatment preferences influence treatment decision-making. Thus, it may be worthwhile to examine the efficacy of a complementary and alternative medicine (CAM) treatment option for PPD that is associated with minimal risk and consistent with maternal preferences.
The current investigation examined the efficacy of a Gentle Vinyasa Flow yoga intervention for PPD. Fifty-seven postpartum women with a score of ≥12 on the Hamilton Depression Rating Scale (HDRS) were randomly assigned to 1 of 2 groups − yoga n = 28) or wait-list control (WLC) ((italic)n(/italic) = 29). The yoga intervention lasted 8 weeks, and consisted of 16 classes taught by a certified yoga instructor in a studio and the recommendation to practice once a week at home with the use of a DVD that included a 30 minute yoga sequence. The primary outcome, depression, was assessed using the clinician-rated HDRS and self-report measures. The HDRS was administered over the telephone by blinded raters at baseline and after 2, 4, 6, and 8 weeks of treatment. Secondary outcomes were anxiety, postpartum adjustment, and HRQOL, with exploratory outcomes including mindfulness and physical activity. These outcomes were assessed using self-report measures completed on the same schedule as that for the HDRS. Growth curve modeling was used to test the hypotheses that women in the yoga group would experience a significantly greater rate of change over the course of the 8-week intervention on primary and secondary outcome measures, relative to the WLC group. As predicted, controlling for age and social anxiety at baseline, women in the yoga group experienced a greater rate of change in depression and well-being scores over the course of the 8-week intervention. The yoga group also experienced a significantly greater rate of improvement on scores of anxiety, postpartum adjustment, HRQOL, and mindfulness over the 8-week intervention, relative to the control group.
These findings support yoga as a promising CAM intervention for PPD; large-scale replication studies are warranted. The findings also shed light on potential mediator and intervention-relevant variables for future research. Yoga is an acceptable and low-risk treatment option that may have broader clinical implications for the PPD treatment literature, and the field of CAM more generally.
Copyright 2013 Melissa Mercedes Buttner
Buttner, Melissa Mercedes. "Efficacy of Yoga for Depressed Postpartum Women: a Randomized Controlled Trial." PhD diss., University of Iowa, 2013.