Author ORCID Identifier

0009-0006-6089-5071

Date of Award

Fall 1-5-2024

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Therese Pigott

Second Advisor

Dr. Alexander Kirpich

Abstract

Postpartum depression (PPD) is a debilitating disorder that affects the functioning of new mothers and their ability to care for their infants. The onset of postpartum depression can be attributed to genetic and social factors as well as fluctuations in hormones during and after pregnancy. Brexanolone is a new medication developed to treat moderate to severe PPD. The present study aimed to complete a systematic review and meta-analysis of the available literature to support the claim that brexanolone is an effective medication to treat PPD. Additional aims include determining the demographic features of participants and the generalizability of the results. The Lancet, PubMed, PsycINFO, Embase, and Science Direct were searched using a Boolean search string to find primary studies and trials that were evaluating the efficacy of brexanolone with an outcome of changes in depression scores measured using the HAM-D among adults within 12 months postpartum. The collected studies were screened for eligibility and coded for study characteristics. The statistical analysis used a fixed effects model due to the small number of studies to estimate the mean effect size (standardized mean difference) using the metafor and tidyverse packages in R. The search yielded 233 articles, of which five were eligible. The statistical analyses yielded an SMD of 3.52 (95% CI: [3.16, 3.88]) for randomized controlled trials and an SMD accounting for pre-post of 2.97 (95% CI: [2.21, 3.73]) for single-group studies comparing outcome results to baseline data. There was significant heterogeneity among both the randomized controlled trial studies and the pre-post studies in their effect size estimates. This was indicated by the results of the Q-test for heterogeneity, which yielded results of Q = 12.8646 (p = 0.0049) and Q = 11.4964 (p = 0.0032) for the randomized controlled trials and pre-post studies, respectively. The Egger’s regression test yielded a result of z = -8.4661 (p-value: <0.0001), indicating potential publication bias. The results were statistically significant, indicating that brexanolone is an effective treatment for women who suffer from moderate to severe PPD. Further studies investigating the efficacy of brexanolone should be conducted with larger and more diverse sample sizes.

DOI

https://doi.org/10.57709/36390255

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