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Figure 8 Acceptance of treatments at pre- and post-information(Charbroil et al, 2004). Acceptance measured on visual analogue scale(0-10, from unacceptable to very acceptable)

Charbroil et al (2004) suggested that low acceptance of antidepressants may decrease patient adherence to prescriptions, especially amongst breastfeeding mothers. However caution is advised in interpreting the findings. The computation of multiple t-Tests increased the probability of a type I error (obtaining a significant result by chance). Moreover, the use of a less stringent significance level (p<.10, rather than<.05) inspires less confidence in the findings - it increases the probability that the results occurred by chance.

The authors do not indicate whether assumptions underlying use of the t-Test/analysis of variance were satisfied. More importantly, the study failed to control for covariates, meaning that group differences may be confounded by relevant background variables, such as past experience (use of antidepressants, pregnancy) and knowledge of postnatal depression prior to the study.

Chapter Three

Overall Synthesis, Critical Analysis of The Literature

Overall, existing literature suggests that antidepressants can be effective in treating PND, and generally have few if any side effects. However, conclusive inferences are negated by various analytic and methodological constraints. These include:

1. Failure to account for covariates

2. Failure to account for moderator effects (which might reveal conditions under which significant treatment-control group differences may emerge)

3. Lack of randomised clinical trials

4. Low statistical power and liberal significance levels

5. Lack of research on MAOIs and other antidepressants (e.g. mirtazapine, nefazodone, bupropion) (Cohen, 2005).

Covariates

Most studies reviewed here, including randomised controlled trials, failed to adequately control for key background variables that may confound observed effects of antidepressants on mood and other outcome variables. Green (2005) identified several important background variables including previous history of depression and other psychopathology (e.g. anxiety) during pregnancy, level of social support (e.g. from friends, family), state of marital relationship, stressful life events (e.g. financial and employment troubles) during pregnancy.

Other factors include previous treatment history and response, side-effect profile, history of compliance with drug regimes, and patient preference for particular treatments. Any differences between antidepressant and placebo or control groups reported in the literature may be confounded by these variables – or covariates. Most prospective controlled and randomised clinical trials reviewed here made attempts to control for background variables, for example by using strict eligibility criteria (Wisner et al, 2004).

Randomisation itself is a form of control, dis本论文由英语论文网提供整理，提供论文代写，英语论文代写，代写论文，代写英语论文，代写留学生论文，代写英文论文，留学生论文代写相关核心关键词搜索。