Paternal Depression Symptoms During Pregnancy and After Childbirth Among Participants in the Growing Up in New Zealand Study

IMPORTANCE

Antenatal and postnatal depression are known to be common and associated with poor outcomes for women and their children. There is little evidence on depression symptoms among men during the perinatal period.

OBJECTIVE

To identify characteristics associated with depression symptoms among men whose partners were pregnant and subsequently gave birth.

DESIGN, SETTING, AND PARTICIPANTS

A longitudinal cohort study provided data from a demographically diverse sample of 3523 New Zealand men who completed interviews during their partner's pregnancy and 9 months after the birth of their child. Participants were drawn from a cohort whose partners were pregnant women with a due date between April 25, 2009, and March 25, 2010, who were enrolled in the Growing Up in New Zealand study. Data analysis was conducted from September 1, 2015, to January 8, 2016.

MAIN OUTCOMES AND MEASURES

Depression symptoms were measured using the Edinburgh Postnatal Depression Scale and the 9-item Patient Health Questionnaire; elevated depression symptoms were defined as scores higher than 12 and 9, respectively.

RESULTS

The mean (SD) age of the participants at the antenatal interview was 33.20 (6.25) years (range, 16-63 years). Elevated antenatal paternal depression symptoms affected 82 fathers (2.3%) and were associated with perceived stress (odds ratio [OR], 1.38; 95% CI, 1.30-1.47) and fair to poor health during their partner's pregnancy (OR, 2.06; 95% CI, 1.18-3.61). Elevated postnatal paternal depression symptoms affected 153 (4.3%) of fathers and were associated with perceived stress in pregnancy (OR, 1.12; 95% CI, 1.08-1.17), no longer being in a relationship with the mother 9 months after childbirth (OR, 6.36; 95% CI, 2.28-17.78), having fair to poor health at 9 months (OR, 3.29; 95% CI, 2.10-5.16), being unemployed at 9 months (OR, 1.86; 95% CI, 1.11-3.10), and a history of depression (OR, 2.84; 95% CI, 1.69-4.78).

CONCLUSIONS AND RELEVANCE

Expectant fathers were at risk of depression symptoms if they felt stressed or were in poor health. Rates of elevated depression symptoms were higher during the postpartum period and were associated with adverse social and relationship factors. Identifying fathers most at risk of depressive symptoms and when best to target interventions (antenatal or postnatal) may be beneficial to men and their families.

Autism spectrum disorder traits among prisoners

Purpose

– The purpose of this paper is to determine the extent of autism spectrum disorder (ASD) traits among prisoners. The authors tested the hypotheses that ASD traits would: be continuously distributed among prisoners; be unrecognised by prison staff; and predict whether a prisoner met diagnostic criteria for ASD.

Design/methodology/approach

– ASD traits were measured among 240 prisoners in a male prison in London, UK using the 20-item Autism Quotient (AQ-20). Further diagnostic assessment was carried out using the Autism Diagnostic Observation Schedule. Results were compared with ASD data from the 2007 Psychiatric Morbidity Survey.

Findings

– There were 39 participants with an AQ-20 score=10; indicating significant autistic traits. The distribution of ASD traits among participants appeared to be normal and was not significantly higher than the rate found in a population-based sample from England.

Originality/value

– Few studies have explored ASD traits among prisoners. The authors identified high levels of unrecognised ASD traits among a group of male prisoners, many of whom went on to meet diagnostic criteria for ASD. The study highlights the need for specialist assessment within the criminal justice system for individuals with neurodevelopmental disorders including ASD. The authors discuss the process of carrying out an ASD assessment project in a prison.

Advances in Tuberous Sclerosis Complex (TSC) research

Purpose

– The purpose of this paper is to provide a brief, descriptive overview of Tuberous Sclerosis Complex (TSC) research with particular reference to studies on Autism Spectrum Disorder (ASD).

Design/methodology/approach

– A search of electronic databases was carried out to identify English language articles on TSC. The literature was explored in more detail with a focus on neurodevelopmental disorders associated with TSC such as ASD.

Findings

– The review included 3,679 references. The earliest articles identified were published in the early twentieth century. Since then research on TSC has advanced rapidly and is being carried out worldwide. Just 62 studies have focused on ASD in TSC, although the number of publications is increasing over time.

Research limitations/implications

– More research on ASD in TSC is needed to benefit those affected by TSC and the broader ASD scientific community.

Practical implications

– Practitioners working with children and adults with ASD should be aware of the wider health issues experienced by those with genetic conditions such as TSC. Similarly, clinicians working with those who have TSC should be aware of the high prevalence of ASD in the group and implications for the way they work with their patients.

Originality/value

– This is the first paper to map and characterise the scientific literature on TSC. There remains a focus on the biomedical aspects of TSC with fewer studies on psychosocial/educational or family impacts. The review concludes with recommended research questions for the future.

Characteristics of prisoners with neurodevelopmental disorders and difficulties

BACKGROUND

Previous studies have found high rates of attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID) within the criminal justice system (CJS). However, little is understood about prisoners with neurodevelopmental disorders and difficulties (NDD) or their needs. This study aimed to identify prisoners with NDD and compare their characteristics with prisoners without NDD on a range of socio-demographic and social functioning measures.

METHOD

This was a descriptive, cross-sectional study carried out using face-to-face interviews with 240 participants in a London Category C prison. Standardised tools were used to assess prisoners for ADHD, ASD and ID.

RESULTS

The study identified 87 prisoners who screened positive for one or more type of NDD. Participants with NDD were significantly younger and more likely to be single [(odds ratio) OR = 2.1], homeless (OR = 3.4) or unemployed (OR = 2.6) before they came into prison. They also had poorer educational achievements that those without NDD. Over 80% of those with NDD had a previous conviction or imprisonment.

CONCLUSIONS

The findings confirm the presence of significant numbers of people with NDD in a male prison. Services across the CJS are required for this group; specifically, there is a need for raised awareness among those working in the CJS to improve the recognition of offenders with NDD. Services in the community need to work with individuals with NDD who are at risk of offending, targeting those who are homeless, unemployed and have poor employment opportunities.

Depression symptoms during pregnancy: Evidence from Growing Up in New Zealand

BACKGROUND

Depression during pregnancy has significant implications for pregnancy outcomes and maternal and child health. There is a need to identify which family, physical and mental health factors are associated with depression during pregnancy.

METHODS

An ethnically and socioeconomically diverse sample of 5664 pregnant women living in New Zealand completed a face-to-face interview during the third trimester. Antenatal depression (AD) symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Maternal demographic, physical and mental health, and family and relationship characteristics were measured. The association between symptoms of AD and maternal characteristics was determined using multiple logistic regression.

RESULTS

11.9% of the participating women had EPDS scores (13+) that indicated probable AD. When considering sociodemographic predictors of AD symptoms, we found that women from non-European ethnicities, specifically Pacific Islander, Asian and other, were more likely to suffer from AD symptoms. Greater perceived stress during pregnancy and a diagnosis of anxiety both before and during pregnancy were also associated with greater odds of having AD according to the EPDS.

LIMITATIONS

The women were in their third trimester of pregnancy at the interview. Therefore, we cannot discount the possibility of recall bias for questions relating to pre-pregnancy status or early-pregnancy behaviours.

CONCLUSIONS

AD is prevalent amongst New Zealand women. Ethnicity, perceived stress and anxiety are particularly associated with a greater likelihood of depression during pregnancy. Further attention to supporting maternal mental health status in the antenatal period is required.

An English perspective on policy for adults with autism

Purpose

– The purpose of this paper is to provide a summary of English policy and legislation which impacts on the health outcomes and social inclusion for adults with autism.

Design/methodology/approach

– A descriptive review of national policy for England was undertaken using key internet search engines such as Google.

Findings

– In spite of innovative legislation and policy relating to autism across England, there are still wide discrepancies in both service models and provision relating to autism. More work is required to communicate what autism services should look like along with greater awareness training for professionals working with adults with autism to ensure reasonable adjustments are occurring across public services.

Originality/value

– This paper outlines current key policy and legislation in England relating to autism.

Screening tools for autism spectrum disorders

Purpose

– Diagnosing autism spectrum disorder (ASD) is important over the whole life span. Standardized instruments may support the assessment process. The purpose of this paper is to describe English- and German-screening tools for ASD.

Design/methodology/approach

– PubMed was used to search for published tools and evidence on their diagnostic validity.

Findings

– Searches identified 46 screening tools for ASD. Most are designed for children, while only few measures are available for adults, especially those with additional intellectual disabilities. Many instruments are under-researched, although a small number such as the Modified Checklist for Autism in Toddlers and the SCQ have been widely examined in a variety of populations.

Originality/value

– The study identified and described a number of ASD screeners that can support clinicians or researchers when deciding whether to carry out a more comprehensive ASD assessment.

Experiences of mental health services by people with intellectual disabilities from different ethnic groups: a Delphi consultation

BACKGROUND

Patient experience of those accessing mental health services has been found to be different between ethnic groups. Although the needs of people with intellectual disabilities (ID) from different ethnic communities are being increasingly recognised, little has been published about their experiences of mental health services. The aim of this study was to establish whether there are any differences in the experiences of people with ID and mental health problems from two ethnic communities in South London.

METHOD

A two-round Delphi process was utilised. White British and Black or Black British service users from a specialist community-based mental health service for adults with ID completed a specially compiled questionnaire. Statements on participants' experiences, including satisfaction with care, staff members' attitudes, cultural awareness and level of support, were rated using a Likert scale.

RESULTS

Twenty-four out of 32 participants (75%) completed both rounds of the Delphi consultation. Consensus (≥80% agreement with the group median) was reached for 20 items in the White group and five items in the Black group. All responses that reached consensus were positive about the services that were being received. The Black group were less positive about a range of their experiences, including the use of medication.

CONCLUSIONS

People with ID from two ethnic groups were able to successfully complete a Delphi consultation regarding their experiences of mental health services. Broad consensus on positive experiences of services was reached in the White group but not for the Black participants.

Psychometric properties of the Disability Assessment Schedule (DAS) for behavior problems: an independent investigation

The present study employed the Disability Assessment Schedule (DAS) to assess problem behaviors in a large sample of adults with ID (N=568) and evaluate the psychometric properties of this instrument. Although the DAS problem behaviors were found to be internally consistent (Cronbach's α=.87), item analysis revealed one weak item ('Objectional habits') with item-total biserial correlation of only .20. An exploratory factor analysis revealed two main factors. The first factor consisted of items relating to disruptive/distractive problems. The second factor consisted of items relating to antisocial/delinquent problems. Disruptive/distractive problems were specifically associated with low ID level. Antisocial/delinquent behaviors were specifically associated with male gender, schizophrenia, hospital admission and troubles with police. For patients who had both disruptive/distractive problems and antisocial/delinquent behaviors, personality disorders and autism were more frequent, where as anxiety and depression were less frequent. On the basis of the obtained results, two new DAS subscales for assessing challenging behavior were proposed. Both subscales had good levels of internal consistency, as well as face and criterion validity. Overall, the new DAS subscales were shown to have acceptable psychometric properties and have therefore potential for use in both research and clinical practice.

Epilepsy and intellectual disability: does epilepsy increase the likelihood of co-morbid psychopathology?

Although epilepsy is particularly common among people with intellectual disability (ID) it remains unclear whether it is associated with an increased likelihood of co-morbid psychopathology. We therefore investigated rates of mental health problems and other clinical characteristics in patients with ID and epilepsy (N = 156) as compared to patients with ID but no epilepsy (N = 596). All participants were consecutive referrals to specialist mental heath services. Specialist clinicians agreed on the mental health diagnoses by applying ICD-10 clinical criteria using information gained from interviews with key informants and the patients. Bivariate and multivariate analyses showed that patients with epilepsy were more likely to live in residential housing and have severe ID in line with previous evidence. However, the presence of epilepsy was not associated with an increased likelihood of co-morbid psychopathology. On the contrary, rates of mental health problems, including schizophrenia spectrum, personality and anxiety disorders, were significantly lower among patients with epilepsy. The results are discussed in the context of mood-stabilizing and other psychotropic effects of anti-epileptic drugs in adults with ID and epilepsy, as well as possible diagnostic overshadowing.

Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression

BACKGROUND

Psychological therapies provided in primary care are usually briefer than in secondary care. There has been no recent comprehensive review comparing their effectiveness for common mental health problems. We aimed to compare the effectiveness of different types of brief psychological therapy administered within primary care across and between anxiety, depressive and mixed disorders.

METHODS

Meta-analysis and meta-regression of randomized controlled trials of brief psychological therapies of adult patients with anxiety, depression or mixed common mental health problems treated in primary care compared to primary care treatment as usual.

RESULTS

Thirty-four studies, involving 3962 patients, were included. Most were of brief cognitive behaviour therapy (CBT; n = 13), counselling (n = 8) or problem solving therapy (PST; n = 12). There was differential effectiveness between studies of CBT, with studies of CBT for anxiety disorders having a pooled effect size [d -1.06, 95% confidence interval (CI) -1.31 to -0.80] greater than that of studies of CBT for depression (d -0.33, 95% CI -0.60 to -0.06) or studies of CBT for mixed anxiety and depression (d -0.26, 95% CI -0.44 to -0.08). Counselling for depression and mixed anxiety and depression (d -0.32, 95% CI -0.52 to -0.11) and problem solving therapy (PST) for depression and mixed anxiety and depression (d -0.21, 95% CI -0.37 to -0.05) were also effective. Controlling for diagnosis, meta-regression found no difference between CBT, counselling and PST.

CONCLUSIONS

Brief CBT, counselling and PST are all effective treatments in primary care, but effect sizes are low compared to longer length treatments. The exception is brief CBT for anxiety, which has comparable effect sizes.

Clinical predictors of severe behavioural problems in people with intellectual disabilities referred to a specialist mental health service

Associations between demographic and clinical variables and severe behavioural problems in people with intellectual disabilities were examined in a cross-sectional survey of 408 adults consecutively referred to a specialist mental health service. Severe behavioural problems were present in 136 (33.3%) of the sample. The demographic and clinical predictors of severe behavioural problems in this sample were identified by logistic regression. Age and gender were not associated with severe behavioural problems. The presence of severe ID independently predicted the presence of severe behavioural problems. Schizophrenia spectrum disorders and personality disorders independently predicted the presence of severe behavioural problems, whereas the presence of an anxiety disorder independently predicted their absence. There is an increasing evidence base of relationships between mental disorders and behavioural problems in people with ID although the pattern of these relationships remains unclear.

Increased Drinking During Withdrawal From Intermittent Ethanol Exposure Is Blocked by the CRF Receptor Antagonist d-Phe-CRF(12?41)

BACKGROUND

Studies in rodents have determined that intermittent exposure to alcohol vapor can increase subsequent ethanol self-administration, measured with operant and 2-bottle choice procedures. Two key procedural factors in demonstrating increased alcohol intake are the establishment of stable alcohol self-administration before alcohol vapor exposure and the number of bouts of intermittent vapor exposure. The present studies provide additional behavioral validation and initial pharmacological validation of this withdrawal-associated drinking procedure.

METHODS

Studies at 2 different sites (Portland and Scripps) examined the effect of intermittent ethanol vapor exposure (3 cycles of 16 hours of ethanol vapor+8 hours air) on 2-hour limited access ethanol preference drinking in male C57BL/6 mice. Separate studies tested 10 or 15% (v/v) ethanol concentrations, and measured intake during the circadian dark. In one study, before measuring ethanol intake after the second bout of intermittent vapor exposure, mice were tested for handling-induced convulsions (HICs) indicative of physical dependence on ethanol. In a second study, the effect of bilateral infusions of the corticotropin-releasing factor (CRF) receptor antagonist D-Phe-CRF(12-41) (0.25 microg/0.5 microL) into the central nucleus of the amygdala (CeA) on ethanol intake was compared in vapor-exposed animals and air controls.

RESULTS

Intermittent ethanol vapor exposure significantly increased ethanol intake by 30 to 40%, and the mice had higher blood ethanol concentrations than controls. Intra-amygdala infusions of D-Phe-CRF(12-41) significantly decreased the withdrawal-associated increase in ethanol intake without altering ethanol consumption in controls. Following the second bout of intermittent vapor exposure, mice exhibited an increase in HICs, when compared with their own baseline scores or the air controls.

CONCLUSIONS

Intermittent alcohol vapor exposure significantly increased alcohol intake and produced signs of physical dependence. Initial pharmacological studies suggest that manipulation of the CRF system in the CeA can block this increased alcohol intake.

Escalated median dose for pituitary macroadenomas using intensity-modulated radiation therapy

Three-dimensional conformal radiotherapy (3D CRT) has become an established treatment for pituitary macroadenomas. This study is an investigation into the possible dosimetric advantages of intensity-modulated radiotherapy for such critically located tumors. Three consecutive patients with pituitary macroadenoma previously treated with 3D CRT were replanned with inverse-planned IMRT using Helax-TMS (V.6.0, Helax AB, Uppsala, Sweden. Fusion of computed tomography (CT) with postoperative magnetic resonance imaging (MRI) was performed within the planning system to define the gross tumor volume (GTV), planning target volume (PTV), and normal structures including the optic chiasm. Dose-volume histograms (DVHs) for the 3D CRT plans were then compared with those of the corresponding prospective IMRT plans. Both techniques maintained critical structure doses below tolerance levels while maintaining a minimum dose of 45 Gy to 100% of the PTV. While IMRT plans deliver consistently more heterogeneous dose distributions to the PTV, the median PTV dose is elevated in the IMRT plans compared with the 3D CRT plans. For critically located tumors like these pituitary macroadenomas, IMRT allows escalation of the median dose to the tumor without an accompanying loss in critical structure sparing or creating unacceptable cold spots within the PTV.