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Pedersen SS, Mathiasen K, Christensen KB, Makransky G. Psychometric analysis of the Patient Health Questionnaire in Danish patients with an implantable cardioverter defibrillator (The DEFIB-WOMEN study). J Psychosom Res 2016; 90:105-112. [PMID: 27772556 DOI: 10.1016/j.jpsychores.2016.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/24/2016] [Accepted: 09/27/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the psychometric properties of the Patient Health Questionnaire (PHQ-9), a measure of depressive symptoms, in a large Danish national cohort of patients with heart disease, implanted with an implantable cardioverter defibrillator (ICD), using item response theory. METHODS A prospective cohort of patients implanted with an ICD (n=1531; 80.4% men) completed the PHQ-9 at the time of implant. Data were analyzed using two item response theory models, the partial credit model and the generalized partial credit model. RESULTS The analysis showed disordered response thresholds in eight of nine items for the partial credit model and five of nine items for the generalized partial credit model, indicating that respondents have difficulty discriminating between response options. When collapsing response options 2 and 3, the rescored PHQ-9 had a better fit to both models. The unidimensionality and the precision of the rescored PHQ-9 were confirmed. Items did not have any differential functioning (DIF) across educational level, age, indication for ICD implantation, and severity of heart failure that influence depression outcomes in patients with an ICD. One item exhibited DIF by gender. Three items did not fit the partial credit model, but the generalized partial credit model could be fitted to the full item set. CONCLUSION The unidimensionality and reliability of the Danish version of the PHQ-9 were confirmed. However, the associated consequences of the number of response options (3-point versus 4-point Likert scale) need to be further examined for the PHQ-9 both as a screening tool and outcome measure.
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Affiliation(s)
- Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Kim Mathiasen
- Department of Psychology, University of Southern Denmark, Odense, Denmark; Mental Health Services, Centre for Telepsychiatry, Odense, Denmark
| | | | - Guido Makransky
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Rodriguez VJ, Cook RR, Peltzer K, Jones DL. Prevalence and psychosocial correlates of suicidal ideation among pregnant women living with HIV in Mpumalanga Province, South Africa. AIDS Care 2016; 29:593-597. [PMID: 27690544 DOI: 10.1080/09540121.2016.1238442] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pregnant women living with HIV (WLHIV) in South Africa (SA) report higher rates of suicidal ideation than those who are HIV uninfected, and antenatal suicidal ideation has been previously associated with adverse maternal and neonatal outcomes. Few studies have attempted to identify correlates and psychosocial predictors of suicidal ideation in this population. In this study, we sought to estimate the prevalence of and identify risk factors for suicidal ideation among pregnant WLHIV in rural SA (N = 673). Thirty-nine percent of women endorsed suicidal ideation (95% CI: 35.2% to 42.3%) and in multivariable logistic regression analysis, suicidal ideation was associated with intimate partner violence and stigma, which interacted to multiplicatively increase the odds of suicidal thoughts. Given the high rates of reported suicidal ideation identified in this sample, and the potential harm to mothers and neonates, suicide risk assessment and management protocols for pregnant WLHIV should be considered for inclusion in the standard of care in rural SA.
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Affiliation(s)
- Violeta J Rodriguez
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Ryan R Cook
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Karl Peltzer
- b HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council , Pretoria , South Africa.,c ASEAN Institute for Health Development , Mahidol University , Salaya , Thailand.,d Department of Psychology , University of Limpopo , Turfloop , South Africa
| | - Deborah L Jones
- a Department of Psychiatry and Behavioral Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
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Gelaye B, Kajeepeta S, Williams MA. Suicidal ideation in pregnancy: an epidemiologic review. Arch Womens Ment Health 2016; 19:741-51. [PMID: 27324912 PMCID: PMC5023474 DOI: 10.1007/s00737-016-0646-0] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
Suicidal behaviors are the leading causes of injury and death worldwide, and are leading causes of maternal deaths in some countries. One of the strongest risk factors, suicidal ideation, is considered a harbinger and distal predictor of later suicide attempt and completion, and also presents an opportunity for interventions prior to physical self-harm. The purpose of this systematic epidemiologic review is to synthesize available research on antepartum suicidal ideation. Original publications were identified through searches of the electronic databases using the search terms pregnancy, pregnant women, suicidal ideation, and pregnan* and suicid* as root searches. We also reviewed references of published articles. We identified a total of 2626 articles through the electronic database search. After irrelevant and redundant articles were excluded, 57 articles were selected. The selected articles were original articles that focused on pregnancy and suicidal ideation. Of the 57 included articles, 20 reported prevalence, 26 reported risk factors, 21 reported consequences of antepartum suicidal ideation, and 5 reported on screening measures. Available evidence indicates that pregnant women are more likely than the general population to endorse suicidal ideation. Additionally, a number of risk factors for antepartum suicidal ideation were identified including intimate partner violence, <12-year education, and major depressive disorder. There is a need for enhanced screening for antepartum suicidal ideation. The few screening instruments that exist are limited as they were primarily developed to measure antepartum and postpartum depression. Given a substantial proportion of women with suicidal ideation that does not meet clinical thresholds of depression and given the stress-diathesis model that shows susceptibility to suicidal behavior independent of depressive disorders, innovative approaches to improve screening and detection of antepartum suicidal ideation are urgently needed.
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Affiliation(s)
- Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, K505F, Boston, MA, 02115, USA.
| | - Sandhya Kajeepeta
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
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Zhong QY, Wells A, Rondon MB, Williams MA, Barrios YV, Sanchez SE, Gelaye B. Childhood abuse and suicidal ideation in a cohort of pregnant Peruvian women. Am J Obstet Gynecol 2016; 215:501.e1-8. [PMID: 27173085 DOI: 10.1016/j.ajog.2016.04.052] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/11/2016] [Accepted: 04/29/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Childhood abuse is a major global and public health problem associated with a myriad of adverse outcomes across the life course. Suicide is one of the leading causes of mortality during the perinatal period. However, few studies have assessed the relationship between experiences of childhood abuse and suicidal ideation in pregnancy. OBJECTIVE We sought to examine the association between exposure to childhood abuse and suicidal ideation among pregnant women. STUDY DESIGN A cross-sectional study was conducted among 2964 pregnant women attending prenatal clinics in Lima, Peru. Childhood abuse was assessed using the Childhood Physical and Sexual Abuse Questionnaire. Depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 scale. Logistic regression procedures were performed to estimate adjusted odds ratios and 95% confidence intervals adjusted for potential confounders. RESULTS Overall, the prevalence of childhood abuse in this cohort was 71.8% and antepartum suicidal ideation was 15.8%. The prevalence of antepartum suicidal ideation was higher among women who reported experiencing any childhood abuse compared to those reporting none (89.3% vs 10.7%, P < .0001). After adjusting for potential confounders, including antepartum depression and lifetime intimate partner violence, those with history of any childhood abuse had a 2.9-fold (2.90, adjusted odds ratio; 95% confidence interval, 2.12-3.97) increased odds of reporting suicidal ideation. Women who experienced both physical and sexual childhood abuse had much higher odds of suicidal ideation (adjusted odds ratio, 4.04; 95% confidence interval, 2.88-5.68). Women who experienced any childhood abuse and reported depression had 3.44-fold (3.44, adjusted odds ratio; 95% confidence interval, 1.84-6.43) increased odds of suicidal ideation compared with depressed women with no history of childhood abuse. Finally, the odds of suicidal ideation increased with increased number of childhood abuse events experienced (P value for linear trend < .001). CONCLUSION Maternal history of childhood abuse was associated with increased odds of antepartum suicidal ideation. It is important for clinicians to be aware of the potential increased risk of suicidal behaviors among pregnant women with a history of childhood physical and sexual abuse.
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Affiliation(s)
- Qiu-Yue Zhong
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.
| | - Anne Wells
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Marta B Rondon
- Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
| | - Michelle A Williams
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Yasmin V Barrios
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Sixto E Sanchez
- Asociacion Civil Proyectos en Salud, Lima, Peru; Universidad Peruana de Ciencias Aplicados, Lima, Peru
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA
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Zhong QY, Gelaye B, Miller M, Fricchione GL, Cai T, Johnson PA, Henderson DC, Williams MA. Suicidal behavior-related hospitalizations among pregnant women in the USA, 2006-2012. Arch Womens Ment Health 2016; 19:463-72. [PMID: 26680447 PMCID: PMC4871736 DOI: 10.1007/s00737-015-0597-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
Suicide is one of the leading causes of maternal mortality in many countries, but little is known about the epidemiology of suicide and suicidal behavior among pregnant women in the USA. We sought to examine trends and provide nationally representative estimates for suicidal behavior (including suicidal ideation and suicide and self-inflicted injury) among pregnant women from 2006 to 2012 in the USA. Pregnant women aged 12-55 years were identified through pregnancy- and delivery-related hospitalization records from the National (Nationwide) Inpatient Sample. Suicidal behavior was identified by the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Annual, nationwide estimates and trends were determined using discharge and hospital weights. The prevalence of suicidal ideation more than doubled from 2006 to 2012 (47.5 to 115.0 per 100,000 pregnancy- and delivery-related hospitalizations), whereas the prevalence of suicide and self-inflicted injury remained stable. Nearly 10 % of suicidal behavior occurred in the 12-18-year group, showing the highest prevalence per 100,000 pregnancy- and delivery-related hospitalizations (158.8 in 2006 and 308.7 in 2012) over the study period. For suicidal ideation, blacks had higher prevalence than whites; women in the lowest income quartile had the highest prevalence. Although the prevalence of suicidal behavior was higher among hospitalizations with depression diagnoses, more than 30 % of hospitalizations were for suicidal behavior without depression diagnoses. Our findings highlight the increasing burden and racial differences in suicidal ideation among US pregnant women. Targeted suicide prevention efforts are needed for high-risk pregnant women including teens, blacks, and low-income women.
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Affiliation(s)
- Qiu-Yue Zhong
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Matthew Miller
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
,Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Gregory L. Fricchione
- Division of Psychiatry and Medicine, Pierce Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tianxi Cai
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Paula A. Johnson
- Mary Horrigan Connors Center for Women’s Health and Gender Biology, Boston, Massachusetts, USA
,Brigham and Women’s Hospital, Division of Women’s Health, Boston, Massachusetts, USA
| | - David C. Henderson
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
,Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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56
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Friedman LE, Gelaye B, Rondon MB, Sanchez SE, Peterlin BL, Williams MA. Association of Migraine Headaches With Suicidal Ideation Among Pregnant Women in Lima, Peru. Headache 2016; 56:741-9. [PMID: 27016264 DOI: 10.1111/head.12793] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Suicide is a leading cause of maternal death globally, and suicide prevalence rates have been shown to be increased in those with migraine. No previous study has examined the association between migraine and suicidal ideation during pregnancy. OBJECTIVE To examine the association between migraine and suicidal ideation among a cohort of pregnant women. METHODS A cross-sectional study was conducted among 3372 pregnant women attending prenatal care clinics in Lima, Peru. Suicidal ideation and depression were assessed using the Patient Health Questionnaire-9 (PHQ-9) scale during early pregnancy. Migraine classification (including migraine and probable migraine) was based on International Classification of Headache Disorders-III beta criteria. Multivariable logistic regression analyses were performed to estimate odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS Suicidal ideation was more common among those with migraine (25.6%) as compared to those with probable migraine (22.1%, P < .001) or non-migraineurs (12.3%, P < .001). After adjusting for confounders, including depression, those with migraine or probable migraine had a 78% increased odds of suicidal ideation (OR = 1.78; 95% CI: 1.46-2.17), as compared with non-migraineurs. Women with both migraine and depression had a 4.14-fold increased odds of suicidal ideation (OR = 4.14; 95% CI: 3.17-5.42) compared to those with neither condition. CONCLUSION Migraine is associated with increased odds of suicidal ideation in pregnant women even when controlling for depression. These findings support the consideration of screening women with comorbid migraine and depression for suicidal behavior during pregnancy.
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Affiliation(s)
- Lauren E Friedman
- Harvard T. H. Chan School of Public Health - Epidemiology, Boston, MA, USA
| | - Bizu Gelaye
- Harvard T. H. Chan School of Public Health - Epidemiology, Boston, MA, USA
| | - Marta B Rondon
- Cayetano Heredia Peruvian University - Department of Medicine, Lima, Peru
| | - Sixto E Sanchez
- Asociación Civil Proyectos en Salud, Lima, Peru.,Universidad Peruana de Ciencias Aplicados, Lima, Peru
| | - B Lee Peterlin
- Johns Hopkins School of Medicine - Neurology, Baltimore, MD, USA
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57
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Orsolini L, Valchera A, Vecchiotti R, Tomasetti C, Iasevoli F, Fornaro M, De Berardis D, Perna G, Pompili M, Bellantuono C. Suicide during Perinatal Period: Epidemiology, Risk Factors, and Clinical Correlates. Front Psychiatry 2016; 7:138. [PMID: 27570512 PMCID: PMC4981602 DOI: 10.3389/fpsyt.2016.00138] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/25/2016] [Indexed: 11/13/2022] Open
Abstract
Perinatal period may pose a great challenge for the clinical management and treatment of psychiatric disorders in women. In fact, several mental illnesses can arise during pregnancy and/or following childbirth. Suicide has been considered a relatively rare event during the perinatal period. However, in some mental disorders (i.e., postpartum depression, bipolar disorder, postpartum psychosis, etc.) have been reported a higher risk of suicidal ideation, suicide attempt, or suicide. Therefore, a complete screening of mothers' mental health should also take into account thoughts of suicide and thoughts about harming infants as well. Clinicians should carefully monitor and early identify related clinical manifestations, potential risk factors, and alarm symptoms related to suicide. The present paper aims at providing a focused review about epidemiological data, risk factors, and an overview about the main clinical correlates associated with the suicidal behavior during the pregnancy and postpartum period. Practical recommendations have been provided as well.
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Affiliation(s)
- Laura Orsolini
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Villa San Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy; Polyedra Research Group, Teramo, Italy; Department of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, Netherlands
| | - Alessandro Valchera
- Villa San Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy; Polyedra Research Group, Teramo, Italy
| | - Roberta Vecchiotti
- Villa San Giuseppe Hospital, Hermanas Hospitalarias, Ascoli Piceno, Italy; Polyedra Research Group, Teramo, Italy; Department of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, Netherlands
| | - Carmine Tomasetti
- Polyedra Research Group, Teramo, Italy; Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment, NHS, Hospital "Maria SS dello Splendore", Giulianova, Italy; Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Napoli, Italy
| | - Felice Iasevoli
- Polyedra Research Group, Teramo, Italy; Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Napoli, Italy
| | - Michele Fornaro
- Polyedra Research Group, Teramo, Italy; New York Psychiatric Institute, Columbia University, New York City, NY, USA
| | - Domenico De Berardis
- Polyedra Research Group, Teramo, Italy; Department of Mental Health ASL Teramo, Psychiatric Service of Diagnosis and Treatment, NHS, Hospital "G. Mazzini", Teramo, Italy; Department of Neuroscience and Imaging, University "G. d'Annunzio", Chieti, Italy
| | - Giampaolo Perna
- Department of Clinical Neurosciences, Hermanas Hospitalarias, FoRiPsi, Villa San Benedetto Menni, Albese con Cassano, Como, Italy; Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Coral Gables, FL, USA
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58
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Gelaye B, Barrios YV, Zhong QY, Rondon MB, Borba CPC, Sánchez SE, Henderson DC, Williams MA. Association of poor subjective sleep quality with suicidal ideation among pregnant Peruvian women. Gen Hosp Psychiatry 2015; 37:441-7. [PMID: 25983188 PMCID: PMC4558240 DOI: 10.1016/j.genhosppsych.2015.04.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/22/2015] [Accepted: 04/30/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the independent and joint relationships of poor subjective sleep quality and antepartum depression with suicidal ideation among pregnant women. METHODS A cross-sectional study was conducted among 641 pregnant women attending prenatal care clinics in Lima, Peru. Antepartum depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 scale. Antepartum subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression procedures were performed to estimate odds ratios (aOR) and 95% confidence intervals (95% CI) adjusted for confounders. RESULTS Overall, the prevalence of suicidal ideation in this cohort was 16.8% and poor subjective sleep quality was more common among women endorsing suicidal ideation as compared to their counterparts who did not (47.2% vs. 24.8%, P<.001). After adjustment for confounders including maternal depression, poor subjective sleep quality (defined using the recommended criteria of PSQI global score of >5 vs. ≤5) was associated with a 1.7-fold increased odds of suicidal ideation (aOR=1.67; 95% CI 1.02-2.71). When assessed as a continuous variable, each 1-unit increase in the global PSQI score resulted in an 18% increase in odds for suicidal ideation, even after adjusting for depression (aOR=1.18; 95% CI 1.08-1.28). Women with both poor subjective sleep quality and depression had a 3.5-fold increased odds of suicidal ideation (aOR=3.48; 95% CI 1.96-6.18) as compared with those who had neither risk factor. CONCLUSION Poor subjective sleep quality was associated with increased odds of suicidal ideation. Replication of these findings may promote investments in studies designed to examine the efficacy of sleep-focused interventions to treat pregnant women with sleep disorders and suicidal ideation.
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Affiliation(s)
- Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Yasmin V Barrios
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Qiu-Yue Zhong
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Marta B Rondon
- Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
| | - Christina P C Borba
- Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Sixto E Sánchez
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Asociación Civil PROESA, Lima, Peru
| | - David C Henderson
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Michelle A Williams
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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