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Listening Visits for maternal depression: a meta-analysis. Arch Womens Ment Health 2021; 24:595-603. [PMID: 33452571 DOI: 10.1007/s00737-020-01101-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Listening Visits are a non-directive counseling intervention delivered by nurses to depressed postpartum women. In 2007, Listening Visits were listed as a recommended treatment in British national guidelines. They were removed from the guideline update, due to the small effect size drawn from a meta-analysis of five clinical trials with depressed and non-depressed postpartum women. The purpose of this meta-analysis is to provide an estimate of the true population effect of Listening Visits as a treatment for maternal depression compared to control conditions. A meta-analytic review was conducted of studies published before October 2020. Inclusion criteria required that the study was a pragmatic or randomized trial of Listening Visits delivered by non-mental health specialists to mothers with elevated symptoms of maternal depression. Post-treatment depression rates for the treatment and control groups were extracted from eligible studies. Six studies met eligibility criteria which included 703 participants. Analyses of observed effect sizes corrected for study artifacts revealed an estimate of 0.66 (95% CI: 0.32, 0.99) with high heterogeneity (Q = 17.95, p = 0.003, I2 = 72.14). After removing outliers and addressing heterogeneity across observed effect sizes, the meta-analytic estimate across four methodologically similar studies and 651 participants was 0.43 (95% CI: 0.24, 0.62). The moderate effect size for Listening Visits, considered together with the advantages afforded by how, where, and who provides this treatment, supports Listening Visits as a first-line intervention in a stepped care approach for mothers with mild to moderately severe depression symptoms.
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Collins HN, Oza-Frank R, Marshall C. Perceived social support and postpartum depression symptoms across geographical contexts: Findings from the 2016 Ohio Pregnancy Assessment survey. Birth 2021; 48:257-264. [PMID: 33570210 DOI: 10.1111/birt.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/23/2020] [Accepted: 01/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study was to examine the association between perceived social support and postpartum depression symptoms (PDS) and to understand how this association may differ for urban, suburban, rural Appalachian, and rural non-Appalachian women in Ohio. METHODS Data were obtained via the 2016 Ohio Pregnancy Assessment Survey (n = 3382), a representative sample of postpartum women in Ohio. We conducted bivariate analyses to assess the associations between self-perceived social support and PDS, and covariates. Univariate and multivariate logistic regressions were conducted using a modified Poisson distribution to estimate the association between social support and PDS, adjusting for sociodemographic characteristics. We also examined geographical context as an independent predictor of PDS and as an effect modifier for the association between social support and PDS. RESULTS 15.6% of survey respondents experienced PDS. Women with low levels of social support had slightly higher prevalence (aPR: 1.4, 95% CI: 1.0-2.1) of PDS compared to women with high social support. Geographic context was an independent predictor of PDS; women in rural Appalachia had significantly lower prevalence (aPR: 0.5, 95% CI: 0.2-0.9) of PDS compared to women in urban areas. We did not find that geographical context modified the relationship between social support and PDS (Wald P = .5). CONCLUSIONS Low social support was associated with increased PDS but did not reach statistical significance. Women living in rural Appalachia had a lower prevalence of PDS. Future studies should explore the reasons for lower rates of PDS in rural Appalachia.
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Prevalence and incidence of postpartum depression and environmental factors: The IGEDEPP cohort. J Psychiatr Res 2021; 138:366-374. [PMID: 33932643 DOI: 10.1016/j.jpsychires.2021.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND IGEDEPP (Interaction of Gene and Environment of Depression during PostPartum) is a prospective multicenter cohort study of 3310 Caucasian women who gave birth between 2011 and 2016, with follow-up until one year postpartum. The aim of the current study is to describe the cohort and estimate the prevalence and cumulative incidence of early and late-onset postpartum depression (PPD). METHODS Socio-demographic data, personal and family psychiatric history, as well as stressful life events during childhood and pregnancy were evaluated at baseline. Early and late-onset PPD were assessed at 8 weeks and 1 year postpartum respectively, using DSM-5 criteria. RESULTS The prevalence of early-onset PPD was 8.3% (95%CI 7.3-9.3), and late PPD 12.9% (95%CI 11.5-14.2), resulting in an 8-week cumulative incidence of 8.5% (95%CI 7.4-9.6) and a one-year cumulative incidence of PPD of 18.1% (95%CI: 17.1-19.2). Nearly half of the cohort (N = 1571, 47.5%) had a history of at least one psychiatric or addictive disorder, primarily depressive disorder (35%). Almost 300 women in the cohort (9.0%) reported childhood trauma. During pregnancy, 47.7% women experienced a stressful event, 30.2% in the first 8 weeks and 43.9% between 8 weeks and one year postpartum. Nearly one in five women reported at least one stressful postpartum event at 8 weeks. CONCLUSION Incident depressive episodes affected nearly one in five women during the first year postpartum. Most women had stressful perinatal events. Further IGEDEPP studies will aim to disentangle the impact of childhood and pregnancy-related stressful events on postpartum mental disorders.
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Navas A, Carrascosa MDC, Artigues C, Ortas S, Portells E, Soler A, Yañez AM, Bennasar-Veny M, Leiva A. Effectiveness of Moderate-Intensity Aerobic Water Exercise during Pregnancy on Quality of Life and Postpartum Depression: A Multi-Center, Randomized Controlled Trial. J Clin Med 2021; 10:jcm10112432. [PMID: 34070842 PMCID: PMC8198819 DOI: 10.3390/jcm10112432] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/03/2021] [Accepted: 05/27/2021] [Indexed: 12/16/2022] Open
Abstract
Background: The global prevalence of postpartum depression is about 20%. This disease has serious consequences for women, their infants, and their families. The aim of this randomized clinical trial was to analyze the effectiveness and safety of a moderate-intensity aerobic water exercise program on postpartum depression, sleep problems, and quality of life in women at one month after delivery. Methods: This was a multi-center, parallel, randomized, evaluator blinded, controlled trial in a primary care setting. Pregnant women (14–20 weeks gestational age) who had low risk of complications and were from five primary care centers in the area covered by the obstetrics unit of Son Llatzer Hospital (Mallorca, Spain) were invited to participate. A total of 320 pregnant women were randomly assigned to two groups, an intervention group (moderate aquatic aerobic exercise) and a control group (usual prenatal care). One month after birth, sleep quality (MOS sleep), quality of life (EQ-5D), and presence of anxiety or depression (EPDS) were recorded. Findings: Women in the intervention group were less likely to report anxiety or depression on the EQ5D (11.5% vs. 22.7%; p < 0.05) and had a lower mean EPDS score (6.1 ± 1.9 vs. 6.8 ± 2.4, p < 0.010). The two groups had no significant differences in other outcomes, maternal adverse events, and indicators of the newborn status. Conclusion: Moderate-intensity aquatic exercise during pregnancy decreased postpartum anxiety and depressive symptoms in mothers and was safe for mothers and their newborns.
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Affiliation(s)
- Araceli Navas
- Hospital Comarcal de Inca, Balearic Islands Health Services, 07300 Inca, Spain;
| | - María del Carmen Carrascosa
- Mallorca Primary Health Care, Balearic Islands Health Services, 07002 Palma, Spain; (M.d.C.C.); (C.A.); (S.O.); (E.P.)
| | - Catalina Artigues
- Mallorca Primary Health Care, Balearic Islands Health Services, 07002 Palma, Spain; (M.d.C.C.); (C.A.); (S.O.); (E.P.)
| | - Silvia Ortas
- Mallorca Primary Health Care, Balearic Islands Health Services, 07002 Palma, Spain; (M.d.C.C.); (C.A.); (S.O.); (E.P.)
| | - Elena Portells
- Mallorca Primary Health Care, Balearic Islands Health Services, 07002 Palma, Spain; (M.d.C.C.); (C.A.); (S.O.); (E.P.)
| | - Aina Soler
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, 07002 Palma, Spain; (A.S.); (A.L.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
| | - Aina M. Yañez
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
- Nursing and Physiotherapy Department, Balearic Islands University, 07122 Palma, Spain
- Correspondence: (A.M.Y.); (M.B.-V.); Tel.: +34-9711-72914 (A.M.Y.); Tel.: +34-9711-72367 (M.B.-V.)
| | - Miquel Bennasar-Veny
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
- Nursing and Physiotherapy Department, Balearic Islands University, 07122 Palma, Spain
- Correspondence: (A.M.Y.); (M.B.-V.); Tel.: +34-9711-72914 (A.M.Y.); Tel.: +34-9711-72367 (M.B.-V.)
| | - Alfonso Leiva
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, 07002 Palma, Spain; (A.S.); (A.L.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
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Wu Z, Zhao P, Peng J, Fang L, Ding J, Yan G, Wang Y, Zhu J, Wang D, Li Y, Chen Z, Zhang Q, Deng Q, Duan G, Zuo Z, Li H. A Patient-Controlled Intravenous Analgesia With Tramadol Ameliorates Postpartum Depression in High-Risk Woman After Cesarean Section: A Randomized Controlled Trial. Front Med (Lausanne) 2021; 8:679159. [PMID: 34124111 PMCID: PMC8191376 DOI: 10.3389/fmed.2021.679159] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Postpartum depression (PPD) is a severe psychiatric disorder. Its risk is associated with the cesarean section (CS). Currently, there are few early intervention strategies for these women with PPD who underwent CS. Methods: This was a parallel-group randomized controlled trial of singleton pregnant women who underwent elective CS in a tertiary referral hospital in China from October, 2017 to September, 2019. After operation, patients received randomly tramadol patient-controlled intravenous analgesia (PCIA; 4 mg/ml; TRA group), hydromorphone PCIA (0.04 mg/ml; HYD group), or ropivacaine patient-controlled epidural analgesia (PCEA; 1.5 mg/ml; ROP group) for 48 h in a 1:1:1 ratio. Total blinding during hospitalization was not feasible due to differences between the PCEA and PCIA treatments. All investigators who performed the follow-up were blinded to the group assignment. Outcomes: A total of 1,230 patients were enrolled for eligibility. Intention-to-treat analysis showed reduced incidence of PPD in the TRA group (n = 27 [6.6%]) than that in the HYD (10.2%, OR 1.62, 95% CI 0.98~2.68; p = 0.059) and ROP groups (10.5%, OR 1.66, 95% CI 1.01~2.75; p = 0.046) at 4 weeks post-operation, however, the difference was not statistically significant (Bonferroni corrected p = 0.118, p = 0.098, respectively). Subgroup analysis in high-risk women (preoperative Edinburgh Postpartum Depression Scale [EPDS] ≥10) showed a significantly lower incidence of PPD in the TRA group (16.5%) than in the HYD (32.6%) and ROP groups (30.9%) (Bonferroni corrected p = 0.022 and p = 0.038, respectively). The per-protocol analysis yielded similar results. Reported adverse events (AEs) were mostly mild. None of the women or infant discontinued treatment due to AEs. Conclusions: Tramadol PCIA after CS in high-risk women can help to reduce the risk of PPD at 4 weeks after elective CS. Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT03309163?term=ETPPD&draw=2&rank=1; ClinicalTrials.gov (NCT03309163).
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Affiliation(s)
- Zhuoxi Wu
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, People's Liberation Army of China (PLA), Chongqing, China
| | - Peng Zhao
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, People's Liberation Army of China (PLA), Chongqing, China.,Department of Anesthesiology, Chinese People's Liberation Army of China (PLA) No. 964 Hospital, Changchun, China
| | - Jing Peng
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, People's Liberation Army of China (PLA), Chongqing, China
| | - Liang Fang
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, People's Liberation Army of China (PLA), Chongqing, China
| | - Jinping Ding
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, People's Liberation Army of China (PLA), Chongqing, China
| | - Guangming Yan
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, People's Liberation Army of China (PLA), Chongqing, China
| | - Yang Wang
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, People's Liberation Army of China (PLA), Chongqing, China
| | - Jing Zhu
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, People's Liberation Army of China (PLA), Chongqing, China
| | - Dongting Wang
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, People's Liberation Army of China (PLA), Chongqing, China
| | - Yang Li
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, People's Liberation Army of China (PLA), Chongqing, China
| | - Zhengqiong Chen
- Department of Obstetrics, Second Affiliated Hospital of Army Medical University, People's Liberation Army of China (PLA), Chongqing, China
| | - Qingling Zhang
- Department of Psychology, Second Affiliated Hospital of Army Medical University, People's Liberation Army of China (PLA), Chongqing, China
| | - Qiangting Deng
- Editorial Office of Journal of Third Military Medical University, Army Medical University, People's Liberation Army of China (PLA), Chongqing, China
| | - Guangyou Duan
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, People's Liberation Army of China (PLA), Chongqing, China
| | - Zhiyi Zuo
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, United States
| | - Hong Li
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, People's Liberation Army of China (PLA), Chongqing, China
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Trifan A, Oliveira JL. Cross-evaluation of social mining for classification of depressed online personas. J Integr Bioinform 2021; 18:101-110. [PMID: 34013675 PMCID: PMC8238472 DOI: 10.1515/jib-2020-0051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/24/2021] [Indexed: 11/15/2022] Open
Abstract
With the continuous increase in the use of social networks, social mining is steadily becoming a powerful component of digital phenotyping. In this paper we explore social mining for the classification of self-diagnosed depressed users of Reddit as social network. We conduct a cross evaluation study based on two public datasets in order to understand the impact of transfer learning when the data source is virtually the same. We further complement these results with an experiment of transfer learning in post-partum depression classification, using a corpus we have collected for the matter. Our findings show that transfer learning in social mining might still be at an early stage in computational research and we thoroughly discuss its implications.
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Affiliation(s)
- Alina Trifan
- IEETA/DETI, University of Aveiro, Aveiro, Portugal
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Abstract
During pregnancy, there are several physiological changes during each trimester that can affect the absorption, distribution, metabolism, and elimination of drugs. Although there is a potential need to understand the pharmacokinetics and pharmacodynamics of drugs in pregnant patients, therapeutic drug monitoring is not well established for various drug classes due to ethical and safety concerns regarding the neonate. Potential risks from in utero drug exposure to the fetus may impact growth and development and may cause malformations or teratogenesis. The clinician must consider the benefits of drug treatment for the pregnant mother versus the risk to the fetus, before prescribing medications during pregnancy. The objective of this review is to aid clinicians, pharmacists, and laboratorians in understanding the pharmacokinetic and pharmacodynamic changes during pregnancy, to provide drug class recommendations for monitoring therapy throughout pregnancy via therapeutic drug monitoring, and to highlight the recent directives of governing agencies on maternal and fetal health.
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Kanner J, Pollack AZ, Ranasinghe S, Stevens DR, Nobles C, Rohn MCH, Sherman S, Mendola P. Chronic exposure to air pollution and risk of mental health disorders complicating pregnancy. ENVIRONMENTAL RESEARCH 2021; 196:110937. [PMID: 33647295 PMCID: PMC9280857 DOI: 10.1016/j.envres.2021.110937] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/22/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Air pollution is associated with mental health in the general population, but its influence on maternal mental health during pregnancy has not been assessed. OBJECTIVE We evaluated the relationship between unspecified mental disorders complicating pregnancy and depression with average air pollution exposure during 3-months preconception, first trimester and whole pregnancy. METHODS Ambient air pollution was derived from a modified Community Multiscale Air Quality model and mental health diagnoses were based on electronic intrapartum medical records. Logistic regression models assessed the odds of unspecified mental disorder complicating pregnancy (n = 11,577) and depression (n = 9793) associated with an interquartile range increase in particulate matter (PM) less than 2.5 μm (PM2.5), PM10, carbon monoxide (CO), nitrogen dioxide (NO2), nitrogen oxide (NOx), sulfur dioxide (SO2), and ozone (O3). Pregnancies without mental health disorders were the reference group (n = 211,645). Models were adjusted for maternal characteristics and study site; analyses were repeated using cases with no additional mental health co-morbidity. RESULTS Whole pregnancy exposure to PM10, PM2.5, NO2, and NOx was associated with a 29%-74% increased odds of unspecified mental disorders complicating pregnancy while CO was associated with 31% decreased odds. Results were similar for depression: whole pregnancy exposure to PM10, PM2.5, NO2, and NOx was associated with 11%-21% increased odds and CO and O3 were associated with 16%-20% decreased odds. SO2 results were inconsistent, with increased odds for unspecified mental disorders complicating pregnancy and decreased odds for depression. While most findings were similar or stronger among cases with no co-morbidity, PM2.5 and NOx were associated with reduced risk and SO2 with increased risk for depression only. DISCUSSION Whole pregnancy exposure to PM10, PM2.5, NO2, and NOx were associated with unspecified mental disorder complicating pregnancy and depression, but some results varied for depression only. These risks merit further investigation.
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Affiliation(s)
- Jenna Kanner
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20892, USA
| | - Anna Z Pollack
- Department of Global and Community Health, College of Health and Human Services, George Mason University, 4400 University Drive MS5B7, Fairfax, VA, 22030, USA
| | - Shamika Ranasinghe
- Department of Global and Community Health, College of Health and Human Services, George Mason University, 4400 University Drive MS5B7, Fairfax, VA, 22030, USA; American Society of Clinical Oncology, 2318 Mill Road, Suite 800, Alexandria, VA, 22314, USA
| | - Danielle R Stevens
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20892, USA
| | - Carrie Nobles
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20892, USA
| | - Matthew C H Rohn
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20892, USA
| | - Seth Sherman
- The Emmes Company, 401 N Washington St # 700, Rockville, MD, 20850, USA
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, Bethesda, MD, 20892, USA; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, USA.
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Are pregnant women at higher risk of depression underdiagnosis? J Affect Disord 2021; 283:192-197. [PMID: 33561799 DOI: 10.1016/j.jad.2021.01.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/04/2021] [Accepted: 01/28/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND we aim to estimate the prevalence of depression underdiagnosis among women and whether pregnant women are at higher risk STUDY DESIGN: we used data from the Brazilian National Survey (PNS 2013), a population-based study. All 22.455 women (18-49 years old) answered the Patient Health Questionnaire-9 (PHQ-9) and a questionnaire with sociodemographic, obstetric and clinical data. There were 2.605 (2.491 non-pregnant and 114 pregnant women) depressed women (PHQ-9 >8)with a clinical diagnosis of depression, in the last 30 days. Classification of depression underdiagnosis was made using the comparison between results obtained from the self-referred question evaluating clinical diagnosis of depression by providers and the results of the PHQ-9 application. Women with a PHQ-9 score > 8 and with a "No" answer in the clinical question were classified as depression underdiagnosis. Logistic regression models were performed to obtain crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI) RESULTS: Depression underdiagnosis prevalence was 71.2% and was more frequent among pregnant women in comparison with non-pregnant women (88.1% vs 68.0%; p = 0.002). In the adjusted analysis, being pregnant was significantly associated with depression underdiagnosis (aOR 3.55, 95% CI 1.66:7.60). Nonwhite skin color women were also at higher risk of depression underdiagnosis (aOR 1.53, 95% CI 1.09:2.14). LIMITATIONS the cross-sectional design and the lack of medical records data about assessment of mental health CONCLUSION(S): in Brazil, depression underdiagnosis by providers is prevalent and pregnant women and minority women are at higher risk of not receiving a correct mental health diagnosis.
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Kubo A, Aghaee S, Kurtovich EM, Nkemere L, Quesenberry CP, McGinnis MK, Avalos LA. mHealth Mindfulness Intervention for Women with Moderate-to-Moderately-Severe Antenatal Depressive Symptoms: a Pilot Study Within an Integrated Health Care System. Mindfulness (N Y) 2021; 12:1387-1397. [PMID: 33723491 PMCID: PMC7947160 DOI: 10.1007/s12671-021-01606-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/28/2022]
Abstract
Objectives Traditional mindfulness-based interventions have been shown to reduce depression symptoms in pregnant women, although in-person classes may pose significant accessibility barriers, particularly during the COVID-19 pandemic. Mobile technology offers greater convenience, but little is known regarding the efficacy of self-paced, mobile-delivered (mHealth) mindfulness interventions in this population. This study tested the feasibility and acceptability of offering such an intervention for pregnant women with moderate-to-moderately-severe depression symptoms. Methods We conducted a single-arm trial within Kaiser Permanente Northern California (KPNC). Participants were identified through KPNC’s universal perinatal depression screening program. Eligible participants included English-speaking pregnant women (<28 weeks of gestation) with moderate-to-moderately-severe depressive symptoms without a regular (<3 times/week) mindfulness/meditation practice. Participants were asked to follow a self-paced, 6-week mindfulness meditation program using a mobile app, Headspace™, 10–20 min/day. Outcome measures included feasibility, acceptability, and patient-reported outcomes (e.g., depression symptoms). Results Of the 27 women enrolled, 20 (74%) completed the study. Over half (55%) of participants used the app ≥50% of the days during the 6-week intervention. Responses to the semi-structured interviews indicated that women appreciated the convenience of the intervention and the ability to engage without having to attend classes or arrange childcare. We observed significant improvements in pre-postintervention scores for depression symptoms, perceived stress, sleep disturbance, and mindfulness. Conclusions Our study demonstrates the feasibility and acceptability of an mHealth mindfulness intervention for women with moderate-to-moderately-severe antenatal depression symptoms. The preliminary data further suggest that an efficacy trial is warranted.
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Affiliation(s)
- Ai Kubo
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 USA
| | - Sara Aghaee
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 USA
| | - Elaine M Kurtovich
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 USA
| | - Linda Nkemere
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 USA
| | | | - MegAnn K McGinnis
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 USA
| | - Lyndsay A Avalos
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612 USA
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Dagla M, Mrvoljak-Theodoropoulou I, Vogiatzoglou M, Giamalidou A, Tsolaridou E, Mavrou M, Dagla C, Antoniou E. Association between Breastfeeding Duration and Long-Term Midwifery-Led Support and Psychosocial Support: Outcomes from a Greek Non-Randomized Controlled Perinatal Health Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041988. [PMID: 33670797 PMCID: PMC7922856 DOI: 10.3390/ijerph18041988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/15/2021] [Indexed: 12/17/2022]
Abstract
Background: This study investigates if a non-randomized controlled perinatal health intervention which offers (a) long-term midwife-led breastfeeding support and (b) psychosocial support of women, is associated with the initiation, exclusivity and duration of breastfeeding. Methods: A sample of 1080 women who attended a 12-month intervention before and after childbirth, during a five-year period (January 2014–January 2019) in a primary mental health care setting in Greece, was examined. Multiple analyses of variance and logistic regression analysis were conducted. Results: The vast majority of women (96.3%) initiated either exclusive breastfeeding (only breast milk) (70.7%) or any breastfeeding (with or without formula or other type of food/drink) (25.6%). At the end of the 6th month postpartum, almost half of the women (44.3%) breastfed exclusively. A greater (quantitatively) midwifery-led support to mothers seemed to correlate with increased chance of exclusive breastfeeding at the end of the 6th month postpartum (p = 0.034), and with longer any breastfeeding duration (p = 0.015). The absence of pathological mental health symptoms and of need for receiving long-term psychotherapy were associated with the longer duration of any breastfeeding (p = 0.029 and p = 0.013 respectively). Conclusions: Continuous long-term midwife-led education and support, and maternal mental well-being are associated with increased exclusive and any breastfeeding duration.
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Affiliation(s)
- Maria Dagla
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
- Correspondence: ; Tel.: +30-210-932-4415
| | - Irina Mrvoljak-Theodoropoulou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Marilena Vogiatzoglou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Anastasia Giamalidou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Eleni Tsolaridou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Marianna Mavrou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Calliope Dagla
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
| | - Evangelia Antoniou
- Day Center for the Care of the Mental Health of Women (Perinatal Mental Health Disorders), Non-Profit Organization “FAINARETI”, 17121 Athens, Greece; (I.M.-T.); (M.V.); (A.G.); (E.T.); (M.M.); (C.D.); (E.A.)
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
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Subramanian Srinivasa Sekaran B, Lippmann S. Depression during pregnancy amidst COVID-19. Hosp Pract (1995) 2021; 49:155-156. [PMID: 33541147 DOI: 10.1080/21548331.2021.1886751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Steven Lippmann
- The University of Louisville School of Medicine, Louisville, KY, USA
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Fitzgerald E, Parent C, Kee MZL, Meaney MJ. Maternal Distress and Offspring Neurodevelopment: Challenges and Opportunities for Pre-clinical Research Models. Front Hum Neurosci 2021; 15:635304. [PMID: 33643013 PMCID: PMC7907173 DOI: 10.3389/fnhum.2021.635304] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Pre-natal exposure to acute maternal trauma or chronic maternal distress can confer increased risk for psychiatric disorders in later life. Acute maternal trauma is the result of unforeseen environmental or personal catastrophes, while chronic maternal distress is associated with anxiety or depression. Animal studies investigating the effects of pre-natal stress have largely used brief stress exposures during pregnancy to identify critical periods of fetal vulnerability, a paradigm which holds face validity to acute maternal trauma in humans. While understanding these effects is undoubtably important, the literature suggests maternal stress in humans is typically chronic and persistent from pre-conception through gestation. In this review, we provide evidence to this effect and suggest a realignment of current animal models to recapitulate this chronicity. We also consider candidate mediators, moderators and mechanisms of maternal distress, and suggest a wider breadth of research is needed, along with the incorporation of advanced -omics technologies, in order to understand the neurodevelopmental etiology of psychiatric risk.
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Affiliation(s)
- Eamon Fitzgerald
- Department of Psychiatry, Faculty of Medicine, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
| | - Carine Parent
- Department of Psychiatry, Faculty of Medicine, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
| | - Michelle Z. L. Kee
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Michael J. Meaney
- Department of Psychiatry, Faculty of Medicine, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Research Centre, McGill University, Montreal, QC, Canada
- Translational Neuroscience Programme, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Latendresse G, Bailey E, Iacob E, Murphy H, Pentecost R, Thompson N, Hogue C. A Group Videoconference Intervention for Reducing Perinatal Depressive Symptoms: A Telehealth Pilot Study. J Midwifery Womens Health 2021; 66:70-77. [PMID: 33576146 PMCID: PMC8684833 DOI: 10.1111/jmwh.13209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Perinatal depression occurs in 12% to 18% of childbearing women. Telehealth is a promising platform for delivering perinatal mental health care, particularly during a pandemic when in-person services have been significantly curtailed. However, there is little research to document the feasibility of telehealth to address perinatal depression. This pilot study evaluated the feasibility and preliminary results of an 8-week facilitated group videoconference intervention. METHODS The study enrolled pregnant and postpartum women into an 8-week group mindfulness-based cognitive behavioral intervention, delivered via videoconference platform. Women receiving care at outpatient clinics who either screened positive for perinatal depression symptoms or had risk factors predictive of perinatal depression were invited to participate. Women attended weekly one-hour group sessions using their own electronic device and completed the Edinburgh Postnatal Depression Scale (EPDS) at several time points. Session attendance and survey completion rates were evaluated. RESULTS A total of 47 women enrolled (8 postpartum; 39 prenatal) into groups of 4 to 6. Twenty-four (51.1%) women were currently experiencing mild to moderate perinatal depression symptoms (EPDS score of 10-20), whereas 23 (48.9%) women had EPDS scores less than 10 but were at high risk for developing perinatal depression due to health history and significant life events. Seventy percent of women attended at least 5 of the 8 sessions. Trajectories of EPDS measures were promising (ie, downward among those with current perinatal depression symptoms and stable among those at high risk for developing perinatal depression). DISCUSSION These observational results are promising, suggesting further study of effectiveness for women with symptoms of perinatal depression, as well as for women at high risk for developing perinatal depression. Randomized trials could evaluate the effectiveness of the intervention, compared with standard of care approaches. Telehealth interventions can be tailored to meet the needs of different communities, and increase access to care, regardless of where women live or inability to receive in-person services.
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Affiliation(s)
| | - ElLois Bailey
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Hannah Murphy
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Ryoko Pentecost
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Nancy Thompson
- Rollns School of Public Health, Emory University, Atlanta, Georgia
| | - Carol Hogue
- Rollns School of Public Health, Emory University, Atlanta, Georgia
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Chan AL, Guo N, Popat R, Robakis T, Blumenfeld YY, Main E, Scott KA, Butwick AJ. Racial and Ethnic Disparities in Hospital-Based Care Associated with Postpartum Depression. J Racial Ethn Health Disparities 2021; 8:220-229. [PMID: 32474833 DOI: 10.1007/s40615-020-00774-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/13/2020] [Accepted: 05/11/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To estimate racial and ethnic differences in rates of hospital-based care associated with postpartum depression. METHODS This is a retrospective cohort study using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes within data from the Office of Statewide Planning and Development in California. We included primiparous women who underwent delivery hospitalization from 2008 to 2012. The primary outcome was the first postpartum hospital encounter with a ICD-9-CM code for depression over a 9-month period after delivery. We examined the cumulative incidence of hospital-based care for postpartum depression by race/ethnicity. Logistic regression was used to estimate relative risk. RESULTS The study cohort consisted of 984,167 primiparous women: 314,037 (32%) were non-Hispanic White; 59,754 (6%) were non-Hispanic Black; 150,855 (15%) were non-Hispanic Asian; 448,770 (46%) were Hispanic; and 10,399 (1%) were other races. The cumulative incidence of hospital-based care for postpartum depression was highest for Black women (39; 95% CI = 34-44 per 10,000 deliveries) and lowest for Asian women (7; 95% CI = 5-8 per 10,000 deliveries). Compared with White women, hospital-based care for postpartum depression was more likely to be provided to Black women (OR = 2.3; 95% CI = 1.9-2.7), whereas care was less likely for Asians (OR = 0.4; 95% CI = 0.3-0.5) and Hispanics (OR = 0.8; 95% CI = 0.7-1.0). Similar findings were observed after excluding women with antepartum depression, adjusting for sociodemographic and clinical variables, and stratifying according to care settings. CONCLUSION Compared with White women, hospital-based care for postpartum depression more frequently impacts Black women. Identifying and improving inequities in access to and utilization of mental health care for postpartum women should be a maternal health priority.
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Affiliation(s)
- Avis L Chan
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Nan Guo
- Department of Anesthesiology, Perioperative, and Pain Medicine (MC:5640), Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Rita Popat
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Thalia Robakis
- Department of Psychiatry, Icahn School of Medicine Mount Sinai, Manhattan, NY, USA
| | - Yair Y Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Elliott Main
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- California Maternal Quality Care Collaborative, Stanford University School of Medicine, Stanford, CA, USA
| | - Karen A Scott
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Alexander J Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine (MC:5640), Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
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Mennen FE, Palmer Molina A, Monro WL, Duan L, Stuart S, Sosna T. Effectiveness of an Interpersonal Psychotherapy (IPT) Group Depression Treatment for Head Start Mothers: A Cluster-Randomized Controlled Trial. J Affect Disord 2021; 280:39-48. [PMID: 33221606 DOI: 10.1016/j.jad.2020.11.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/14/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Maternal depression is known to be a serious problem with higher rates among poor and racial/ethnic minority mothers that can have numerous negative impacts on their children. These mothers have less access to effective care and may be wary of traditional mental health care because of the stigma. The purpose of this study was to test whether an adaptation of an Interpersonal Psychotherapy group for perinatal depression could be effective in reducing depressive symptoms of mothers whose children were enrolled in Head Start. METHODS Forty-nine mothers, randomized by site, were recruited into the intervention group, 70 into the control group. They were measured on depressive symptoms, parenting stress, parenting behavior, and parent child interaction at intake, at end of the group, and 6 months following. RESULTS The intervention group was lower in depressive symptoms at the end of treatment with a further decrease 6 months post intervention. There was no change in the control group. The intervention group also improved in parenting stress. LIMITATIONS The sample size for the intervention group was smaller than desired. CONCLUSIONS This study supports the effectiveness of this 12 session IPT group which was highly effective for a population of Head Start mothers. It is a strategy that can be adapted to other settings that serve low income mothers.
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Affiliation(s)
- Ferol E Mennen
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34th St, Los Angeles, CA 90089.
| | | | - William L Monro
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Lei Duan
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | | | - Todd Sosna
- Children's Institute Inc., Los Angeles, CA
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Soderlund PD, Martinez Hollingsworth AS, Heilemann MV. Participant Engagement in a Transmedia Storytelling Web-Based App Intervention for Mental Health of Latina Women: Qualitative Analysis. JMIR Ment Health 2021; 8:e22575. [PMID: 33439137 PMCID: PMC7840278 DOI: 10.2196/22575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/23/2020] [Accepted: 12/05/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Stigma, fear, and lack of knowledge regarding treatment options or where to get help create delays for Latina women in accessing needed mental health help. Story-based media interventions hold appeal for Latina women. Thus, we drew upon the Social Cognitive Theory by Bandura to create an evidence-based, transmedia storytelling web-based app for mental health called Catalina: Confronting My Emotions to connect Latina women to a curated set of mental health resources. Understanding how Latina women perceive various aspects of the web-based app will help design future expansions. OBJECTIVE A previously published analysis led to the development of a category on how participants related to the lead character (Catalina) in the story line of the web-based app as a real person. However, the purpose of this analysis was to gain an understanding of participants' experiences with the extension of the dramatic story line of the web-based app beyond Catalina to a Latina nurse-therapist character named Veronica, who was featured prominently in the app's interactive content and bonus videos. METHODS Qualitative analyses were conducted with interview data from a community-based sample of 28 English-speaking Latina women aged between 21 and 50 years who scored above the threshold for anxiety (Generalized Anxiety Disorder-7) and/or depression (Patient Health Questionnaire-9) but were not suicidal at screening. Data were collected 72 hours after participants engaged with our transmedia storytelling web-based app for mental health. Grounded theory methodology guided the analysis and interpretation of data that had been collected telephonically, recorded, and transcribed with identifiers removed. Analyses included initial and focused coding using process codes (gerund form of verbs in codes focused on action), informed by symbolic interactionism, and the development of categories with properties through constant comparison, memo writing, and the use of charts and diagrams. RESULTS Our participants experienced a multiphase process that was most heavily related to Veronica, the Latina nurse-therapist character in our web-based app, who led them through a process to a place of action. We conceptualized this process as moving from passive viewer to active participant of a transmedia storytelling web-based app intervention. Overall, 3 new conceptual categories provided insight into women's experiences, including encountering a trustworthy nurse-therapist character, taking in messages that dispel old beliefs, and preparing when and how to take action. Each category has nuanced properties that reflect participants' experiences. CONCLUSIONS Active engagement with our web-based app led our sample to successfully transition from the viewpoint of the observer to the viewpoint of the experiencer, moving from a passive position of watching to active engagement that involved imagining, thinking, reflecting, and acting. Careful development of dramatic material for health-related web-based apps using transmedia story extension and bonus videos needs to be based on input from the target group from the start of development through evaluation and testing.
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Affiliation(s)
| | - Adrienne S Martinez Hollingsworth
- Department of Internal Medicine, UCLA School of Medicine, National Clinician Scholars Program, University of California, Los Angeles, Los Angeles, CA, United States
| | - MarySue V Heilemann
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
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Chorbadjian TN, Deavenport-Saman A, Higgins C, Chao SM, Yang JH, Koolwijk I, Vanderbilt DL. Maternal Depressive Symptoms and Developmental Delay at Age 2: A Diverse Population-Based Longitudinal Study. Matern Child Health J 2020; 24:1267-1277. [PMID: 32780269 DOI: 10.1007/s10995-020-02990-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Children raised by depressed mothers perform lower on measures of cognitive, emotional, and behavioral skills, compared to children of non-depressed mothers. It is unclear how maternal depressive symptoms (MDS), which persist and accrue over time, impact child development. The purpose of this study was to determine whether cumulative MDS from pre-pregnancy to postpartum influences child development in children by age 2.5. METHODS Using a longitudinal population-based study design, 2679 racially and ethnically diverse mothers completed the 2014 Los Angeles Mommy and Baby (LAMB) and 2016 Follow-Up surveys. A total MDS score was created based on responses to standardized questions, including the Patient Health Questionnaire-2 (PHQ-2). Data was collected for before pregnancy, during pregnancy, and 4 months postpartum in the 2014 survey, and at 2.5 years postpartum in the 2016 survey. Child development was measured using the CDC's Learn the Signs. Act Early Milestones Checklist. Bivariate and multivariate logistic regressions were conducted. RESULTS The prevalence of any cumulative MDS was 45.2%. Language, cognitive/adaptive, motor, and social-emotional delays for surveyed toddlers were 7.7%, 4.0%, 1.2%, and 14.2%. After adjusting for covariates, mothers reporting depressive symptoms at all four time points were significantly more likely to report a social-emotional delay in their child (aOR = 4.39, 95% CI - 1.72 to 11.18). CONCLUSIONS FOR PRACTICE Mothers with cumulative depressive symptoms are at-risk of reporting social-emotional delays by age 2.5. Understanding these effects may help direct resources to target interventions that support mothers with depressive symptoms early-on and promote positive developmental outcomes among their children.
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Affiliation(s)
- Tamar Nazerian Chorbadjian
- Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA.
- Kaiser Permanente Baldwin Park, 1011 Baldwin Park Blvd., Baldwin Park, CA, 91706, USA.
| | - Alexis Deavenport-Saman
- Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA
- Keck School of Medicine of USC, Los Angeles, CA, 90033, USA
| | - Chandra Higgins
- Los Angeles Department of Public Health, Los Angeles County Department of Public Health Maternal, Child, and Adolescent Health Programs, 600 S. Commonwealth Av #800, Los Angeles, CA, 90005, USA
| | - Shin Margaret Chao
- Los Angeles Department of Public Health, Los Angeles County Department of Public Health Maternal, Child, and Adolescent Health Programs, 600 S. Commonwealth Av #800, Los Angeles, CA, 90005, USA
| | - Jeffrey H Yang
- Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA
- Keck School of Medicine of USC, Los Angeles, CA, 90033, USA
| | - Irene Koolwijk
- Department of General Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, 300 Medical Plaza, Suite 3300, Los Angeles, CA, 90095, USA
| | - Douglas L Vanderbilt
- Children's Hospital of Los Angeles, 4650 Sunset Blvd., Los Angeles, CA, 90027, USA
- Keck School of Medicine of USC, Los Angeles, CA, 90033, USA
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Wagner T, Thompson EL, Gadson A, Stark M, Bush K, Raines-Milenkov A. Postpartum Education and Health Literacy: New Moms’ Perspectives. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2020. [DOI: 10.1080/15398285.2020.1810964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Teresa Wagner
- School of Health Professions, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Erika L. Thompson
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Amber Gadson
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Marie Stark
- Harris College of Nursing, Texas Christian University, Fort Worth, Texas, USA
| | - Kim Bush
- Center of Population Health, Analytics, and Quality Advancement, University of Texas Health Science Center, Tyler, Texas, USA
| | - Amy Raines-Milenkov
- Department of Maternal Child Health, University of North Texas Health Science Center, Fort Worth, Texas, USA
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Browne PD, Bossenbroek R, Kluft A, van Tetering EMA, de Weerth C. Prenatal Anxiety and Depression: Treatment Uptake, Barriers, and Facilitators in Midwifery Care. J Womens Health (Larchmt) 2020; 30:1116-1126. [PMID: 33275492 DOI: 10.1089/jwh.2019.8198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: While many women experience prenatal symptoms of anxiety and/or depression (PSAD), treatment uptake rates are relatively low. Left untreated, symptoms can unfavorably affect maternal and infant health. The first aim of this study was to identify the treatment uptake rate and modalities of treatment received in a community sample of Dutch pregnant women. The second aim was to investigate reasons for not engaging in treatment and to describe facilitators for treatment uptake. The third aim was to determine facilitators and barriers for self-disclosure of feelings to midwives. Materials and Methods: Data were collected from a convenience sample of 1439 Dutch women with low-risk mid-term pregnancies in midwifery care. PSAD was assessed with online questionnaires on symptoms. Reasons, facilitators, and barriers were determined with checklists and open questions. Data were analyzed using conventional content analysis and open code quantification. Results: Only 15% of women with PSAD (scoring above cutoffs; 22% of the full sample) received treatment. Psychotherapy was the most commonly received treatment. The main reason for not engaging in treatment was regarding PSAD as a natural part of pregnancy (71%). The main facilitator to engage in treatment was referral by midwives (16%), and for self-disclosure was the midwife asking about PSAD (59%), whereas not asking formed the main barrier for self-disclosure (23%). Conclusions: Relatively few pregnant women received treatment for PSAD. Midwives play an essential role in identifying and referring women for treatment. Routine screening may be a starting point to offer support and, if needed, referral.
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Affiliation(s)
- Pamela D Browne
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Earth & Life Sciences, Athena Institute, VU University, Amsterdam, The Netherlands
| | - Rineke Bossenbroek
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Arne Kluft
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
| | | | - Carolina de Weerth
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition, and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
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Salameh TN, Hall LA, Crawford TN, Staten RR, Hall MT. Trends in mental health and substance use disorders and treatment receipt among pregnant and nonpregnant women in the United States, 2008-2014. J Psychosom Obstet Gynaecol 2020; 41:298-307. [PMID: 31718367 DOI: 10.1080/0167482x.2019.1689949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To compare trends in mental health and substance use disorders and treatment receipt of pregnant and nonpregnant women from 2008 to 2014. METHODS Using data from the 2008-2014 National Survey on Drug Use and Health, logistic regression was used to compare trends in mental health and substance use disorders and treatment receipt for mental health and substance use disorders among propensity score-matched groups of pregnant (n = 5520) and nonpregnant women (n = 11,040). Among women in the matched sample who met criteria for at least one mental illness, trends in mental health treatment receipt of pregnant (n = 1003) and nonpregnant women (n = 2634) were compared. RESULTS There were no differences in the trends by pregnancy status from 2008 to 2014. Past-year anxiety disorder, past-month psychological distress and illicit drug use disorder increased in the total sample from 2008 to 2014, yet trends in mental health treatment and unmet need for substance use treatment did not change over time. Pregnant women had lower odds of mental illness, but those who had mental illness were less likely to receive mental health treatment than their nonpregnant counterparts. CONCLUSIONS There is a need for preventive strategies addressing anxiety disorder, psychological distress and illicit drug use among women of childbearing age as well as initiatives to increase access to mental health treatment among pregnant women.
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Affiliation(s)
| | - Lynne A Hall
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - Timothy N Crawford
- Department of Population and Public Health Sciences, Wright State University, Dayton, OH, USA
| | - Ruth R Staten
- School of Nursing, University of Louisville, Louisville, KY, USA
| | - Martin T Hall
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
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Anderson KN, Lind JN, Simeone RM, Bobo WV, Mitchell AA, Riehle-Colarusso T, Polen KN, Reefhuis J. Maternal Use of Specific Antidepressant Medications During Early Pregnancy and the Risk of Selected Birth Defects. JAMA Psychiatry 2020; 77:1246-1255. [PMID: 32777011 PMCID: PMC7407327 DOI: 10.1001/jamapsychiatry.2020.2453] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/29/2020] [Indexed: 01/31/2023]
Abstract
Importance Antidepressants are commonly used during pregnancy, but limited information is available about individual antidepressants and specific birth defect risks. Objective To examine associations between individual antidepressants and specific birth defects with and without attempts to partially account for potential confounding by underlying conditions. Design, Setting, and Participants The population-based, multicenter case-control National Birth Defects Prevention Study (October 1997-December 2011) included cases with selected birth defects who were identified from surveillance systems; controls were randomly sampled live-born infants without major birth defects. Mothers of cases and controls participated in an interview after the expected delivery date. The data were analyzed after the completion of the National Birth Defects Prevent Study's data collection. Exposures Self-reported antidepressant exposure was coded to indicate monotherapy exposure to antidepressants. Main Outcomes and Measures We used multivariable logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals for associations between maternal antidepressant use and birth defects. We compared early pregnancy antidepressant-exposed women with those without antidepressant exposure and, to partially account for confounding by underlying maternal conditions, those exposed to antidepressants outside of the birth defect development critical period. Results This study included 30 630 case mothers of infants with birth defects and 11 478 control mothers (aged 12-53 years). Early pregnancy antidepressant use was reported by 1562 case mothers (5.1%) and 467 control mothers (4.1%), for whom elevated aORs were observed for individual selective serotonin reuptake inhibitors (SSRIs) and selected congenital heart defects (CHD) (eg, fluoxetine and anomalous pulmonary venous return: aOR, 2.56; 95% CI, 1.10-5.93; this association was attenuated after partially accounting for underlying conditions: aOR, 1.89; 95% CI, 0.56-6.42). This pattern was observed for many SSRI-CHD combinations. Associations between SSRIs and non-CHD birth defects often persisted or strengthened after partially accounting for underlying conditions (eg, citalopram and diaphragmatic hernia: aOR, 5.11; 95% CI, 1.29-20.24). Venlafaxine had elevated associations with multiple defects that persisted after partially accounting for underlying conditions (eg, anencephaly and craniorachischisis: aOR, 9.14; 95% CI, 1.91-43.83). Conclusions and Relevance We found some associations between maternal antidepressant use and specific birth defects. Venlafaxine was associated with the highest number of defects, which needs confirmation given the limited literature on venlafaxine use during pregnancy and risk for birth defects. Our results suggest confounding by underlying conditions should be considered when assessing risk. Fully informed treatment decision-making requires balancing the risks and benefits of proposed interventions against those of untreated depression or anxiety.
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Affiliation(s)
- Kayla N. Anderson
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer N. Lind
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Atlanta, Georgia
| | - Regina M. Simeone
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, Florida
| | - Allen A. Mitchell
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | - Tiffany Riehle-Colarusso
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kara N. Polen
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennita Reefhuis
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Tabb KM, Hsieh WJ, Gavin AR, Eigbike M, Faisal-Cury A, Hajaraih SKM, Huang WHD, Laurent H, Carter D, Nidey N, Ryckman K, Zivin K. Racial differences in immediate postpartum depression and suicidal ideation among women in a Midwestern delivery hospital. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020. [DOI: 10.1016/j.jadr.2020.100008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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74
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Franco C, Mowers E, Lewis DL. Equitable Care for Pregnant Incarcerated Women: Infant Contact After Birth-A Human Right. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:211-215. [PMID: 33369047 DOI: 10.1363/psrh.12166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Affiliation(s)
| | - Erika Mowers
- Department of Obstetrics and Gynecology, St. Joseph Mercy Hospital, Ann Arbor, MI
| | - Deborah Landis Lewis
- Department of Obstetrics and Gynecology, St. Joseph Mercy Hospital, Ann Arbor, MI
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Zhou Y, Yang G, Peng W, Zhang H, Peng Z, Ding N, Guo T, Cai Y, Deng Q, Chai X. Relationship between Depression Symptoms and Different Types of Measures of Obesity (BMI, SAD) in US Women. Behav Neurol 2020; 2020:9624106. [PMID: 33299495 PMCID: PMC7705436 DOI: 10.1155/2020/9624106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/18/2020] [Accepted: 10/30/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To estimate the relationship between obesity (defined by both BMI and SAD) and various levels of depressive symptoms in women in the United States. METHODS This is a cross-sectional design. All data were collected from NHANES 2011-2012 and 2013-2014. The Patient Health Questionnaire (PHQ-9) was the primary variable used to index depressive symptoms. SAD was assessed using an abdominal caliper. We stratified participates into three groups according to SAD (trisection): T1: low (11.8-18.4 cm), T2: middle (18.5-22.8 cm), and T3: high (22.9-40.1 cm). Other data were collected following the NHANES protocols. We aimed to investigate the effects of obesity on the depression in the NHANES populations. RESULTS A total of 4477 women were enrolled in the final study population. Participants with a high SAD had the highest risk of clinical depression symptoms (OR = 1.2, 95% CI: 1.1-1.4), which was, in particular, the case for moderate-severe depression (OR = 1.4, 95% CI: 1.1-1.7) and severe depression (OR = 1.4, 95% CI: 1.0-1.9). We also found a significant relationship between SAD and BMI (r = 0.836). We did, however, not find a significant relationship between BMI and severe depression. CONCLUSIONS SAD had a better correlation with clinical depression symptoms than BMI, especially regarding severe depression symptoms.
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Affiliation(s)
- Yang Zhou
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Guifang Yang
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Wen Peng
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Hongliang Zhang
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhenyu Peng
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Ning Ding
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Tao Guo
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuzhong Cai
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
| | - Qijian Deng
- Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiangping Chai
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China
- Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China
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Hoffmann E, Vintzileos WS, Akerman M, Vertichio R, Sicuranza GB, Vintzileos AM. Impact of cesarean delivery due to maternal choice on perinatal outcome in term nulliparous patients with a singleton fetus in a vertex presentation. J Matern Fetal Neonatal Med 2020; 35:4156-4161. [PMID: 33172330 DOI: 10.1080/14767058.2020.1847078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objectives of our study were to: (1) evaluate the prevalence of cesarean delivery due to maternal request among nulliparous, term, singleton, vertex (NTSV) patients; (2) identify the clinical profile, if any, of these patients; and (3) compare the perinatal outcomes between NTSV patients who requested a cesarean delivery versus patients who did not request cesarean delivery. STUDY DESIGN This was a retrospective case control study performed at a single institution between November 2018 and July 2019. All NTSV patients who had a cesarean delivery due to maternal choice were identified and compared to the next two NTSV patients in labor who delivered vaginally or by medically indicated cesarean delivery following a cesarean delivery by maternal choice. The primary outcome was composite neonatal morbidity. Secondary outcomes were individual components of composite neonatal and maternal morbidity. RESULTS Of 1138 NTSV patients, 61 (5.4%) patients opted for cesarean delivery by maternal choice. There were significant differences in the demographic/clinical profile between cases and controls including BMI (35.3 kg/m2 vs. 32.7 kg/m2, p < .01), birthweight (3552 gr vs. 3333 gr, p < .001) and documented mental illness (41.0% vs. 22.1% respectively, p < .01). There was no significant difference in composite neonatal morbidity between cases and controls (6.6% vs. 5.7%, adjusted odds ratio [aOR] 0.96, 95% CI 0.25-3.61). The risk for postpartum hemorrhage requiring blood transfusion was higher (but not statistically significant) in the study group (5.0% vs. 0.0%, aOR 6.43, 95% CI: 0.65-63.24). Patients who chose cesarean delivery during the intrapartum period had a higher (but not statistically significant) composite neonatal morbidity (14.3% vs. 5.7%, aOR 2.24, 95% CI 0.52-9.78) and composite maternal morbidity (28.6% vs.11.8%, aOR 2.90, 95% CI 0.92-9.16) and significantly higher transfusion rate (aOR 16.93, 95% CI 1.53-187.74). CONCLUSION Cesarean delivery by maternal choice in NTSV patients is not associated with improved neonatal outcomes; in contrast, it is associated with increased composite maternal morbidity and increased transfusion rate.
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Affiliation(s)
- Eva Hoffmann
- NYU Winthrop Hospital, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, NYU Long Island School of Medicine, Mineola, NY, USA
| | - William S Vintzileos
- NYU Winthrop Hospital, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Meredith Akerman
- NYU Winthrop Hospital, Department of Biostatistics, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Rosanne Vertichio
- NYU Winthrop Hospital, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Genevieve B Sicuranza
- NYU Winthrop Hospital, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Anthony M Vintzileos
- NYU Winthrop Hospital, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health, NYU Long Island School of Medicine, Mineola, NY, USA
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Embryonic exposure to hyper glucocorticoids suppresses brown fat development and thermogenesis via REDD1. Sci Bull (Beijing) 2020; 66:478-489. [PMID: 33936858 DOI: 10.1016/j.scib.2020.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Maternal stress during pregnancy is prevailing worldwide, which exposes fetuses to intrauterine hyper glucocorticoids (GC), programming offspring to obesity and metabolic diseases. Despite the importance of brown adipose tissue (BAT) in maintaining long-term metabolic health, impacts of prenatal hyper GC on postnatal BAT thermogenesis and underlying regulations remain poorly defined. Pregnant mice were administrated with synthetic GC dexamethasone (DEX) at levels comparable to fetal GC exposure of stressed mothers. Prenatal GC exposure dose-dependently reduced BAT thermogenic activity, contributing to lower body temperature and higher mortality of neonates; such difference was abolished under thermoneutrality, underscoring BAT deficiency was the major contributor to adverse changes in postnatal thermogenesis due to excessive GC. Prenatal GC exposure highly activated Redd1 expression and reduced Ppargc1a transcription from the alternative promoter (Ppargc1a-AP) in neonatal BAT. During brown adipocyte differentiation, ectopic Redd1 expression reduced Ppargc1a-AP expression and mitochondrial biogenesis; and the inhibitory effects of GC on mitochondrial biogenesis and Ppargc1a-AP expression were blocked by Redd1 ablation. Redd1 reduced protein kinase A phosphorylation and suppressed cyclic adenosine monophosphate (cAMP) -responsive element-binding protein (CREB) binding to the cAMP regulatory element (CRE) in Ppargc1a-AP promoter, leading to Ppargc1a-AP inactivation. In summary, excessive maternal GC exposure during pregnancy dysregulates Redd1-Ppargc1a-AP axis, which impairs fetal BAT development, hampering postnatal thermogenic adaptation and metabolic health of offspring.
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Barber KS, Brunner Huber LR, Portwood SG, Boyd AS, Smith J, Walker LS. The Association between Having a Preterm Birth and Later Maternal Mental Health: An Analysis of U.S. Pregnancy Risk Assessment Monitoring System Data. Womens Health Issues 2020; 31:49-56. [PMID: 32972809 DOI: 10.1016/j.whi.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 08/14/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Although previous studies have found a relationship between having a preterm birth and maternal depression, methodologic issues may have limited the generalizability of results. Thus, the purpose of this study was to evaluate the relationship between having a preterm birth and postpartum depressive symptoms using a large, population-based sample of U.S. women. METHODS This secondary data analysis used 2012-2014 U.S. Pregnancy Risk Assessment Monitoring System data (N = 89,366). Data on the exposure, preterm birth, were obtained from birth certificates. Infants born at 32 to less than 37 weeks' gestation were considered moderate to late preterm, infants born at 28 to less than 32 full weeks' gestation were considered very preterm, and infant born at less than 28 full weeks' gestation were considered extremely preterm. To assess the outcome, two Pregnancy Risk Assessment Monitoring System questions measuring postpartum depressive symptoms were used. Logistic regression was used to calculate unadjusted and adjusted odds ratios (ORs) and 95% confidence interval (CIs). RESULTS After adjustment for confounders, the relationship between having a preterm birth and maternal hopelessness was statistically significant for those who had very preterm and extremely preterm births (moderate to late preterm OR, 1.19; 95% CI, 1.00-1.42; very preterm OR, 1.28; 95% CI, 1.04-1.58; extremely preterm OR, 1.81; 95% CI, 1.31-2.49). In addition, after adjustment, findings indicated no association between preterm birth and maternal loss of interest (extremely preterm OR, 0.85 95% CI, 0.60-1.19; very preterm OR, 1.04; 95% CI, 0.86-1.26; preterm OR, 0.95; 95% CI, 0.82-1.10). CONCLUSIONS Given the statistically significant increased association between having a preterm birth and postpartum depressive symptoms, health professionals may consider implementing comprehensive screening for depression and other mental illnesses among women who give birth prematurely. Findings may also inform future interventions to emphasize the importance of postpartum care among women who have experienced preterm birth.
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Affiliation(s)
| | | | - Sharon G Portwood
- Department of Public Health Sciences, UNC Charlotte, Charlotte, North Carolina
| | - A Suzanne Boyd
- Department of Public Health Sciences, UNC Charlotte, Charlotte, North Carolina
| | - JaneDiane Smith
- Department of Special Education & Child Development, UNC Charlotte, Charlotte, North Carolina
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Porthan E, Lindberg M, Ekholm E, Scheinin NM, Karlsson L, Karlsson H, Härkönen J. Parental divorce in childhood does not independently predict maternal depressive symptoms during pregnancy. BMC Pregnancy Childbirth 2020; 20:520. [PMID: 32894091 PMCID: PMC7487523 DOI: 10.1186/s12884-020-03227-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background This study sought to investigate if parental divorce in childhood increases the risk for depressive symptoms in pregnancy. Methods Women were recruited during their ultrasound screening in gestational week (gwk) 12. The final study sample consisted of 2,899 pregnant women. Questionnaires (including the Edinburgh Postnatal Depression Scale) were completed at three measurement points (gwk 14, 24 and 34). Prenatal depressive symptoms were defined as Edinburgh Postnatal Depression Scale score ≥ 13. Parental divorce and other stressful life events in childhood were assessed at gwk 14. Parental divorce was defined as separation of parents who were married or cohabiting. Questionnaire data was supplemented with data from Statistics Finland and the Finnish Medical Birth Register. Results Parental divorce in childhood increased the risk for depressive symptoms during pregnancy (OR 1.47; 95% CI 1.02–2.13), but the connection was no longer significant after adjusting for socioeconomic status, family conflicts and witnessing domestic violence in the childhood family (OR 0.80; 95% CI 0.54–1.18). Conclusions Parental divorce alone does not predict depressive symptoms during pregnancy.
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Affiliation(s)
- Elviira Porthan
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center and Centre for Population Health Research, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20520, Turku, Finland.
| | - Matti Lindberg
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center and Centre for Population Health Research, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20520, Turku, Finland.,Faculty of Social Sciences, Department of Social Research, University of Turku, Turku, Finland
| | - Eeva Ekholm
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center and Centre for Population Health Research, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20520, Turku, Finland.,Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Noora M Scheinin
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center and Centre for Population Health Research, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20520, Turku, Finland.,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center and Centre for Population Health Research, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20520, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital and University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center and Centre for Population Health Research, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20520, Turku, Finland.,Department of Psychiatry, Turku University Hospital and University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Juho Härkönen
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center and Centre for Population Health Research, Department of Clinical Medicine, University of Turku, Lemminkäisenkatu 3, 20520, Turku, Finland.,Department of Political and Social Sciences, European University Institute, Firenze, Italy.,Department of Sociology, Stockholm University, Stockholm, Finland
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Wiggins LD, Rubenstein E, Daniels J, DiGuiseppi C, Yeargin-Allsopp M, Schieve LA, Tian LH, Sabourin K, Moody E, Pinto-Martin J, Reyes N, Levy SE. A Phenotype of Childhood Autism Is Associated with Preexisting Maternal Anxiety and Depression. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:731-740. [PMID: 30128718 DOI: 10.1007/s10802-018-0469-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study explored whether ASD phenotypes in the child were associated with a history of anxiety or depression in the mother. We hypothesized that an ASD profile in children characterized by mild delays and increased rates of dysregulation would be associated with preexisting maternal anxiety or depression. Participants were 672 preschool children with ASD and their mothers. Children were classified as ASD after a comprehensive developmental evaluation. Mothers reported whether a healthcare provider ever diagnosed them with anxiety or depression before the birth of their child. Four child ASD phenotypes were derived from latent class analysis: Mild Language Delay with Cognitive Rigidity (Type 1), Significant Developmental Delay with Repetitive Motor Behaviors (Type 2), General Developmental Delay (Type 3), and Mild Language and Motor Delay with Dysregulation (i.e., aggression, anxiety, depression, emotional reactivity, inattention, somatic complaints, and sleep problems) (Type 4). Type 2 ASD served as the referent category in statistical analyses. Results showed that 22.6% of mothers reported a diagnosis of anxiety or depression before the birth of their child. Maternal anxiety or depression was associated with 2.7 times the odds (95% confidence interval: 1.4, 5.3) of Type 4 or Dysregulated ASD in the child; maternal anxiety and depression was associated with 4.4 times the odds (95% confidence interval: 1.4, 14.0) of Type 4 or Dysregulated ASD in the child. Our findings suggest an association between Dysregulated ASD in the child and anxiety and depression in the mother. These findings can enhance screening methods and inform future research efforts.
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Affiliation(s)
- Lisa D Wiggins
- NCBDDD, Centers for Disease Control and Prevention, 4770 Buford Highway MS E-86, Atlanta, GA, 30341, USA.
| | | | | | | | - Marshalyn Yeargin-Allsopp
- NCBDDD, Centers for Disease Control and Prevention, 4770 Buford Highway MS E-86, Atlanta, GA, 30341, USA
| | - Laura A Schieve
- NCBDDD, Centers for Disease Control and Prevention, 4770 Buford Highway MS E-86, Atlanta, GA, 30341, USA
| | - Lin H Tian
- NCBDDD, Centers for Disease Control and Prevention, 4770 Buford Highway MS E-86, Atlanta, GA, 30341, USA
| | | | - Eric Moody
- University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | | | - Nuri Reyes
- University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Susan E Levy
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Grisbrook MA, Letourneau N. Improving maternal postpartum mental health screening guidelines requires assessment of post-traumatic stress disorder. Canadian Journal of Public Health 2020; 112:240-243. [PMID: 32780347 DOI: 10.17269/s41997-020-00373-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022]
Abstract
Post-traumatic stress disorder (PTSD) has a prevalence of 4-17% in the postpartum period and, like better known postpartum depression (PPD), is linked to reduced quality maternal-child interactions, decreased maternal sense of life satisfaction and functioning, and negative impacts on child development. Currently, provincial and public health organizations throughout Canada screen new mothers for PPD with the Edinburgh Postpartum Depression Scale, which while laudable does not capture PTSD. PTSD is highly associated with PPD, 65% of women with PTSD also present with PPD, presenting a significant gap in postpartum maternal mental health screening. Numerous self-report PTSD screening questionnaires are available that could be incorporated into routine maternal postpartum mental health care. Furthermore, across Canada, regional differences in availability of maternal mental health screening, services, and programs suggest a gap in one of the tenets of Canadian health care-lack of universality. Not only does Canada require national maternal mental health screening, service and program guidelines, but PTSD screening must be incorporated, in order to identify and treat new mothers experiencing mental health problems.
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Affiliation(s)
- Marie-Andrée Grisbrook
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada. .,Child Development Centre, ACHRI Owerko Centre, 3rd floor, 2888 Shaganappi Trail, Calgary, AB, T3B 6A8, Canada.
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Child Development Centre, ACHRI Owerko Centre, 3rd floor, 2888 Shaganappi Trail, Calgary, AB, T3B 6A8, Canada.,Department of Pediatrics and Department of Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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82
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Swami V, Vintila M, Goian C, Tudorel O, Bucur V. Mental Health Literacy of Maternal and Paternal Postnatal Depression in a Community Sample of Romanian Adults. ACTA ACUST UNITED AC 2020. [DOI: 10.1037/ipp0000130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Postnatal depression affects a large proportion of Romanian parents, but no existing research has examined knowledge of postnatal depression in Romanian adults. To rectify this, we examined the ability of Romanian adults to correctly identify cases of maternal and paternal postnatal depression, as well as attitudes toward cases of postnatal depression. A total of 1,248 Romanian adults were presented with vignettes describing cases of maternal or paternal postnatal depression. Based on the vignettes, participants were asked to report if they thought anything was wrong with the targets and, if so, to describe what they thought was wrong. Participants also rated the targets on several attitudinal dimensions. Participants were more likely to indicate that something was wrong when the target was female (67.9%) compared with male (46.4%). Of those who believed something was wrong, 57.7% of participants correctly described the female target as experiencing postnatal depression, but only 37.1% did so for the male target. Women held significantly more positive attitudes toward the targets than men, particularly when the target was female. Mental health literacy of postnatal depression appears to be poor in Romanian adults compared with other national groups, especially in the case of paternal postnatal depression.
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Affiliation(s)
- Viren Swami
- Division of Psychology and Sport Science, Anglia Ruskin University, and Centre for Psychological Medicine, Perdana University
| | - Mona Vintila
- Department of Psychology, West University of Timișoara
| | - Cosmin Goian
- Department of Social Work, West University of Timișoara
| | | | - Venera Bucur
- Department of Social Work, West University of Timișoara
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83
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Masters GA, Li N, Lapane KL, Liu SH, Person SD, Byatt N. Utilization of Health Care Among Perinatal Women in the United States: The Role of Depression. J Womens Health (Larchmt) 2020; 29:944-951. [PMID: 32077784 PMCID: PMC7371545 DOI: 10.1089/jwh.2019.7903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: Individuals with depression have increased nonpsychiatric health care utilization. Associations between depression and utilization have not been studied in perinatal women, despite their heightened depression risk. We examined patterns of nonpsychiatric health care utilization by symptoms of perinatal depression, expecting more frequent use of acute services while being less likely to have routine medical care. Materials and Methods: We identified 1,103 perinatal participants from the 2005 to 2016 National Health and Nutrition Examination Surveys. The Patient Health Questionnaire was used to identify depression (score ≥10). We evaluated associations between perinatal depressive symptoms and health care utilization using logistic models and relative excess risk due to interaction (RERI) using adjusted models with appropriate weighting to provide national estimates. Results: Among perinatal U.S. women, 7.3% had depressive symptoms. Relative to those without these symptoms, women experiencing depressive symptoms were younger, more impoverished, and uninsured (p < 0.05). Women with depressive symptoms, compared with those without them, had twice the odds of being without routine medical care (21.6% vs. 12.5%, adjusted odds ratio [aOR]: 2.1, 95% confidence interval [CI]: 1.1 to 4.1) and of using urgent care more frequently (26.5% vs. 15.1%, aOR: 1.9, 95% CI: 1.0 to 3.9). Depressive symptoms combined with lack of insurance generally increased the odds of not having routine care (RERI: 8.4, 95% CI: -0.5 to 17.3) and more frequent use of urgent care (RERI: 7.1, 95% CI: -2.7 to 17.0). Conclusions: Perinatal depression is a prevalent, high-risk illness that requires more nonpsychiatric services and increased psychiatric care. Approaches that facilitate establishing a place for routine care and decreasing acute care use are necessary.
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Affiliation(s)
- Grace A. Masters
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nienchen Li
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kate L. Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Shao-Hsien Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sharina D. Person
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts
- UMass Memorial Health Care, Worcester, Massachusetts
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Saleh ZT, Elshatarat RA, Ebeid IA, Aljohani MS, Al-Za'areer MS, Alhujaili AD, Al Tarawneh NS, Abu Raddaha AH. Caring for Women With Postpartum Depression in Saudi Arabia: Nurses' and Midwives' Opinions About Their Roles. J Psychosoc Nurs Ment Health Serv 2020; 58:42-51. [PMID: 32396208 DOI: 10.3928/02793695-20200506-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 04/14/2020] [Indexed: 11/20/2022]
Abstract
The current cross-sectional study was conducted to investigate nurses' and midwives' opinions about their roles in caring for women with postpartum depression (PPD) in Saudi Arabia. Convenience sampling was used to recruit 181 nurses and 141 midwives. A self-administered questionnaire was used to collect data. Participants lacked experience assessing and managing PPD and providing health education and counseling to mothers about PPD. Moreover, participants underestimated the importance of their roles in preventing PPD risk factors, and detecting, assessing, and managing PPD. Findings show significant differences between nurses' and midwives' opinions, with more frequency of agreement among nurses than midwives regarding their roles in caring for women with PPD. Continuing health education programs for nurses and midwives are recommended to improve knowledge, skills, and awareness of their roles in assessing and managing PPD. [Journal of Psychosocial Nursing and Mental Health Services, 58(7), 42-51.].
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85
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Bauman BL, Ko JY, Cox S, D'Angelo Mph DV, Warner L, Folger S, Tevendale HD, Coy KC, Harrison L, Barfield WD. Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression - United States, 2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:575-581. [PMID: 32407302 PMCID: PMC7238954 DOI: 10.15585/mmwr.mm6919a2] [Citation(s) in RCA: 195] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Perinatal depression is a complication of pregnancy that can result in adverse maternal and infant outcomes. Screening to identify pregnant and postpartum women with depressive symptoms is recommended to provide diagnosis, treatment, and follow-up care to reduce poor outcomes. Methods CDC analyzed 2018 data from the Pregnancy Risk Assessment Monitoring System to describe postpartum depressive symptoms (PDS) among women with a recent live birth and to assess whether health care providers asked women about depression during prenatal and postpartum health care visits, by site and maternal and infant characteristics. Results Among respondents from 31 sites, the prevalence of PDS was 13.2%, ranging from 9.7% in Illinois to 23.5% in Mississippi. The prevalence of PDS exceeded 20% among women who were aged ≤19 years, were American Indian/Alaska Native, smoked during or after pregnancy, experienced intimate partner violence before or during pregnancy, self-reported depression before or during pregnancy, or whose infant had died since birth. The prevalence of women reporting that a health care provider asked about depression during prenatal care visits was 79.1% overall, ranging from 51.3% in Puerto Rico to 90.7% in Alaska. The prevalence of women reporting that a provider asked about depression during postpartum visits was 87.4% overall, ranging from 50.7% in Puerto Rico to 96.2% in Vermont. Conclusions and Implications for Public Health Practice The prevalence of self-reported PDS varied by site and maternal and infant characteristics. Whether providers asked women about perinatal depression was not consistent across sites. Provision of recommended screenings and appropriate referrals for diagnosis, treatment, and follow-up care can ensure early and effective management of depression to reduce adverse maternal and infant outcomes.
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Affiliation(s)
- Brenda L Bauman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Jean Y Ko
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Shanna Cox
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Denise V D'Angelo Mph
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Suzanne Folger
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Heather D Tevendale
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Kelsey C Coy
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Leslie Harrison
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
| | - Wanda D Barfield
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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86
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Marecková K, Klasnja A, Bencurova P, Andrýsková L, Brázdil M, Paus T. Prenatal Stress, Mood, and Gray Matter Volume in Young Adulthood. Cereb Cortex 2020; 29:1244-1250. [PMID: 29425268 DOI: 10.1093/cercor/bhy030] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 01/19/2018] [Indexed: 01/22/2023] Open
Abstract
This study aimed to determine whether prenatal stress, measured by the number of stressful life events during the first 20 weeks of pregnancy, might relate to mood dysregulation and altered brain structure in young adulthood. Participants included 93 young adults from a community-based birth cohort from the Czech Republic. Information on prenatal stress exposure was collected from their mothers in 1990-1992. Magnetic resonance imaging (MRI) and mood-related data were collected from the young adults in 2015. MRI analyses focused on overall gray matter (GM) volume and GM volume of cortical regions previously associated with major depression. Higher prenatal stress predicted more mood dysregulation, lower overall GM volume, and lower GM volume in mid-dorsolateral frontal cortex, anterior cingulate cortex, and precuneus in young adulthood. We observed no prenatal stress by sex interactions for any of the relations. We conclude that prenatal stress is an important risk factor that relates to worse mood states and altered brain structure in young adulthood irrespective of sex. Our results point to the importance and long-lasting effects of prenatal programming and suggest that offspring of mothers who went through substantial stress during pregnancy might benefit from early intervention that would reduce the odds of mental illness in later life.
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Affiliation(s)
- Klára Marecková
- Brain and Mind Research Programme, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Anja Klasnja
- Rotman Research Institute, Baycrest, Toronto, ON, Canada
| | - Petra Bencurova
- Brain and Mind Research Programme, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Lenka Andrýsková
- Research Centre for Toxic Compounds in the Environment (RECETOX), Faculty of Science, MU, Brno, Czech Republic
| | - Milan Brázdil
- Brain and Mind Research Programme, Central European Institute of Technology, Masaryk University, Brno, Czech Republic.,Department of Neurology, St. Anne's University Hospital and Faculty of medicine, MU, Brno, Czech Republic
| | - Tomáš Paus
- Rotman Research Institute, Baycrest, Toronto, ON, Canada.,Departments of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada.,Child Mind Institute, New York, NY, USA
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Abstract
Prenatal care is one of the most widely used preventive care services in the United States, yet prenatal care delivery recommendations have remained largely unchanged since just before World War II. The current prenatal care model can be improved to better serve modern patients and the health care providers who care for them in three key ways: 1) focusing more on promotion of health and wellness as opposed to primarily focusing on medical complications, 2) flexibly incorporating patient preferences, and 3) individualizing care. As key policymakers and stakeholders grapple with higher maternity care costs and poorer outcomes, including lagging access, equity, and maternal and infant morbidity and mortality in the United States compared with other high-income countries, the opportunity to improve prenatal care has been given insufficient attention. In this manuscript, we present a new conceptual model for prenatal care that incorporates both patients' medical and social needs into four phenotypes, and use human-centered design methods to describe how better matching patient needs with prenatal services can increase the use of high-value services and decrease the use of low-value services. Finally, we address some of the key challenges to implementing right-sized prenatal care, including capturing outcomes through research and payment.
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Shore JH, Waugh M, Calderone J, Donahue A, Rodriguez J, Peters D, Thomas M, Giese A. Evaluation of Telepsychiatry-Enabled Perinatal Integrated Care. Psychiatr Serv 2020; 71:427-432. [PMID: 32019433 DOI: 10.1176/appi.ps.201900143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the implementation of the first known telepsychiatry-enabled model of perinatal integrated care and to report initial results following implementation. METHODS Behavioral health screening data were collected from 712 patients at an urban women's clinic, and a more in-depth set of process and outcome measures, including treatment engagement, services utilized, and delivery and postpartum patient outcomes, was collected from 135 patients referred for behavioral health services. Using nationally published metrics to provide context, the authors applied a descriptive design to evaluate and conduct analyses of program outcomes. RESULTS The telehealth-enabled integrated care model was successfully implemented within a specialty obstetrics practice. Identification and treatment of behavioral health issues exceeded nationally published rates. The model was also associated with positive indices related to birth weight and breastfeeding behavior. CONCLUSIONS These initial results point to telepsychiatry as an effective tool for expanding perinatal integrated care and lay the foundation for further study and model refinement. The results also add to the growing body of evidence for the use of telepsychiatry-supported integrated care across diverse clinical settings and patient populations.
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Affiliation(s)
- Jay H Shore
- University of Colorado School of Medicine, Aurora (Shore, Calderone, Thomas, Giese); Colorado Access, Aurora (Shore, Waugh, Donahue, Rodriguez, Peters, Thomas, Giese)
| | - Maryann Waugh
- University of Colorado School of Medicine, Aurora (Shore, Calderone, Thomas, Giese); Colorado Access, Aurora (Shore, Waugh, Donahue, Rodriguez, Peters, Thomas, Giese)
| | - Jacqueline Calderone
- University of Colorado School of Medicine, Aurora (Shore, Calderone, Thomas, Giese); Colorado Access, Aurora (Shore, Waugh, Donahue, Rodriguez, Peters, Thomas, Giese)
| | - Amy Donahue
- University of Colorado School of Medicine, Aurora (Shore, Calderone, Thomas, Giese); Colorado Access, Aurora (Shore, Waugh, Donahue, Rodriguez, Peters, Thomas, Giese)
| | - Jennifer Rodriguez
- University of Colorado School of Medicine, Aurora (Shore, Calderone, Thomas, Giese); Colorado Access, Aurora (Shore, Waugh, Donahue, Rodriguez, Peters, Thomas, Giese)
| | - Danielle Peters
- University of Colorado School of Medicine, Aurora (Shore, Calderone, Thomas, Giese); Colorado Access, Aurora (Shore, Waugh, Donahue, Rodriguez, Peters, Thomas, Giese)
| | - Marshall Thomas
- University of Colorado School of Medicine, Aurora (Shore, Calderone, Thomas, Giese); Colorado Access, Aurora (Shore, Waugh, Donahue, Rodriguez, Peters, Thomas, Giese)
| | - Alexis Giese
- University of Colorado School of Medicine, Aurora (Shore, Calderone, Thomas, Giese); Colorado Access, Aurora (Shore, Waugh, Donahue, Rodriguez, Peters, Thomas, Giese)
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Lin SC, Tyus N, Maloney M, Ohri B, Sripipatana A. Mental health status among women of reproductive age from underserved communities in the United States and the associations between depression and physical health. A cross-sectional study. PLoS One 2020; 15:e0231243. [PMID: 32267903 PMCID: PMC7141664 DOI: 10.1371/journal.pone.0231243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 03/06/2020] [Indexed: 01/19/2023] Open
Abstract
Background In 2017, 46.6 million U.S. adults aged 18 or older self-reported as having mental illness of which 52.0% or 24.2 million are women age 18–49. Perinatal depression and anxiety are linked to adverse outcomes concerning pregnancy, maternal functioning, and healthy child development. Methods and findings Using the 2014 Health Center Patient Survey (HCPS), the objectives of the cross-sectional study are to assess the prevalence of self-reported mental health conditions among female patients of reproductive age and to examine the association between depression and physical health. Physical health conditions of interest included self-rated health, obesity, hypertension, smoking, and diabetes, which all have established associations with potential pregnancy complications and fetal health. The study found 40.8% of patients reported depression; 28.8% reported generalized anxiety; and 15.2% met the criteria for serious psychological distress on the Kessler 6 scale. Furthermore, patients with depression had two to three times higher odds of experiencing co-occurring physical health conditions. Conclusions This study expands the discourse on maternal mental health, throughout the preconception, post-partum, and inter-conception care periods to improve understanding of the inter-correlated physical and mental health issues that could impact pregnancy outcomes and life course trajectory. From 2014 to 2018, the Health Resources and Services Administration (HRSA) has supported investments of nearly $750 million to improve and expand access to mental health and substance use disorder services for prevention, treatment, health education and awareness through comprehensive primary care integration. Moving forward, HRSA will implement strategic training and technical assistance (T/TA) framework that is designed to accelerate the adoption of science driven solutions in primary care in addressing depression for patients with co-occurring chronic conditions and advancing positive maternal outcomes.
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Affiliation(s)
- Sue C. Lin
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
- * E-mail:
| | - Nadra Tyus
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
| | - Maura Maloney
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
| | - Bonnie Ohri
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
| | - Alek Sripipatana
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Office of Quality Improvement, Rockville, MD, United States of America
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90
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Dennis CL, Grigoriadis S, Zupancic J, Kiss A, Ravitz P. Telephone-based nurse-delivered interpersonal psychotherapy for postpartum depression: nationwide randomised controlled trial. Br J Psychiatry 2020; 216:189-196. [PMID: 32029010 DOI: 10.1192/bjp.2019.275] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Postpartum depression and anxiety are under-addressed public health problems with numerous treatment access barriers, including insufficiently available mental health specialist providers. AIMS To examine the effectiveness of nurse-delivered telephone interpersonal psychotherapy (IPT) for postpartum depression. Trial registration ISRCTN88987377. METHOD Postpartum women (n = 241) with major depression (on the Structured Clinical Interview for DSM-IV (SCID-I)) from 36 Canadian public health regions in rural and urban settings were randomly assigned to 12 weekly 60 min nurse-delivered telephone-IPT sessions or standard locally available care. The primary outcome was the proportion of women clinically depressed at 12 weeks post-randomisation, with masked intention-to-treat analysis. Secondary outcomes examined included comorbid anxiety, self-reported attachment and partner relationship quality. RESULTS At 12 weeks, 10.6% of women in the IPT group (11/104) and 35% in the control group (35/100) remained depressed (OR = 0.22, 95% CI 0.10-0.46), with the IPT group 4.5 times less likely to be clinically depressed (SCID); 21.2% in the IPT group and 51% in the control group had an Edinburgh Postnatal Depression Scale (EPDS) score >12 (OR = 0.26, 95% CI 0.14-0.48), and attachment avoidance decreased more in the IPT group than in the control group (P = 0.02). Significant differences favoured the IPT group for comorbid anxiety and partner relationship quality at all time points, with no differences in health service or antidepressant use. None of the IPT responders relapsed by 36 weeks. Between-group SCID differences were sustained at 24 weeks, but not at 36 weeks. CONCLUSIONS Nurse-delivered telephone IPT is an effective treatment for diverse urban and rural women with postpartum depression and anxiety that can improve treatment access disparities.
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Affiliation(s)
- Cindy-Lee Dennis
- Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Women's Health Research Chair, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Sophie Grigoriadis
- Associate Professor of Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Toronto; and Head, Woman's Mood and Anxiety Clinic: Reproductive Transitions, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - John Zupancic
- Associate Professor of Paediatrics, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alex Kiss
- Scientist, Department of Research Design and Biostatistics, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paula Ravitz
- Associate Professor of Psychiatry, Department of Psychiatry, Faculty of Medicine, University of Toronto, Canada; and Morgan Firestone Psychotherapy Chair, Department of Psychiatry, Sinai Health System, Mount Sinai Hospital, Toronto, Canada
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91
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Li X, Gao R, Dai X, Liu H, Zhang J, Liu X, Si D, Deng T, Xia W. The association between symptoms of depression during pregnancy and low birth weight: a prospective study. BMC Pregnancy Childbirth 2020; 20:147. [PMID: 32138708 PMCID: PMC7059656 DOI: 10.1186/s12884-020-2842-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 02/25/2020] [Indexed: 12/04/2022] Open
Abstract
Background Most studies have showed that maternal depression is associated with pregnancy complications. However, there were limited evidences in Chinese population. We examined the associations of antenatal depression symptoms with pregnancy outcomes, especially for low birth weight. Methods A total of 1377 singleton pregnant women were recruited from Nanshan Maternity & Child Healthcare Hospital of Shenzhen in this prospective cohort study. Depression symptoms were assessed by the Edinburgh postnatal depression scale (EPDS) questionnaire in the second trimester of gestation; cut-points for the indication of antenatal depression were ≧12 scores in this study. Socio-demographic data, life-style and pregnancy outcomes were collected through Shenzhen Maternity & Child Healthcare database. The risks of adverse outcomes in pregnant women with antenatal depression were determined by multivariate logistic regression and represented as odds ratio(OR) and 95% confidence interval (CI). Results Of the 1377 subjects, the prevalence of antenatal depression was 19.1%. The EPDS scores were 13.8 ± 2.0 and 6.5 ± 2.9 (P < 0.001) in subjects with and without antenatal depression, respectively. After adjustment for maternal age, education, parity, pre-pregnancy body mass index (BMI), residential area, fetal gender, an EPDS score ≥ 12 (versus. < 12) was associated with an increased risk for low birth weight (odds ratio: 2.05, 95% CI: 1.12–4.64), but not for preterm birth, large for gestational age, small for gestational age or macrosomia. Conclusion Pregnant women presenting antenatal depressive symptoms are at elevated risk of low birth weight. Mental health problems of pregnancy should be addressed for the prevention of low birth weight.
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Affiliation(s)
- Xiuxiu Li
- Nanshan Maternity & Child Healthcare Hospital of Shenzhen, Shenzhen, China
| | - Rui Gao
- Nanshan Maternity & Child Healthcare Hospital of Shenzhen, Shenzhen, China
| | - Xiaowei Dai
- Nanshan Maternity & Child Healthcare Hospital of Shenzhen, Shenzhen, China.
| | - Hong Liu
- Nanshan Maternity & Child Healthcare Hospital of Shenzhen, Shenzhen, China
| | | | - Xuemei Liu
- Nanshan Maternity & Child Healthcare Hospital of Shenzhen, Shenzhen, China
| | - Dongmei Si
- Nanshan Maternity & Child Healthcare Hospital of Shenzhen, Shenzhen, China
| | - Te Deng
- Nanshan Maternity & Child Healthcare Hospital of Shenzhen, Shenzhen, China
| | - Wei Xia
- Nanshan Maternity & Child Healthcare Hospital of Shenzhen, Shenzhen, China
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92
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Ponting C, Mahrer NE, Zelcer H, Schetter CD, Chavira DA. Psychological interventions for depression and anxiety in pregnant Latina and Black women in the United States: A systematic review. Clin Psychol Psychother 2020; 27:249-265. [PMID: 31960525 PMCID: PMC7125032 DOI: 10.1002/cpp.2424] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/10/2020] [Indexed: 12/19/2022]
Abstract
Black women and Latinas have more symptoms of depression and anxiety during pregnancy than do their non-Latina White counterparts. Although effective interventions targeting internalizing disorders in pregnancy are available, they are primarily tested with White women. This article reviews randomized controlled trials and non-randomized studies to better understand the effectiveness of psychological interventions for anxiety and depression during pregnancy in Latinas and Black women. Additionally, this review summarizes important characteristics of interventions such as intervention format, treatment modality, and the use of cultural adaptations. Literature searches of relevant research citation databases produced 68 studies; 13 of which were included in the final review. Most studies were excluded because their samples were not majority Latina or Black women or because they did not test an intervention. Of the included studies, three interventions outperformed a control group condition and showed statistically significant reductions in depressive symptoms. An additional two studies showed reductions in depressive symptoms from pretreatment to post-treatment using non-controlled designs. The remaining eight studies (seven randomized and one non-randomized) did not show significant intervention effects. Cognitive behavioral therapy was the modality with most evidence for reducing depressive symptoms in pregnant Black and Latina women. No intervention was found to reduce anxiety symptoms, although only two of the 13 measured anxiety as an outcome. Five studies made cultural adaptations to their treatment protocols. Future studies should strive to better understand the importance of cultural modifications to improve engagement and clinical outcomes with pregnant women receiving treatment for anxiety and depression.
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Affiliation(s)
- Carolyn Ponting
- Department of Psychology, University of California, Los
Angeles. Los Angeles, CA
| | - Nicole E. Mahrer
- Department of Psychology, University of California, Los
Angeles. Los Angeles, CA
- Department of Psychology, University of La Verne, La Verne,
CA
| | - Hannah Zelcer
- Department of Psychology, University of California, Los
Angeles. Los Angeles, CA
| | | | - Denise A. Chavira
- Department of Psychology, University of California, Los
Angeles. Los Angeles, CA
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93
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Assessing Mothers' Postpartum Depression From Their Infants' Cry Vocalizations. Behav Sci (Basel) 2020; 10:bs10020055. [PMID: 32041121 PMCID: PMC7071351 DOI: 10.3390/bs10020055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 11/17/2022] Open
Abstract
Postpartum Depression (PPD), a condition that affects up to 15% of mothers in high-income countries, reduces attention to the needs of the child and is among the first causes of infanticide. PPD is usually identified using self-report measures and therefore it is possible that mothers are unwilling to report PPD because of a social desirability bias. Previous studies have highlighted the presence of significant differences in the acoustical properties of the vocalizations of infants of depressed and healthy mothers, suggesting that the mothers’ behavior can induce changes in infants’ vocalizations. In this study, cry episodes of infants (N = 56, 157.4 days ± 8.5, 62% firstborn) of depressed (N = 29) and non-depressed (N = 27) mothers (mean age = 31.1 years ± 3.9) are analyzed to investigate the possibility that a cloud-based machine learning model can identify PPD in mothers from the acoustical properties of their infants’ vocalizations. Acoustic features (fundamental frequency, first four formants, and intensity) are first extracted from recordings of crying infants, then cloud-based artificial intelligence models are employed to identify maternal depression versus non-depression from estimated features. The trained model shows that commonly adopted acoustical features can be successfully used to identify postpartum depressed mothers with high accuracy (89.5%). Data Set License: CC-BY-NC
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94
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Taka-Eilola Nèe Riekki T, Veijola J, Miettunen J, Koskela J, Kantojärvi L, Mäki P. Antisocial and borderline personality disorders in the offspring of antenatally depressed mothers - a follow-up until mid-adulthood in the Northern Finland 1966 birth cohort. Nord J Psychiatry 2020; 74:138-146. [PMID: 31647361 DOI: 10.1080/08039488.2019.1681508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Maternal depression is common during pregnancy, affecting 10-15% of mothers. In previous reports, the offspring of antenatally depressed mothers have had an elevated risk for antisocial, criminal and violent behaviour in adolescence, and for borderline personality features in childhood, but long-term outcomes are unknown.Aims: To study whether the adult offspring of antenatally depressed mothers have an elevated risk for antisocial (ASPD) or borderline personality disorder (BPD) when followed until mid-adulthood.Methods: In the general population-based Northern Finland 1966 Birth Cohort, mothers of 12,058 children were asked during mid-gestation if they felt depressed. Of the mothers, 14% reported being depressed. The offspring were followed for 49 years. The diagnoses of in- and outpatient-treated ASPD and BPD in the offspring were detected using the Finnish Care Register for Healthcare. Maternal antenatal smoking, newborn´s low birthweight or short gestational age, father's social class, and family type at birth were considered as confounding variables. Logistic regression analyses on the potential confounders were performed. Maternal postnatal depression and paternal ASPD information was not available.Results: In the male offspring of antenatally depressed mothers, the risk for ASPD was elevated (adjusted odds ratio 5.6; 95% confidence interval 1.8-17.8), but not in female offspring. The risk for BPD was not elevated in the offspring of antenatally depressed mothers in this study.Conclusions: The sons of antenatally depressed mothers had an increased risk for ASPD. Prevention and treatment of antenatal depression might present an opportunity to decrease the risk of antisocial personality in the offspring.
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Affiliation(s)
- Tiina Taka-Eilola Nèe Riekki
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Basic Health Care District of Kallio, Finland
| | - Juha Veijola
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Department of Psychiatry, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jouko Miettunen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Jari Koskela
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - Liisa Kantojärvi
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Pirjo Mäki
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Department of Psychiatry, Oulu University Hospital, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Psychiatry, Länsi-Pohja Healthcare District, Kemi, Finland.,Department of Psychiatry, The Middle Ostrobothnia Central Hospital, Soite Mental Health Services, Joint Municipal Authority of Wellbeing in Raahe District, Mental Health Services and Basic Health Care District of Kallio, Finland.,Department of Psychiatry, Kainuu Central Hospital, Kainuu Social and Healthcare District, Kainuu, Finland
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95
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Ditch S, Roberts TA, Hansen S. The influence of health care utilization on the association between hormonal contraception initiation and subsequent depression diagnosis and antidepressant use. Contraception 2020; 101:237-243. [PMID: 31935385 DOI: 10.1016/j.contraception.2019.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Assess the influence of healthcare utilization on previously reported associations between contraception initiation, diagnosis of depression, and dispensing of antidepressant medications. STUDY DESIGN Retrospective cohort analysis of insurance records from 272,693 women ages 12-34 years old enrolled in the United States Military Healthcare System in September 2014 and followed for 12 months. We compared outcomes of women who initiated hormonal contraception with all women eligible for care and then with women who accessed care during the study month using Kaplan-Meier and Cox proportional hazards analyses. RESULTS Women age 12-34 who initiated hormonal contraception experienced a higher risk of depression diagnosis and antidepressant use when compared to all enrolled women but not when compared to women who accessed care. Among those who accessed care, some progestins (i.e., levonorgestrel, Hazard Ratio (HR) = 1.46, and norelgestromin, HR = 1.93) were associated with an increased rate of depression diagnosis but not antidepressant use; norethindrone (HR = 0.21) was associated with a decreased rate of depression diagnosis. CONCLUSION When compared to women utilizing their health insurance, associations between initiating hormonal contraception and depression diagnosis and antidepressant use decreased or disappeared. This suggests that healthcare utilization may have confounded previous reports of an association between hormonal contraception use and depression and antidepressant use.
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Affiliation(s)
- Sarah Ditch
- Adolescent Medicine, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr., Fort Sam Houston, TX 78234, United States.
| | - Timothy A Roberts
- Adolescent Medicine/Pediatrics, Children's Mercy Kansas City, University of Missouri, Kansas City, School of Medicine, Kansas City, MO, United States.
| | - Shana Hansen
- Adolescent Medicine/Pediatrics, San Antonio Military Medical Center, 3100 Schofield Rd. Bldg. 1179, Fort Sam Houston, TX 78234, United States
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96
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Mirsalimi F, Ghofranipour F, Noroozi A, Montazeri A. The postpartum depression literacy scale (PoDLiS): development and psychometric properties. BMC Pregnancy Childbirth 2020; 20:13. [PMID: 31900131 PMCID: PMC6942397 DOI: 10.1186/s12884-019-2705-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 12/26/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Maternal mental health including postpartum mental health is essential to women's health. This study aimed to develop a specific measure for assessing postpartum depression literacy and consequently evaluate its psychometric properties among a sample of perinatal women. METHODS This investigation was composed of two studies: developing the measure, and evaluating of psychometric properties of the developed questionnaire. In development stage an item pool was created. Then, based on definition of mental health literacy and preliminary screening, an initial questionnaire was developed. The content and face validity of the questionnaire were then assessed. In the second study psychometric properties of the questionnaire were examined. Overall 692 perinatal women with the mean age of 27.63 years (ranging from 17 to 43) participated in the study. RESULTS In all an item pool of 86 items was generated. Of these, 31 items were removed and the remaining 55 items subjected to content and face validity and further 16 items removed. In the second stage a 39-item questionnaire namely the Postpartum Depression Literacy Scale (PoDLis) was evaluated. In principal component factor analysis, 31 items were loaded indicating a 7-factor solution for the questionnaire. The factors designated the following constructs: ability to recognize postpartum depression, knowledge of risk factors and causes, knowledge and belief of self-care activities, knowledge about professional help available, beliefs about professional help available, attitudes which facilitate recognition of postpartum depression and appropriate help-seeking, and knowledge of how to seek information related to postpartum depression. Finally performing the confirmatory factor analysis, the Postpartum Depression Literacy Scale with 31 items was supported for the structures suggested by theoretical model and findings from the exploratory factor analysis. The Cronbach's alpha coefficient for the scale was .78 and it ranged from .70 to .83 for each factor lending support to the internal consistency of the questionnaire. CONCLUSION The findings suggest that the Postpartum Depression Literacy Scale (PoDLiS) is a reliable and valid instrument for measuring the postpartum depression literacy and now can be used in studies of mental health literacy in women.
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Affiliation(s)
- Fatemeh Mirsalimi
- Department of Health Education and Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fazlollah Ghofranipour
- Department of Health Education and Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Azita Noroozi
- Department of Health, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
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97
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Salameh TN, Hall LA. Depression, Anxiety, and Substance Use Disorders and Treatment Receipt Among Pregnant Women in the United States: A Systematic Review of Trend and Population-Based Studies. Issues Ment Health Nurs 2020; 41:7-23. [PMID: 31855501 DOI: 10.1080/01612840.2019.1667460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this systematic review was to synthesize findings of trend and population-based studies on depression, anxiety, and substance use disorders and treatment receipt among pregnant women in the United States. Twenty-eight articles (nine trend studies and 19 population-based studies) were included for review. Two trend studies showed that illicit drug use disorder increased in pregnant women over the past decade, particularly opioid and marijuana use disorders. Three studies reported an increase in treatment admissions for these disorders from 1992 to 2012; however, the overall treatment admission rate for pregnant women remained relatively stable at 4%. Three studies identified an increase in antidepressant use from 1995 to 2010 in pregnant women. Nine of 19 population-based studies revealed that White ethnicity, older reproductive age, college education, and health insurance coverage were associated with mental health and substance use treatment receipt among pregnant women. Further studies are warranted among a nationally representative sample of pregnant women.
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Affiliation(s)
| | - Lynne A Hall
- University of Louisville School of Nursing, Louisville, Kentucky, USA
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98
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Herbell K, Zauszniewski JA, Williams E. Stress and Depressive Symptoms Among Demographically Diverse American Pregnant Women. Issues Ment Health Nurs 2020; 41:73-82. [PMID: 31770053 DOI: 10.1080/01612840.2019.1662145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pregnancy is a sensitive period of life where mental health is of utmost importance to the mother's and child's well-being peripartum and beyond. To better prevent and treat common mental health conditions such as depressive symptoms and perceived stress (defined in this study to encompass psychological and physiological (heart rate variability (HRV)) dimensions), it is crucial to examine and report differences in mental health outcomes among demographically diverse pregnant women. Therefore, the purpose of this secondary analysis (N = 79) was to determine if there are differences in mental health outcomes between pregnant women who differ across demographic factors, as well as to determine if demographic factors predict mental health outcomes when controlling for other demographic variables. Findings indicate that there were significant differences in depressive symptoms and perceived stress by all demographic factors except age. Marital status and total household income were the only significant predictors of depressive symptoms and perceived stress, respectively, when all other factors were controlled. There were no significant differences or correlations between demographic variables and HRV. Pregnant women may be predisposed to adverse mental health outcomes, illustrating the need for more refined interventions that are sensitive to pre-existing factors.
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Affiliation(s)
| | - Jaclene A Zauszniewski
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
| | - Elizabeth Williams
- Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, Ohio, USA
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99
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Januwalla AA, Goldberg AE, Flanders CE, Yudin MH, Ross LE. Reproductive and Pregnancy Experiences of Diverse Sexual Minority Women: A Descriptive Exploratory Study. Matern Child Health J 2019; 23:1071-1078. [PMID: 31055700 DOI: 10.1007/s10995-019-02741-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objectives This study sought to explore how sexual minority women (SMW) and heterosexual women compare in terms of reproductive history, with a particular focus on examining within-group differences among SMW. Methods Women were predominantly recruited through consecutive sampling during presentation for prenatal care in Toronto Canada, and Massachusetts, USA. In total, 96 partnered pregnant women (62 SMW, 34 heterosexual) completed an internet survey during 2013-2015. Results We found few significant differences in reproductive history outcomes when comparing SMW and heterosexual groups. However, when we compared male-partnered SMW to female-partnered SMW, we found potentially important differences in rates of miscarriage and pregnancy complications, indicating that partner gender may be an important contributor to differences in reproductive history among SMW. Conclusions for Practice These findings highlight the need to recognize the unique health risks with which male-partnered SMW may present. Considering that this group is often invisible in clinical practice, the findings from this exploratory study have important implications for providers who treat women during the transition to parenthood. Future research should further examine the differences in social and health access within larger samples of SMW groups, as well as seek to understand the complex relationships between sexual identity and perinatal health for this understudied group of women.
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Affiliation(s)
- Alia A Januwalla
- Dalla Lana School of Public Health, University of Toronto, 155 College Street Room 560, Toronto, ON, M5T 3M7, Canada.
| | - Abbie E Goldberg
- Department of Psychology, Clark University, 950 Main St., Worcester, MA, 01610, USA
| | - Corey E Flanders
- Department of Psychology and Education, Mount Holyoke College, 50 College St., South Hadley, MA, 01075, USA
| | - Mark H Yudin
- Obstetrics, Gynecology, & Reproductive Infectious Diseases, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, 155 College Street Room 560, Toronto, ON, M5T 3M7, Canada
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100
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Woldetsadik AM, Ayele AN, Roba AE, Haile GF, Mubashir K. Prevalence of common mental disorder and associated factors among pregnant women in South-East Ethiopia, 2017: a community based cross-sectional study. Reprod Health 2019; 16:173. [PMID: 31779669 PMCID: PMC6883571 DOI: 10.1186/s12978-019-0834-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 11/05/2019] [Indexed: 12/03/2022] Open
Abstract
Background Mothers suffering from common mental disorder (CMD), such as anxiety and depression may not be able to function properly, which could adversely affect the mother-infant bond and even result in increased infant morbidity and mortality. The purpose of this study was to assess the prevalence of CMD and its determinants among pregnant women in Southeast Ethiopia. Methods Data was collected from 743 pregnant women via interview-administered, standardised questionnaires during Dec–Jan 2017. The WHO Self-Reported Questionnaire (SRQ) was used to screen CMD. Multivariate logistic regression was conducted and ORs and 95% confidence intervals were calculated. Results The prevalence of CMD during pregnancy was 35.8% (95% CI: 34–38%) and the main determinants of CMD were: illiteracy, presence of health risk, financial instability, physical or emotional abuse, having sexual intercourse without her willingness, family history of psychiatric illness and history of chronic medical illness. Conclusion CMD prevalence during pregnancy was high, indicating a need to regularly screen pregnant women for CMD and its determinants as part of routine obstetric care.
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Affiliation(s)
- Ashenafi Mekonnen Woldetsadik
- Department of Midwifery, Madda Walabu University, Goba Referral Hospital, School of Health Science, Bale Goba, Ethiopia
| | - Abebaw Nigussie Ayele
- Department of Physiology, Madda Walabu University, Goba Referral Hospital, School of Medicine, Bale Goba, Ethiopia
| | - Adem Esmael Roba
- Department of Nursing, Madda Walabu University, Goba Referral Hospital, School of Health Science, Bale Goba, Ethiopia
| | - Genet Fikadu Haile
- Department of Midwifery, Madda Walabu University, Goba Referral Hospital, School of Health Science, Bale Goba, Ethiopia
| | - Khan Mubashir
- Department of Biochemistry, Madda Walabu University, Goba Referral Hospital, School of Medicine, Bale Goba, Ethiopia.
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