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Lamsal R, Yeh EA, Pullenayegum E, Ungar WJ. A Systematic Review of Methods and Practice for Integrating Maternal, Fetal, and Child Health Outcomes, and Family Spillover Effects into Cost-Utility Analyses. PHARMACOECONOMICS 2024:10.1007/s40273-024-01397-5. [PMID: 38819718 DOI: 10.1007/s40273-024-01397-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Maternal-perinatal interventions delivered during pregnancy or childbirth have unique characteristics that impact the health-related quality of life (HRQoL) of the mother, fetus, and newborn child. However, maternal-perinatal cost-utility analyses (CUAs) often only consider either maternal or child health outcomes. Challenges include, but are not limited to, measuring fetal, newborn, and infant health outcomes, and assessing their impact on maternal HRQoL. It is also important to recognize the impact of maternal-perinatal health on family members' HRQoL (i.e., family spillover effects) and to incorporate these effects in maternal-perinatal CUAs. OBJECTIVE The aim was to systematically review the methods used to include health outcomes of pregnant women, fetuses, and children and to incorporate family spillover effects in maternal-perinatal CUAs. METHODS A literature search was conducted in Medline, Embase, EconLit, Cochrane Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL), International Network of Agencies for Health Technology Assessment (INAHTA), and the Pediatric Economic Database Evaluation (PEDE) databases from inception to 2020 to identify maternal-perinatal CUAs that included health outcomes for pregnant women, fetuses, and/or children. The search was updated to December 2022 using PEDE. Data describing how the health outcomes of mothers, fetuses, and children were measured, incorporated, and reported along with the data on family spillover effects were extracted. RESULTS Out of 174 maternal-perinatal CUAs identified, 62 considered the health outcomes of pregnant women, and children. Among the 54 quality-adjusted life year (QALY)-based CUAs, 12 included fetal health outcomes, the impact of fetal loss on mothers' HRQoL, and the impact of neonatal demise on mothers' HRQoL. Four studies considered fetal health outcomes and the effects of fetal loss on mothers' HRQoL. One study included fetal health outcomes and the impact of neonatal demise on maternal HRQoL. Furthermore, six studies considered the impact of neonatal demise on maternal HRQoL, while four included fetal health outcomes. One study included the impact of fetal loss on maternal HRQoL. The remaining 26 only included the health outcomes of pregnant women and children. Among the eight disability-adjusted life year (DALY)-based CUAs, two measured fetal health outcomes. Out of 174 studies, only one study included family spillover effects. The most common measurement approach was to measure the health outcomes of pregnant women and children separately. Various approaches were used to assess fetal losses in terms of QALYs or DALYs and their impact on HRQoL of mothers. The most common integration approach was to sum the QALYs or DALYs for pregnant women and children. Most studies reported combined QALYs and incremental QALYs, or DALYs and incremental DALYs, at the family level for pregnant women and children. CONCLUSIONS Approximately one-third of maternal-perinatal CUAs included the health outcomes of pregnant women, fetuses, and/or children. Future CUAs of maternal-perinatal interventions, conducted from a societal perspective, should aim to incorporate health outcomes for mothers, fetuses, and children when appropriate. The various approaches used within these CUAs highlight the need for standardized measurement and integration methods, potentially leading to rigorous and standardized inclusion practices, providing higher-quality evidence to better inform decision-makers about the costs and benefits of maternal-perinatal interventions. Health Technology Assessment agencies may consider providing guidance for interventions affecting future lives in future updates.
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Affiliation(s)
- Ramesh Lamsal
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada.
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Lemon CA, Svob C, Bonomo Y, Dhungana S, Supanya S, Sittanomai N, Diatri H, Haider II, Javed A, Chandra P, Herrman H, Hoven CW, Sartorius N. Priorities for research promoting mental health in the south and east of Asia. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 23:100287. [PMID: 38404519 PMCID: PMC10884971 DOI: 10.1016/j.lansea.2023.100287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 02/27/2024]
Abstract
Progress in promoting mental health, preventing mental illness, and improving care for people affected by mental illness is unlikely to occur if efforts remain separated from existing public health programs and the principles of public health action. Experts met recently to discuss integrating public health and mental health strategies in the south and east of Asia, especially in low- and middle-income countries. Areas of research identified as high priority were: 1) integrating mental health into perinatal care; 2) providing culturally-adjusted support for carers of people with mental and physical disorders; 3) using digital health technologies for mental health care in areas with limited resources and 4) building local research capacity. Selection of these areas was informed by their relative novelty in the region, ease of implementation, likely widespread benefit, and potential low costs. In this article, we summarise available evidence, highlight gaps and call for collaborations with research centres, leaders and persons with lived experience within and beyond the region.
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Affiliation(s)
- Christopher A. Lemon
- NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Connie Svob
- Department of Psychiatry, College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, United States of America
| | - Yvonne Bonomo
- Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Victoria, Australia
- Department of Addiction Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Saraswati Dhungana
- Department of Psychiatry, Institute of Medicine, Tribhuvan University, Nepal
| | - Suttha Supanya
- Somdet Chaopraya Institute of Psychiatry, Department of Mental Health, Bangkok, Thailand
| | - Napat Sittanomai
- Division of Child and Adolescent Psychiatry, Department of Paediatrics, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - Hervita Diatri
- Department of Psychiatry, Faculty Medicine Universitas Indonesia and Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | | | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | - Prabha Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christina W. Hoven
- Department of Psychiatry, College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
- Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, United States of America
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
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Ishitsuka K, Yamamoto-Hanada K, Mezawa H, Yang L, Saito-Abe M, Nishizato M, Sato M, Miyaji Y, Kumasaka N, Ohya Y, Kamijima M, Yamazaki S, Kishi R, Yaegashi N, Hashimoto K, Mori C, Ito S, Yamagata Z, Inadera H, Nakayama T, Iso H, Shima M, Nakamura H, Suganuma N, Kusuhara K, Katoh T. Teenage and young adult pregnancy and depression: findings from the Japan environment and children's study. Arch Womens Ment Health 2024; 27:293-299. [PMID: 37989798 DOI: 10.1007/s00737-023-01400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
Teenage pregnancy increases the threat of depression because of its many factors. Pregnancy during young adulthood may also have several risk factors for depression compared to older pregnancies. However, data on depression in young adult pregnancies are lacking. This study investigated the association between teenage and young adult pregnancy and depression. Data from the Japan Environment and Children's study was used as a nationwide multicenter prospective cohort study. A multivariate logistic regression was performed to investigate the association between age groups (14-19, 20-24, 25-29, 30-34, ≥ 35 years) and depression, adjusted for behavioral and sociodemographic characteristics. Depression was assessed using the Kessler Psychological Distress Scale. In total, 96,808 pregnant women responded to the questionnaire. Teenage (14-19 years) and young adult (20-24 years) pregnancy were associated with an increased risk of depression compared to older pregnancy (≥ 35 years) (teenage: OR 4.28, 95% confidence interval, CI [3.24-5.64]; young adult: OR 3.00, 95% CI [2.64-3.41]). After adjusting for covariates, the magnitude of the risk of depression was attenuated. However, teenage and young adult pregnancy remained at a significantly increased risk of depression compared to older pregnancy (teenage: OR 2.38, 95% CI [1.77-3.21]; young adult: OR 2.14, 95% CI [1.87-2.46]). Our findings indicate that teenage and young adults' pregnancy are at an increased risk of depression compared to older pregnancy. These findings suggest prioritizing teenage and young pregnant women for prevention and interventions related to depression.
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Affiliation(s)
- Kazue Ishitsuka
- JECS Medical Support Center, National Center for Child Health and Development, Tokyo, Japan.
- Department of Social Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, 1578535, Japan.
| | - Kiwako Yamamoto-Hanada
- JECS Medical Support Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hidetoshi Mezawa
- JECS Medical Support Center, National Center for Child Health and Development, Tokyo, Japan
| | - Limin Yang
- JECS Medical Support Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mayako Saito-Abe
- JECS Medical Support Center, National Center for Child Health and Development, Tokyo, Japan
| | - Minaho Nishizato
- JECS Medical Support Center, National Center for Child Health and Development, Tokyo, Japan
| | - Miori Sato
- JECS Medical Support Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yumiko Miyaji
- JECS Medical Support Center, National Center for Child Health and Development, Tokyo, Japan
| | - Natsuhiko Kumasaka
- JECS Medical Support Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- JECS Medical Support Center, National Center for Child Health and Development, Tokyo, Japan
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Platt IS, Pendl-Robinson EL, Dehus E, O'Neil SS, Vohra D, Kenny M, Pentenrieder L, Zivin K. Societal costs of untreated perinatal mood and anxiety disorders in Vermont. Arch Womens Ment Health 2024:10.1007/s00737-024-01429-1. [PMID: 38321244 DOI: 10.1007/s00737-024-01429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/19/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE To estimate the societal costs of untreated perinatal mood and anxiety disorders (PMADs) in Vermont for the 2018-2020 average annual birth cohort from conception through five years postpartum. METHODS We developed a cost analysis model to calculate the excess cases of outcomes attributed to PMADs in the state of Vermont. Then, we modeled the associated costs of each outcome incurred by birthing parents and their children, projected five years for birthing parents who do not achieve remission by the end of the first year postpartum. RESULTS We estimated that the total societal cost of untreated PMADs in Vermont could reach $48 million for an annual birth cohort from conception to five years postpartum, amounting to $35,910 in excess societal costs per birthing parent with an untreated PMAD and their child. CONCLUSION Our model provides evidence of the high costs of untreated PMADs for birthing parents and their children in Vermont. Our estimates for Vermont are slightly higher but comparable to national estimates, which are $35,500 per birthing parent-child pair, adjusted to 2021 US dollars. Investing in perinatal mental health prevention and treatment could improve health outcomes and reduce economic burden of PMADs on individuals, families, employers, and the state.
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Affiliation(s)
- Isabel S Platt
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA.
| | | | - Eric Dehus
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA
| | - Sasigant So O'Neil
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA
| | - Divya Vohra
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA
| | - Michael Kenny
- Vermont Department of Health, 108 Cherry Street, Burlington, VT, 05402, USA
| | - Laura Pentenrieder
- Vermont Department of Health, 108 Cherry Street, Burlington, VT, 05402, USA
| | - Kara Zivin
- Mathematica, 1100 First Street, NE, 12th Floor, Washington, DC, 20002, USA
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Liu Z, Sun L, Yang R, Cui S, Yao G, Liu Y, Liu H. Teenage pregnancy: focus on people with mental disorders. Front Psychiatry 2024; 15:1305572. [PMID: 38370558 PMCID: PMC10869549 DOI: 10.3389/fpsyt.2024.1305572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Affiliation(s)
- Zhiwei Liu
- Department of Psychiatry, The Third People’s Hospital of Fuyang, Fuyang, China
| | - Liang Sun
- Department of Psychiatry, The Third People’s Hospital of Fuyang, Fuyang, China
| | - Rongchun Yang
- Department of Psychiatry, The Third People’s Hospital of Fuyang, Fuyang, China
| | - Shu Cui
- Department of Psychiatry, The Third People’s Hospital of Fuyang, Fuyang, China
| | - Gaofeng Yao
- Department of Psychiatry, The Third People’s Hospital of Fuyang, Fuyang, China
| | - Yun Liu
- Department of Psychiatry, The Third People’s Hospital of Fuyang, Fuyang, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
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Kathono J, Nyongesa V, Mwaniga S, Obonyo G, Yator O, Wambugu M, Banerjee J, Breuer E, Duffy M, Lai J, Levy M, Njuguna S, Kumar M. Adolescent perspectives on peripartum mental health prevention and promotion from Kenya: Findings from a design thinking approach. PLoS One 2024; 19:e0290868. [PMID: 38165879 PMCID: PMC10760697 DOI: 10.1371/journal.pone.0290868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/17/2023] [Indexed: 01/04/2024] Open
Abstract
In Kenya, approximately one in five girls aged 15-19 years old are pregnant or already a mother. Adolescent girls and young women experience significant mental health vulnerabilities during the pregnancy and postpartum periods, leading to poor antenatal and postnatal care attendance and inferior infant and maternal health outcomes. Pregnant adolescents often experience stigma and disenfranchisement due to their pregnancy status and at the same time lack access to mental health support within health settings, schools, religious institutions, and communities. This paper presents the results of qualitative interviews embedded within the human-centered design (HCD) process used to adapt the Helping Adolescents Thrive (HAT) program for Kenyan peripartum adolescents including young fathers. This qualitative study used two phases. First, a HAT advisory group participated in a series of four workshops to help identify and articulate mental health promotion needs and deepened the team's understanding of youth-centered thinking. Second, qualitative interviews were conducted with 39 pregnant and parenting adolescents to understand their perspectives on mental health prevention and promotion. Pregnant and parenting adolescents articulated different needs including poor support, stigma, and psychological disturbances. Parenting adolescents reported disturbed relationships, managing motherhood, poor health, and social empowerment. Participants highlighted sources of stress including economic challenges, fear of delivery, strained relationships, rejection, and stigma. Participants described psychological disturbances such as feeling stressed, worthless, withdrawn, and suicidal. Coping mechanisms reported by participants included engaging in domestic activities, hobbies, and social networking. Peers, family and spirituality were identified as important sources of support, as well as school integration, livelihoods, support groups and mentorships. Findings from this study can be used to strengthen and adapt HAT program, policy and practice for mental health prevention and promotion for pregnant and parenting adolescents.
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Affiliation(s)
| | | | | | | | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | | | - Erica Breuer
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Malia Duffy
- St Ambrose University, Davenport, Iowa, United States of America
- Health Across Humanity, LLC, Boston, Massachusetts, United States of America
| | - Joanna Lai
- UNICEF Headquarters, New York, NY, United States of America
| | - Marcy Levy
- UNICEF Headquarters, New York, NY, United States of America
| | - Simon Njuguna
- Division of Mental Health, Ministry of Health, Nairobi, Kenya
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, United States of America
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7
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Fetene SM, Haile TG, Dadi A. Effect of adverse perinatal outcomes on postpartum maternal mental health in low-income and middle-income countries: a protocol for systematic review. BMJ Open 2023; 13:e074447. [PMID: 38101849 PMCID: PMC10729045 DOI: 10.1136/bmjopen-2023-074447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION More than three-fourths of adverse perinatal outcomes (preterm, small for gestational age, low birth weight, congenital anomalies, stillbirth and neonatal death) occur in low-income and middle-income countries. These adverse perinatal outcomes can have both short-term and long-term consequences on maternal mental health. Even though there are few empirical studies on the effect of perinatal loss on maternal mental illness, comprehensive information on the impact of adverse perinatal outcomes in resource-limited settings is scarce. Therefore, we aim to systematically review and synthesise evidence on the effect of adverse perinatal outcomes on maternal mental health. METHODS AND ANALYSIS The primary outcome of our review will be postpartum maternal mental illness (anxiety, depression, post-traumatic stress disorder and postpartum psychosis) following adverse perinatal outcomes. All peer-reviewed primary studies published in English will be retrieved from databases: PubMed, MEDLINE, CINAHL Ultimate (EBSCO), PsycINFO, Embase, Scopus and Global Health through the three main searching terms-adverse perinatal outcomes, maternal mental illness and settings, with a variant of subject headings and keywords. We will follow the Joanna Briggs Institute critical appraisal checklist to assess the quality of the studies we are including. The review findings will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. Estimate-based meta-analysis will be performed. We will assess heterogeneity between studies using the I2 statistics and publication bias will be checked using funnel plots and Egger's test. A subgroup analysis will be conducted to explore potential sources of heterogeneity (if available). Finally, the certainty of the evidence will be evaluated using the Grading of Recommendations, Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION Since this systematic review does not involve human participants, ethical approval is not required. The review will be submitted for publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023405980.
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Affiliation(s)
| | | | - Abel Dadi
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Regan M, Muhihi A, Saleh A, Duggan CP, Ulenga N, Alwy Al-Beity FM, Aboud S, Fawzi WW, Manji KP, Sudfeld CR. Antenatal depression and adverse birth outcomes among pregnant women living with HIV in Dar es Salaam, Tanzania. J Affect Disord 2023; 339:82-88. [PMID: 37437720 PMCID: PMC10538406 DOI: 10.1016/j.jad.2023.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/28/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Women who experience antenatal depression may be at increased risk of adverse birth outcomes. Few studies have examined this association among women living with HIV (WHIV). METHODS We conducted a prospective cohort study of 2298 pregnant WHIV on antiretroviral therapy (ART) in Dar es Salaam, Tanzania, who were participants in a randomized trial of vitamin D3 supplementation. Depressive symptoms were assessed at 12-27 weeks gestation using the Hopkins Symptoms Checklist (HSCL-25). Generalized estimating equations to account for twins were used to assess the relative risks of adverse birth outcomes. RESULTS Approximately 67 % of the women in our study population reported symptoms consistent with depression. We observed a 4.0 % prevalence of stillbirth and a 25.1 % prevalence of preterm birth. We found that low social support, higher education, and more recent initiation of ART were associated with a greater risk of antenatal depression. There was no association of antenatal depression with risk of fetal loss, stillbirth, low birth weight, birth weight, preterm birth, gestational age at delivery, or small-for-gestational age. LIMITATIONS Depression was self-reported and only collected at one timepoint in pregnancy. Our findings may not be generalizable to all WHIV. CONCLUSIONS Our findings illustrate the high risk of both depression and adverse birth outcomes among WHIV and underscore the need for interventions to improve their mental health and the health of their infants; however, the relationship between depression and birth outcomes remains unclear. Further research on this topic is merited, particularly examining the chronicity and timing of depression in pregnancy.
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Affiliation(s)
- Mathilda Regan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
| | - Alfa Muhihi
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Arvin Saleh
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Christopher P Duggan
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nzovu Ulenga
- Management and Development for Health, Dar es Salaam, Tanzania
| | - Fadhlun M Alwy Al-Beity
- Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Karim P Manji
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
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9
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Langham J, Gurol-Urganci I, Muller P, Webster K, Tassie E, Heslin M, Byford S, Khalil A, Harris T, Sharp H, Pasupathy D, van der Meulen J, Howard LM, O'Mahen HA. Obstetric and neonatal outcomes in pregnant women with and without a history of specialist mental health care: a national population-based cohort study using linked routinely collected data in England. Lancet Psychiatry 2023; 10:748-759. [PMID: 37591294 DOI: 10.1016/s2215-0366(23)00200-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Pregnant women with pre-existing mental illnesses have increased risks of adverse obstetric and neonatal outcomes compared with pregnant women without pre-existing mental illnesses. We aimed to estimate these differences in risks according to the highest level of pre-pregnancy specialist mental health care, defined as psychiatric hospital admission, crisis resolution team (CRT) contact, or specialist community care only, and the timing of the most recent care episode in the 7 years before pregnancy. METHODS Hospital and birth registration records of women with singleton births between April 1, 2014, and March 31, 2018 in England were linked to records of babies and records from specialist mental health services provided by the England National Health Service, a publicly funded health-care system. We compared the risks of adverse pregnancy outcomes, including fetal and neonatal death, preterm birth, and babies being born small for gestational age (SGA; birthweight <10th percentile), and composite indicators for neonatal adverse outcomes and maternal morbidity, between women with and without a history of contact with specialist mental health care. We calculated odds ratios adjusted for maternal characteristics (aORs), using logistic regression. FINDINGS Of 2 081 043 included women (mean age 30·0 years; range 18-55 years; 77·7% White, 11·4% South Asian, 4·7% Black, and 6·2% mixed or other ethnic background), 151 770 (7·3%) had at least one pre-pregnancy specialist mental health-care contact. 7247 (0·3%) had been admitted to a psychiatric hospital, 29 770 (1·4%) had CRT contact, and 114 753 (5·5%) had community care only. With a pre-pregnancy mental health-care contact, risk of stillbirth or neonatal death within 7 days of birth was not significantly increased (0·45-0·49%; aOR 1·11, 95% CI 0·99-1·24): risk of preterm birth (<37 weeks) increased (6·5-9·8%; aOR 1·53, 1·35-1·73), as did risk of SGA (6·2- 7·5%; aOR 1·34, 1·30-1·37) and neonatal adverse outcomes (6·4-8·4%; aOR 1·37, 1·21-1·55). With a pre-pregnancy mental health-care contact, risk of maternal morbidity increased slightly from 0·9% to 1·0% (aOR 1·18, 1·12-1·25). Overall, risks were highest for women who had a psychiatric hospital admission any time or a mental health-care contact in the year before pregnancy. INTERPRETATION Information about the level and timing of pre-pregnancy specialist mental health-care contacts helps to identify women at increased risk of adverse obstetric and neonatal outcomes. These women are most likely to benefit from dedicated community perinatal mental health teams working closely with maternity services to provide integrated care. FUNDING National Institute for Health Research.
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Affiliation(s)
- Julia Langham
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Royal College of Obstetricians and Gynaecologists, London, UK
| | - Ipek Gurol-Urganci
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Royal College of Obstetricians and Gynaecologists, London, UK
| | - Patrick Muller
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Royal College of Obstetricians and Gynaecologists, London, UK
| | - Kirstin Webster
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Emma Tassie
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Margaret Heslin
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sarah Byford
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Asma Khalil
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals, NHS Foundation Trust, London, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Tina Harris
- Centre for Reproduction Research, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Helen Sharp
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, King's College London, London, UK; Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jan van der Meulen
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Royal College of Obstetricians and Gynaecologists, London, UK.
| | - Louise M Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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10
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Adane AA, Shepherd CCJ, Walker R, Bailey HD, Galbally M, Marriott R. Perinatal outcomes of Aboriginal women with mental health disorders. Aust N Z J Psychiatry 2023; 57:1331-1342. [PMID: 36927100 PMCID: PMC10517592 DOI: 10.1177/00048674231160986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Maternal mental disorders have been associated with adverse perinatal outcomes such as low birthweight and preterm birth, although these links have been examined rarely among Australian Aboriginal populations. We aimed to evaluate the association between maternal mental disorders and adverse perinatal outcomes among Aboriginal births. METHODS We used whole population-based linked data to conduct a retrospective cohort study (N = 38,592) using all Western Australia singleton Aboriginal births (1990-2015). Maternal mental disorders were identified based on the International Classification of Diseases diagnoses and grouped into six broad diagnostic categories. The perinatal outcomes evaluated were preterm birth, small for gestational age, perinatal death, major congenital anomalies, foetal distress, low birthweight and 5-minute Apgar score. We employed log-binomial/-Poisson models to calculate risk ratios and 95% confidence intervals. RESULTS After adjustment for sociodemographic factors and pre-existing medical conditions, having a maternal mental disorder in the five years before the birth was associated with adverse perinatal outcomes, with risk ratios (95% confidence intervals) ranging from 1.26 [1.17, 1.36] for foetal distress to 2.00 [1.87, 2.15] for low birthweight. We found similar associations for each maternal mental illness category and neonatal outcomes, with slightly stronger associations when maternal mental illnesses were reported within 1 year rather than 5 years before birth and for substance use disorder. CONCLUSIONS This large population-based study demonstrated an increased risk of several adverse birth outcomes among Aboriginal women with mental disorders. Holistic perinatal care, treatment and support for women with mental disorders may reduce the burden of adverse birth outcomes.
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Affiliation(s)
- Akilew A Adane
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Carrington CJ Shepherd
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Roz Walker
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- School of Indigenous Studies, The University of Western Australia, Crawley, WA, Australia
| | - Helen D Bailey
- Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Megan Galbally
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
- School of Clinical Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Rhonda Marriott
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
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11
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Kwok SWH, Kotz J, Reibel T, Wang G, Walker R, Marriott R. Coupling Machine Learning Models with Innovative Technology-based Screening Tool for Identifying Psychological Distress among Aboriginal Perinatal Mothers. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082817 DOI: 10.1109/embc40787.2023.10340563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Aboriginal perinatal mothers are at a significant risk of experiencing mental health problems, which can have profound negative impacts, despite their overall resilience. This work aimed to build prediction models for identifying high psychological distress among Aboriginal perinatal mothers by coupling machine learning models with an innovative and culturally-safe screening tool. The original dataset of 179 Aboriginal mothers with 337 variables was obtained from twelve perinatal health settings at Perth metropolitan and regional centers in Western Australia between July and September 2022, using a specifically designed web-based rubric for the perinatal mental health assessment. After data preprocessing and feature selection, 23 variables related to emotional manifestations, the problematic partner, worries about daily living, and the need for follow-up wraparound support were identified as significant predictors for the high risk of psychological distress measured by the Kessler 5 plus adaptation. The selected predictors were used to train prediction models, and most of the chosen machine learning models achieved satisfactory results, with Random Forest and Support Vector Machine yielding the highest AUC of over 0.95, accuracy over 0.86, and F1 score above 0.87. This study demonstrates the potential of using machine learning-based models in clinical decision-making to facilitate healthcare and social and emotional well-being for Aboriginal families.
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12
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Adams RS, Akobirshoev I, Brenner LA, Katon JG, Mitra M. Pregnancy, Fetal, and Neonatal Outcomes Among Women With Traumatic Brain Injury. J Head Trauma Rehabil 2023; 38:E167-E176. [PMID: 36731040 PMCID: PMC10102258 DOI: 10.1097/htr.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE There have been no systematic studies of pregnancy outcomes among women with traumatic brain injury (TBI), potentially limiting informed clinical care for women with such injuries. The purpose of this exploratory study was to evaluate pregnancy and fetal/neonatal outcomes among women with a TBI diagnosis recorded during their delivery hospitalization compared with women without TBI. SETTING In this cross-sectional study, we identified women with delivery hospitalizations using 2004-2014 data from the Nationwide Inpatient Sample of the Health Care and Cost Utilization Project. PARTICIPANTS We identified deliveries to women with a TBI diagnosis on hospital discharge records, which included all diagnoses recorded during the delivery, and compared them with deliveries of women without a TBI diagnosis. MAIN MEASURES Pregnancy outcomes included gestational diabetes; preeclampsia/eclampsia; placental abruption; cesarean delivery; and others. Fetal/neonatal outcomes included preterm birth; stillbirth; and small or large gestational age. DESIGN We modeled risk for each outcome among deliveries to women with TBI compared with women without TBI, using multivariate Poisson regression. Models included sociodemographic and hospital characteristics; secondary models added clinical characteristics (eg, psychiatric disorders) that may be influenced by TBI. RESULTS We identified 3 597 deliveries to women with a TBI diagnosis and 9 106 312 deliveries to women without TBI. Women with TBI were at an increased risk for placental abruption (relative risk [RR] = 2.73; 95% CI, 2.26-3.30) and associated sequelae (ie, antepartum hemorrhage, cesarean delivery). Women with TBI were at an increased risk for stillbirth (RR = 2.55; 95% CI, 1.97-3.29) and having a baby large for gestational age (RR = 1.30; 95% CI, 1.09-1.56). Findings persisted after controlling for clinical characteristics. CONCLUSIONS Risk for adverse pregnancy outcomes, including placental abruption and stillbirth, were increased among women with TBI. Future research is needed to examine the association between TBI and pregnancy outcomes using longitudinal and prospective data and to investigate potential mechanisms that may heighten risk for adverse outcomes.
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Affiliation(s)
- Rachel Sayko Adams
- Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Lisa A. Brenner
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jodie G. Katon
- Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, US Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
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13
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Inequities in Availability of Evidence-Based Birth Supports to Improve Perinatal Health for Socially Vulnerable Rural Residents. CHILDREN 2022; 9:children9071077. [PMID: 35884061 PMCID: PMC9324486 DOI: 10.3390/children9071077] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 11/17/2022]
Abstract
Rural residents in the United States (US) have disproportionately high rates of maternal and infant mortality. Rural residents who are Black, Indigenous, and People of Color (BIPOC) face multiple social risk factors and have some of the worst maternal and infant health outcomes in the U.S. The purpose of this study was to determine the rural availability of evidence-based supports and services that promote maternal and infant health. We developed and conducted a national survey of a sample of rural hospitals. We determined for each responding hospital the county-level scores on the 2018 CDC Social Vulnerability Index (SVI). The sample’s (n = 93) median SVI score [IQR] was 0.55 [0.25–0.88]; for majority-BIPOC counties (n = 29) the median SVI score was 0.93 [0.88–0.98] compared with 0.38 [0.19–0.64] for majority-White counties (n = 64). Among counties where responding hospitals were located, 86.2% located in majority-BIPOC counties ranked in the most socially vulnerable quartile of counties nationally (SVI ≥ 0.75), compared with 14.1% of majority-White counties. In analyses adjusted for geography and hospital size, certified lactation support (aOR 0.36, 95% CI 0.13–0.97), midwifery care (aOR 0.35, 95% CI 0.12–0.99), doula support (aOR 0.30, 95% CI 0.11–0.84), postpartum support groups (aOR 0.25, 95% CI 0.09–0.68), and childbirth education classes (aOR 0.08, 95% CI 0.01–0.69) were significantly less available in the most vulnerable counties compared with less vulnerable counties. Residents in the most socially vulnerable rural counties, many of whom are BIPOC and thus at higher risk for poor birth outcomes, are significantly less likely to have access to evidence-based supports for maternal and infant health.
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Barger MK. Current Resources for Evidence-Based Practice, November/December 2021. J Midwifery Womens Health 2021; 66:806-812. [PMID: 34883545 DOI: 10.1111/jmwh.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, California
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15
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Bovbjerg ML. Current Resources for Evidence-Based Practice, November 2021. J Obstet Gynecol Neonatal Nurs 2021; 50:789-800. [PMID: 34653377 DOI: 10.1016/j.jogn.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of autonomy and respect in maternity care and commentaries on reviews focused on whether to induce women who present with mild preeclampsia in the late preterm period and the extent to which urinary incontinence symptoms prevent women from participating in exercise. It also includes a brief update about the USPSTF guidelines on screening for gestational diabetes.
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16
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McDonald SE, Tomlinson CA, Applebaum JW, Moyer SW, Brown SM, Carter S, Kinser PA. Human-Animal Interaction and Perinatal Mental Health: A Narrative Review of Selected Literature and Call for Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10114. [PMID: 34639416 PMCID: PMC8508333 DOI: 10.3390/ijerph181910114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022]
Abstract
There is a paucity of research exploring how relationships with household pets may impact maternal mental health. We are unaware of any study to date that has examined associations between individuals' relationships with their pets and psychological adjustment in the perinatal period. Using a biobehavioral lens, this paper provides a narrative overview of the literature on perinatal mental health and human-animal interaction (HAI). We focus on the role of social relationships, stress, and stress reduction in relation to perinatal mental health; the role of HAI in perceptions of social support, stressors, and stress reduction; and gaps in empirical knowledge concerning the role of HAI in perinatal mental health. Finally, we integrate contemporary biobehavioral models of perinatal mental health and HAI (i.e., Comprehensive Model of Mental Health during the Perinatal Period and the HAI-HPA Transactional Model) to propose a new conceptual framework that depicts ways in which HAI during the perinatal period may influence maternal and child health and wellbeing. To our knowledge, this is the first paper to consider the role of HAI in biobehavioral responses and mental health during the perinatal period. We conclude with recommendations for future research and improved perinatal care.
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Affiliation(s)
- Shelby E. McDonald
- Children, Families, and Animals Research (CFAR) Group, LLC, Richmond, VA 23223, USA
| | - Camie A. Tomlinson
- School of Social Work, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Jennifer W. Applebaum
- Department of Sociology and Criminology & Law, University of Florida, Gainesville, FL 32611, USA;
| | - Sara W. Moyer
- School of Nursing, Virginia Commonwealth University, Richmond, VA 23298, USA; (S.W.M.); (P.A.K.)
| | - Samantha M. Brown
- School of Social Work, Colorado State University, Fort Collins, CO 80523, USA;
| | - Sue Carter
- The Kinsey Institute, Indiana University, Bloomington, IN 47405, USA;
| | - Patricia A. Kinser
- School of Nursing, Virginia Commonwealth University, Richmond, VA 23298, USA; (S.W.M.); (P.A.K.)
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