1
|
Dudeney E, Coates R, Ayers S, McCabe R. Measures of suicidality in perinatal women: A systematic review. J Affect Disord 2023; 324:210-231. [PMID: 36584713 DOI: 10.1016/j.jad.2022.12.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Suicide is a leading cause of death for perinatal women. Identifying women at risk of suicide is critical. Research on the validity and/or reliability of measures assessing suicidality in perinatal women is limited. This review sought to: (1) identify; and (2) evaluate the psychometric properties of suicidality measures validated in perinatal populations. METHODS Nine electronic databases were systematically searched from inception to January 2022. Additional articles were identified through citation tracking. Study quality was assessed using an adapted tool, and the psychometric properties of measures were reviewed and presented using a narrative synthesis. RESULTS A total of 208 studies were included. Thirty-five studies reported psychometric data on ten suicidality measures. Fifteen studies reported both validity and reliability data, 12 reported more than one type of validity, seven validated more than one measure and four only reported reliability. Nearly all measures primarily screened for depression, with an item or subscale assessing suicidal ideation and/or behaviours. Three measures were specifically developed for perinatal women, but only two were validated in more than one study. The Postpartum Depression Screening Scale (PDSS), suicidal thoughts subscale, was validated most frequently. LIMITATIONS Methodological differences and variability between the measures (e.g., suicidality construct assessed, number of items and administration) precluded direct comparisons. CONCLUSION Further validation of suicidality measures is needed in perinatal women. Screening for perinatal suicidality often occurs in the context of depression. The development of a standalone measure specifically assessing suicidality in perinatal women may be warranted, particularly for use in maternity care settings.
Collapse
Affiliation(s)
- Elizabeth Dudeney
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK.
| | - Rose Coates
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Rose McCabe
- Centre for Mental Health Research, School of Health and Psychological Sciences, University of London, UK
| |
Collapse
|
2
|
Léniz-Maturana L, Vilaseca R, Leiva D. Maternal self-efficacy and emotional well-being in Chilean adolescent mothers: the relationship with their children's social-emotional development. PeerJ 2022; 10:e13162. [PMID: 35433128 PMCID: PMC9012175 DOI: 10.7717/peerj.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 03/03/2022] [Indexed: 01/12/2023] Open
Abstract
Background Low maternal self-efficacy and high levels of anxiety, depression, and stress can be triggered in adolescent mothers due to an incomplete development process that makes them physically or psychologically unprepared for the responsibilities of motherhood and parenting. These factors may be linked to difficulties with their children's social-emotional development. The present study aims to: (a) analyze the relationship between maternal self-efficacy and stress, depression, and anxiety levels in low-income adolescent mothers; (b) examine the relationship between maternal self-efficacy and well-being with children's social-emotional development; and (c) describe the effects of maternal self-efficacy on children's social-emotional development, mediated by maternal well-being. Methods A sample of 79 dyads comprising low-income Chilean adolescent mothers aged from 15 to 21 years old (M = 19.1, SD = 1.66) and their children aged 10 to 24 months (M = 15.5, SD = 4.2) participated in this research. A set of psychometric scales was used to measure maternal self-efficacy (Parental Evaluation Scale, EEP), the mothers' anxiety and depression (Hospital Anxiety and Depression Scale, HADS), maternal stress (Parental Stress Scale, PSS), and the children's social-emotional development (Ages and Stages Questionnaire Socio-emotional, ASQ-SE). Bivariate analyses and mediation models were employed to estimate and test the relevant relationships. Results A bivariate analysis showed that maternal self-efficacy was negatively related to the mother's anxiety, depression, and stress. Moreover, there was a significant relationship between maternal self-efficacy and maternal stress, and children's self-regulation and social-emotional development. Maternal self-efficacy, mediated by maternal anxiety, depression, and stress scores, had a significant effect on the development of children's self-regulation. Conclusions The results confirm the importance of adolescent mothers' emotional well-being and maternal self- efficacy with respect to their children's social-emotional development. This makes it necessary to have detailed information about how emotional and self-perception status influences a mother's role in the development of her children.
Collapse
Affiliation(s)
- Laura Léniz-Maturana
- Department of Cognition, Development and Educational Psychology, Universitat de Barcelona, Barcelona, Spain
| | - Rosa Vilaseca
- Department of Cognition, Development and Educational Psychology, Universitat de Barcelona, Barcelona, Spain
| | - David Leiva
- Department of Social Psychology and Quantitative Psychology, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
3
|
Domains of Psychosocial Risk Factors Affecting Young Construction Workers: A Systematic Review. BUILDINGS 2022. [DOI: 10.3390/buildings12030335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Despite being a key provider of employment, construction work significantly contributes to poor mental health among young construction workers worldwide. Although there are studies on the psychosocial risk factors (PRFs) that make young construction workers susceptible to poor mental health, the literature is fragmented. This has obscured a deeper understanding of PRFs and the direction for future research, thus making it challenging to develop appropriate interventions. To address this challenge, we systematically reviewed the literature on young construction workers’ PRFs using meta-aggregation, guided by the PICo, PEO, and PRISMA frameworks. We sought to synthesize the domains of PRFs that affect young construction workers’ mental health, and to determine the relationships between the PRF domains, psychological distress, and poor mental health. A total of 235 studies were retrieved and 31 studies published between 1993 and 2020 met the inclusion criteria. We identified 30 PRFs and categorized them into ten domains, which were further classified into personal, socio-economic, and organizational/industrial factors. The findings of this review contribute to achieving an in-depth understanding of young construction workers’ PRF domains and their patterns of interaction. The findings are also useful to researchers and policymakers for identifying PRFs that are in critical need of attention.
Collapse
|
4
|
Pozuelo JR, Desborough L, Stein A, Cipriani A. Systematic Review and Meta-analysis: Depressive Symptoms and Risky Behaviors Among Adolescents in Low- and Middle-Income Countries. J Am Acad Child Adolesc Psychiatry 2022; 61:255-276. [PMID: 34015483 DOI: 10.1016/j.jaac.2021.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/24/2021] [Accepted: 05/06/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Several studies conducted in high-income countries have found an association between depressive symptoms and risky behaviors among adolescents. Evidence from low- and middle-income countries (LMICs), where 90% of the world's adolescents live, remains scarce. This meta-analysis systematically reviewed evidence examining the association between depressive symptoms and risky behaviors among adolescents in LMICs. METHOD Fifteen electronic databases were searched for published or unpublished cohort and case-control studies about adolescents in LMICs. The primary outcome was the association (odds ratio [OR]) between depressive symptoms and risky sexual behavior and substance use. Secondary outcomes included delinquency, adverse school behavior, self-harm, and suicidal behavior. ORs from all studies were pooled using the random-effects model. Quality of studies was assessed using the Newcastle-Ottawa scale, and strength of the overall body of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS Searches yielded 31,148 potentially relevant studies. After screening, 33 studies were included in the systematic review, of which 30 comprised the meta-analysis. Studies encompassed 35,918 adolescents living in 17 LMICs: 5 from Africa, 7 from Asia, and 5 from Latin America and the Caribbean. Adolescents with depressive symptoms were more likely to engage in risky sexual behavior (OR 1.3 95% CI 1.1-1.5) and substance use (OR 1.8, 95% CI 1.4-2.2) compared with nondepressed adolescents. Results for secondary outcomes showed a similar pattern, with higher delinquency (OR 3.2, 95% CI 1.8-5.6), self-harm (OR 4.4, 95% CI 1.3-14.4), and suicidal behavior (OR 6.6, 95% CI 2.3-18.9) among adolescents with depression compared with healthy adolescents. CONCLUSION This study suggests that adolescents with depression in LMICs carry a double burden: depression and increased risk of engaging in risky behaviors. This combination may lead to further psychological and physical health problems that persist over the life course and may impose a health burden on society as a whole. Taken together, these findings highlight the urgent need for scalable and sustainable approaches to prevent and/or treat depression among adolescents in resource-poor settings.
Collapse
Affiliation(s)
- Julia Ruiz Pozuelo
- University of Oxford, United Kingdom; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of Witwatersrand, Johannesburg, South Africa.
| | - Lucy Desborough
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, Cambridgeshire, United Kingdom
| | - Alan Stein
- University of Oxford, United Kingdom; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of Witwatersrand, Johannesburg, South Africa
| | - Andrea Cipriani
- University of Oxford, United Kingdom; Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| |
Collapse
|
5
|
Öztürk S. Evaluation of the opinions of midwifery students on adolescent pregnancy: A phenomenological qualitative study in eastern Turkey. Eur J Midwifery 2021; 5:49. [PMID: 34734170 PMCID: PMC8544601 DOI: 10.18332/ejm/138593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/09/2021] [Accepted: 06/06/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Adolescent pregnancy is a major health problem that is significantly associated with adverse impacts on the health of both teenage mothers and their newborns. This study was conducted to evaluate the opinions of midwifery students on adolescent pregnancy. METHODS The participants were selected using a purposeful sampling method. Thirty-seven students studying at the final year of the midwifery department were interviewed in the study in Erzurum, Turkey, in 2018. The interviews were analyzed by the phenomenological qualitative method. RESULTS Students thought that adolescent pregnancy was a social problem in addition to its maternal and fetal risks. The students indicated that adolescent pregnancy was perceived as normal in a family in which cultural values were important (especially in those families that live in the Eastern and South-Eastern regions). Only one student attracted attention to the effect of the media in this respect. The students stated that adolescent pregnancy was a social problem, and a multidisciplinary approach was required for its solution. CONCLUSIONS Our qualitative study provides insight into the role of adolescent pregnancy in Turkey. Participants expressed the idea that increasing the education level of girls and raising awareness among mothers may be an effective solution to the problem. The students were aware that adolescent pregnancy was an important social problem.
Collapse
Affiliation(s)
- Sibel Öztürk
- Department of Midwifery, Faculty of Health Sciences, Atatürk University, Erzurum, Turkey
| |
Collapse
|
6
|
Nannini S, Tung I, Northrup JB, Stepp SD, Keenan K, Hipwell AE. Changes in severity of depression and borderline personality disorder symptoms from pregnancy to three years postpartum in adolescent mothers. J Affect Disord 2021; 294:459-463. [PMID: 34325165 PMCID: PMC8410668 DOI: 10.1016/j.jad.2021.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/30/2021] [Accepted: 07/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The transition to motherhood is associated with the emergence or exacerbation of symptoms of emotional distress disorders for many women. Although adolescence is a developmental period of increased risk for mood disorders and emotion dysregulation among women, little is known about changes in emotional distress across the early postpartum years among adolescent mothers. We tested the hypothesis that symptoms of depression and borderline personality disorder (BPD) would differ between pregnant and non-pregnant adolescents, and that these differences would be maintained in the three years following delivery. METHODS Data were drawn from the longitudinal Pittsburgh Girls Study: 307 adolescent mothers (14-18 years) and 307 never-pregnant adolescents, matched on age, race and household receipt of public assistance, self-reported severity of depression and BPD across four years. RESULTS There were no group differences on depression severity during or after pregnancy. However, compared with their non-pregnant peers, pregnant adolescents reported more severe BPD symptoms even after comorbid depression symptoms were accounted for, and this group difference was sustained during the following three years. LIMITATIONS Findings are based on a community sample rather than a clinical sample, which may have limited the severity of symptoms captured. CONCLUSIONS Findings suggest that adolescent mothers are a high-risk group for BPD symptoms during and after pregnancy, highlighting pregnancy as a critical window of opportunity to reduce morbidity among young mothers and potential negative effects on the next generation.
Collapse
Affiliation(s)
- Sierra Nannini
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Irene Tung
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | | | - Stephanie D. Stepp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA,Department of Psychology, University of Pittsburgh, Pittsburgh, PA, Corresponding author: Alison E. Hipwell PhD, ClinPsyD. Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA 15213.
| |
Collapse
|
7
|
Göbel K, Cohrdes C. The whole is greater than the sum of its parts: profiles of multiple mental health risk factors using Latent class analysis. Child Adolesc Psychiatry Ment Health 2021; 15:27. [PMID: 34127038 PMCID: PMC8204434 DOI: 10.1186/s13034-021-00380-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/01/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The exposure to an accumulation of various risk factors during childhood and adolescence relative to a single risk is associated with poorer mental health. Identification of distinct constellations of risk factors is an essential step towards the development of effective prevention strategies of mental disorders. A Latent class analysis (LCA) extracts different combinations of risk factors or subgroups and examines the association between profiles of multiple risk and mental health outcomes. METHODS The current study used longitudinal survey data (KiGGS) of 10,853 German children, adolescents and young adults. The LCA included 27 robust risk and protective factors across multiple domains for mental health. RESULTS The LCA identified four subgroups of individuals with different risk profiles: a basic-risk (51.4%), high-risk (23.4%), parental-risk (11.8%) and social-risk class (13.4%). Multiple risk factors of the family domain, in particular family instability were associated with negative mental health outcomes (e.g. mental health problems, depression, ADHD) and predominately comprised late adolescent girls. The social environment represented a more common risk domain for young males. CONCLUSION The understanding of multiple risk and different risk "profiles" helps to understand and adjust targeted interventions with a focus on vulnerable groups.
Collapse
Affiliation(s)
- Kristin Göbel
- Department of Epidemiology and Health Monitoring, Mental Health Unit, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany
- Present Address: Department of Educational Science and Psychology, Division of Developmental Science and Applied Developmental Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Caroline Cohrdes
- Department of Epidemiology and Health Monitoring, Mental Health Unit, Robert Koch Institute, General-Pape-Straße 62-66, 12101 Berlin, Germany
| |
Collapse
|
8
|
Catamaran T, Savoy C, Layton H, Lipman E, Boylan K, Lieshout RJV. Feasibility of Delivering a Cognitive Behavioural Therapy-Based Resilience Curriculum to Young Mothers by Public Health Nurses. ADOLESCENT PSYCHIATRY 2021. [DOI: 10.2174/2210676611666210111093742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Young mothers have higher rates of mental health problems, yet can be difficult to engage in care. Few interventions exist targeting the full range of mental health problems these women face. While transdiagnostic psychotherapies have been utilized in adolescent groups, they have not been tested in young mothers.
Objective:
Our objective was to examine the feasibility and acceptability of a public health nurse-delivered transdiagnostic CBT-based resilience curriculum for young mothers in a supported school setting, and to determine preliminary estimates of the program’s effects.
Methods:
56 mothers, 21 years of age or younger were recruited from a supported high school program in Canada. Using a pretest/post-test design with no control group, measures of maternal depression, anxiety, emotion regulation, and offspring behaviour were collected immediately before and after the completion of the weekly 10-session intervention.
Results:
The intervention was feasible and acceptable to young mothers. While few statistically significant changes were noted in the complete sample, for those with moderate-severe depression at baseline, program participation resulted in clinically meaningful improvements in depression, anxiety, and emotion regulation.
Conclusion:
Provision of a transdiagnostic CBT-based resilience-building program delivered by public health nurses in a supported school setting was both feasible and well-tolerated. Given the preliminary nature of this study, its clinical utility is unclear, though it may have benefits for young mothers with more significant mental health problems at baseline.
Collapse
Affiliation(s)
- Thyna Catamaran
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Calan Savoy
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Haley Layton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ellen Lipman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Khrista Boylan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Ryan J. Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
9
|
Musyimi CW, Mutiso VN, Nyamai DN, Ebuenyi I, Ndetei DM. Suicidal behavior risks during adolescent pregnancy in a low-resource setting: A qualitative study. PLoS One 2020; 15:e0236269. [PMID: 32697791 PMCID: PMC7375578 DOI: 10.1371/journal.pone.0236269] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background Suicide is one of the most common causes of death among female adolescents. A greater risk is seen among adolescent mothers who become pregnant outside marriage and consider suicide as the solution to unresolved problems. We aimed to investigate the factors associated with suicidal behavior among adolescent pregnant mothers in Kenya. Methods A total of 27 Focus Group Discussions (FGDs) and 8 Key Informant Interviews (KIIs) were conducted in a rural setting (Makueni County) in Kenya. The study participants consisted of formal health care workers and informal health care providers (traditional birth attendants and community health workers), adolescent and adult pregnant and post-natal (up to six weeks post-delivery) women including first-time adolescent mothers, and caregivers (husbands and/or mothers-in-law of pregnant women) and local key opinion leaders. The qualitative data was analyzed using Qualitative Solution for Research (QSR) NVivo version 10. Results Five themes associated with suicidal behavior risk among adolescent mothers emerged from this study. These included: (i) poverty, (ii) intimate partner violence (IPV), (iii) family rejection, (iv) social isolation and stigma from the community, and (v) chronic physical illnesses. Low economic status was associated with hopelessness and suicidal ideation. IPV was related to drug abuse (especially alcohol) by the male partner, predisposing the adolescent mothers to suicidal ideation. Rejection by parents and isolation by peers at school; and diagnosis of a chronic illness such as HIV/AIDS were other contributing factors to suicidal behavior in adolescent mothers. Conclusion Improved social relations, economic and health circumstances of adolescent mothers can lead to reduction of suicidal behaviour. Therefore, concerted efforts by stakeholders including family members, community leaders, health care workers and policy makers should explore ways of addressing IPV, economic empowerment and access to youth friendly health care centers for chronic physical illnesses. Prevention strategies should include monitoring for suicidal behavior risks during pregnancy in both community and health care settings. Additionally, utilizing lay workers in conducting dialogue discussions and early screening could address some of the risk factors and reduce pregnancy- related suicide mortality in LMICs.
Collapse
Affiliation(s)
| | | | - Darius N. Nyamai
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Ikenna Ebuenyi
- Department of Psychology and Assisting Living and Learning Institute, Maynooth University, Maynooth, Ireland
| | - David M. Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- University of Nairobi, Nairobi, Kenya
| |
Collapse
|
10
|
Laurenzi CA, Gordon S, Abrahams N, du Toit S, Bradshaw M, Brand A, Melendez-Torres GJ, Tomlinson M, Ross DA, Servili C, Carvajal-Aguirre L, Lai J, Dua T, Fleischmann A, Skeen S. Psychosocial interventions targeting mental health in pregnant adolescents and adolescent parents: a systematic review. Reprod Health 2020; 17:65. [PMID: 32410710 PMCID: PMC7227359 DOI: 10.1186/s12978-020-00913-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/24/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pregnancy and parenthood are known to be high-risk times for mental health. However, less is known about the mental health of pregnant adolescents or adolescent parents. Despite the substantial literature on the risks associated with adolescent pregnancy, there is limited evidence on best practices for preventing poor mental health in this vulnerable group. This systematic review therefore aimed to identify whether psychosocial interventions can effectively promote positive mental health and prevent mental health conditions in pregnant and parenting adolescents. METHODS We used the standardized systematic review methodology based on the process outlined in the World Health Organization's Handbook for Guidelines Development. This review focused on randomized controlled trials of preventive psychosocial interventions to promote the mental health of pregnant and parenting adolescents, as compared to treatment as usual. We searched PubMed/Medline, PsycINFO, ERIC, EMBASE and ASSIA databases, as well as reference lists of relevant articles, grey literature, and consultation with experts in the field. GRADE was used to assess the quality of evidence. RESULTS We included 17 eligible studies (n = 3245 participants). Interventions had small to moderate, beneficial effects on positive mental health (SMD = 0.35, very low quality evidence), and moderate beneficial effects on school attendance (SMD = 0.64, high quality evidence). There was limited evidence for the effectiveness of psychosocial interventions on mental health disorders including depression and anxiety, substance use, risky sexual and reproductive health behaviors, adherence to antenatal and postnatal care, and parenting skills. There were no available data for outcomes on self-harm and suicide; aggressive, disruptive, and oppositional behaviors; or exposure to intimate partner violence. Only two studies included adolescent fathers. No studies were based in low- or middle-income countries. CONCLUSION Despite the encouraging findings in terms of effects on positive mental health and school attendance outcomes, there is a critical evidence gap related to the effectiveness of psychosocial interventions for improving mental health, preventing disorders, self-harm, and other risk behaviors among pregnant and parenting adolescents. There is an urgent need to adapt and design new psychosocial interventions that can be pilot-tested and scaled with pregnant adolescents and adolescent parents and their extended networks, particularly in low-income settings.
Collapse
Affiliation(s)
- Christina A Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa.
| | - Sarah Gordon
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Nina Abrahams
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Stefani du Toit
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Melissa Bradshaw
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Amanda Brand
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | | | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - David A Ross
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Liliana Carvajal-Aguirre
- Data and Analytics Section, Division of Data, Analysis, Planning and Monitoring, UNICEF Headquarters, New York, USA
| | - Joanna Lai
- Maternal, Newborn and Adolescent Health Unit, Health Section, UNICEF Headquarters, New York, USA
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Alexandra Fleischmann
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| |
Collapse
|
11
|
Rocha AG, de Souza PRA, Wachholz GE, Fraga LR, Sanseverino MTV, Terra AP, da Silva AA, Vianna FSL, Abeche AM, Larrandaburu M, Del Campo M, Schuler-Faccini L. Fetal Alcohol Spectrum Disorders: Health Needs Assessment in Brazil. Alcohol Clin Exp Res 2020; 44:660-668. [PMID: 31984499 DOI: 10.1111/acer.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fetal alcohol syndrome (FAS) is a disorder caused by alterations in embryo-fetal development due to prenatal alcohol exposure. It is estimated that between 0.5 and 2 per 1,000 individuals are born with FAS every year. In Brazil, there are few studies addressing the extent of the problem of FAS/fetal alcohol spectrum disorders (FASD); these studies are confined to limited geographic areas. Therefore, we decided to perform a health needs assessment for FAS/FASD in Brazil. METHODS To estimate the prevalence of FAS and FASD in Brazil, we used information from the literature, which estimates between 0.5 and 2/1,000 births per year for FAS and 10 to 50/1,000 for FASD. RESULTS We estimated that approximately 1,500 to 6,000 children are born with FAS every year. Considering the whole population, the prevalence would be 95,377 to 380,000 affected people. However, when we consider FASD as a whole, we estimate that between 1,900,000 and 9,500,000 Brazilians might suffer the more severe consequences of alcohol exposure during pregnancy and be living with FASD. CONCLUSION The results of the current study indicate that FAS and FASD are prevalent disorders in Brazil, and more policies targeting alcohol intake during pregnancy must be developed.
Collapse
Affiliation(s)
- Anastácia Guimarães Rocha
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Paulo Ricardo Assis de Souza
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gabriela Elis Wachholz
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Rosa Fraga
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Morphological Sciences, Institute of Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Genomic Medicine Laboratory, Experimental Research Center, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Teresa V Sanseverino
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Anna Pires Terra
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - André Anjos da Silva
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,School of Medicine, Univates University, Lajeado, Brazil
| | - Fernanda Sales Luiz Vianna
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alberto Mantovani Abeche
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Miguel Del Campo
- Department of Pediatrics, University of California San Diego, San Diego, California
| | - Lavínia Schuler-Faccini
- From the Brazilian Teratogen Information Service, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Postgraduate Program in Genetics and Molecular Biology, Institute of Biosciencces, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Program in Child and Adolescent Health, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
12
|
Abstract
Background:
Adolescent pregnancy is a major public health concern with medical,
psychiatric, and social implications. Within this population, there is an elevated rate of
co-occurring psychiatric conditions including mood disorders, anxiety disorders, suicidality,
and substance use. However, little is known about the assessment and treatment of adolescent
pregnancy within the context of these co-occurring psychiatric conditions, particularly
in an emergency situation.
Objective:
This article utilizes a case report to illustrate the challenges faced in consultative
psychiatry in the assessment and treatment of a pregnant suicidal youth with a complex psychosocial
history. Topics addressed include: 1) The role of childhood trauma and suicidality
in adolescent pregnancy 2) A consideration of the risks and benefits of treating adolescents
with psychotropics during pregnancy.
Method:
A literature search was performed with the key words of adolescent, pregnancy,
child sexual abuse and psychiatric illness. In addition, expert opinions of a reproductive psychiatrist
and a psychiatrist who had specialized in addiction and adolescents were enlisted on
key aspects of the case formulation and treatment.
Results:
Several studies were found that focused on depression, substance abuse and trauma
in adolescent pregnancy. There were more studies that looked at psychopharmacological
treatment in adult pregnant women and a few that focused on adolescents.
Conclusion:
Addressing the crisis of psychiatric illness in adolescent pregnancy requires a
thorough approach in understanding the severity of the illness and the contribution of child
abuse and suicidality. Psychotherapeutic interventions are most certainly always necessary
and beneficial when dealing with this population. Deciding when to start and maintain medication
during pregnancy should be individualized, with considerations of the risks of untreated
illness and of medication exposure.
Collapse
Affiliation(s)
| | - Faith O. Nomamiukor
- University of North Carolina at Greensboro, Greensboro, North Carolina, United States
| | | | | |
Collapse
|
13
|
Assarsson R, Petersen S, Högberg B, Strandh M, Johansson K. Gender inequality and adolescent suicide ideation across Africa, Asia, the South Pacific and Latin America - a cross-sectional study based on the Global School Health Survey (GSHS). Glob Health Action 2019; 11:1663619. [PMID: 31544685 PMCID: PMC6764350 DOI: 10.1080/16549716.2019.1663619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Suicide ideation is a health issue affecting adolescents worldwide. There are significant variations in suicide ideation between countries and genders, which have not been fully explained. Research is especially lacking in countries outside Europe and North America. Gender equality has been shown to matter in other aspects of adolescent mental health, such as life satisfaction, but has not been researched in relation to suicide ideation at national level. Objective: To investigate how national gender inequality is related to self-reported suicide ideation among adolescents, and whether this association differs between boys and girls. Methods: This is a cross-national, cross-sectional study using individual survey data from the Global School-based Student Health Survey, a survey in Africa, Asia, Latin America and the South Pacific, developed and supported by among others the WHO and the CDC; connecting this to national data: the gender inequality index from the UNDP; controlling for GDP per capita and secondary school enrolment. The data was analysed using a multilevel logistic regression method and included 149,306 students from 37 countries. Results: Higher national gender inequality, as measured by the gender inequality index, was significantly associated with a higher likelihood of suicide ideation in both girls and boys (odds ratio: 1.38 p-value: 0.015), but for girls and both sexes this was only after adjusting for selection bias due to secondary school enrolment (as well as GDP/capita). Interaction models showed that this association was stronger in boys than in girls. Conclusions: National gender inequality seems to be associated with higher levels of suicide ideation among adolescents in mainly low- and middle-income countries, especially among boys.
Collapse
Affiliation(s)
- Rebecka Assarsson
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Solveig Petersen
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| | - Björn Högberg
- Department of Social Work, Umeå University , Umeå , Sweden
| | - Mattias Strandh
- Department of Social Work, Umeå University , Umeå , Sweden.,Center for Research on Child and Adolescent Mental Health, Karlstad University , Karlstad , Sweden
| | - Klara Johansson
- Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden
| |
Collapse
|
14
|
Dinwiddie KJ, Schillerstrom TL, Schillerstrom JE. Postpartum depression in adolescent mothers. J Psychosom Obstet Gynaecol 2018; 39:168-175. [PMID: 28574297 DOI: 10.1080/0167482x.2017.1334051] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Postpartum depression has been extensively studied in adults but is less understood in adolescent mothers, despite a prevalence that is double that observed in adult mothers. The purpose of this review was to describe the epidemiology, risk factors, treatment and prognosis for adolescents with postpartum depression. We also sought to identify limitations of the available literature and propose areas for future study targeting postpartum depression in this vulnerable population. METHODS A Medline literature search was conducted for articles published between 1996 and 2015. We identified relevant studies by combining the indexed search terms 'pregnancy in adolescence or teenage pregnancy' and 'depression or postpartum depression'. Additional studies were identified from references of selected articles. We limited our search results to adolescents (18 years or younger) and English language publications. Case studies/series and editorials were excluded. RESULTS The Medline database search identified 134 articles of which 57 met inclusion criteria. Ten additional articles were identified from reference lists yielding a total of n = 67 articles for review. Among the articles selected, 10 described epidemiology, 27 identified risk factors, nine measured long-term outcome and 21 proposed treatment strategies for postpartum depression in adolescent mothers. CONCLUSIONS There is limited literature addressing adolescent postpartum depression, but there has been a significant growth of interest in recent years. There is a need for more randomized control trials to establish gold standards for assessing postpartum depression in adolescent mothers and standards for treatment in these patients.
Collapse
Affiliation(s)
- Katharine J Dinwiddie
- a Department of Psychiatry , University of Texas Health Science Center at San Antonio , San Antonio , TX , USA
| | - Tracy L Schillerstrom
- a Department of Psychiatry , University of Texas Health Science Center at San Antonio , San Antonio , TX , USA
| | - Jason E Schillerstrom
- a Department of Psychiatry , University of Texas Health Science Center at San Antonio , San Antonio , TX , USA
| |
Collapse
|
15
|
de Matos MB, Scholl CC, Trettim JP, Molina ML, Soares MC, Coelho FT, Castelli RD, da Silva RA, Pinheiro KAT, da Cunha Coelho FM, Quevedo LDA, Pinheiro RT. The perception of parental bonding in pregnant adolescents and its association with generalized anxiety disorder. Eur Psychiatry 2018; 54:51-56. [PMID: 30121505 DOI: 10.1016/j.eurpsy.2018.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The parental bonding is influenced by two dimensions: care and control or protection over the child of both parents. The lack of care during childhood may make the individual more susceptible to the onset of psychiatric disorders when adult. These psychiatric disorders when present during pregnancy may have a negative impact on the health of pregnant women and children. The aim of this study was to assess the association between generalized anxiety disorder (GAD) in pregnant adolescents and the perception of parental bonding. METHODS This is a cross-sectional study with 871 pregnant women under the age of 19, receiving prenatal care in 47 Basic Health Units in the one city, Brazil. The generalized anxiety disorder was measured using the Mini International Neuropsychiatric Interview (MINI) and the perception of parental bonding in childhood using the Parental Bonding Instrument (PBI). RESULTS The prevalence of GAD was 8.5%. Among all the parental bonding dimensions, only a perceived lack of maternal care under 16 years was associated with GAD. CONCLUSIONS The results showed that only the perception of maternal bonding was associated with later GAD. It suggests that an adequate maternal bond is an essential component of psychological health.
Collapse
Affiliation(s)
- Mariana Bonati de Matos
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas (UCPel) - Gonçalves Chaves, 377 - 411 C - CEP: 96015-560 Pelotas, RS Brazil.
| | - Carolina Coelho Scholl
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas (UCPel) - Gonçalves Chaves, 377 - 411 C - CEP: 96015-560 Pelotas, RS Brazil
| | - Jéssica Puchalski Trettim
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas (UCPel) - Gonçalves Chaves, 377 - 411 C - CEP: 96015-560 Pelotas, RS Brazil
| | - Mariane Lopez Molina
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas (UCPel) - Gonçalves Chaves, 377 - 411 C - CEP: 96015-560 Pelotas, RS Brazil
| | - Mariana Carret Soares
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas (UCPel) - Gonçalves Chaves, 377 - 411 C - CEP: 96015-560 Pelotas, RS Brazil
| | - Fernanda Teixeira Coelho
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas (UCPel) - Gonçalves Chaves, 377 - 411 C - CEP: 96015-560 Pelotas, RS Brazil
| | - Rochele Dias Castelli
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas (UCPel) - Gonçalves Chaves, 377 - 411 C - CEP: 96015-560 Pelotas, RS Brazil
| | - Ricardo Azevedo da Silva
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas (UCPel) - Gonçalves Chaves, 377 - 411 C - CEP: 96015-560 Pelotas, RS Brazil
| | - Karen Amaral Tavares Pinheiro
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas (UCPel) - Gonçalves Chaves, 377 - 411 C - CEP: 96015-560 Pelotas, RS Brazil
| | - Fábio Monteiro da Cunha Coelho
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas (UCPel) - Gonçalves Chaves, 377 - 411 C - CEP: 96015-560 Pelotas, RS Brazil
| | - Luciana de Avila Quevedo
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas (UCPel) - Gonçalves Chaves, 377 - 411 C - CEP: 96015-560 Pelotas, RS Brazil
| | - Ricardo Tavares Pinheiro
- Postgraduate Programme in Health and Behavior, Catholic University of Pelotas (UCPel) - Gonçalves Chaves, 377 - 411 C - CEP: 96015-560 Pelotas, RS Brazil
| |
Collapse
|
16
|
Nasreen HE, Rahman JA, Rus RM, Kartiwi M, Sutan R, Edhborg M. Prevalence and determinants of antepartum depressive and anxiety symptoms in expectant mothers and fathers: results from a perinatal psychiatric morbidity cohort study in the east and west coasts of Malaysia. BMC Psychiatry 2018; 18:195. [PMID: 29902985 PMCID: PMC6002988 DOI: 10.1186/s12888-018-1781-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/07/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Research on antepartum psychiatric morbidities investigating depressive and anxiety symptoms in expectant mothers and fathers is lacking in low- and middle-income countries. This study aimed to estimate the prevalence of antepartum depressive, anxiety and co-occurring significant symptoms and explore the associated factors in a cross-section of Malaysian expectant mothers and fathers. METHODS We used cross-sectional data from a prospective cohort study of 911 expectant mothers and 587 expectant fathers during their third trimester of pregnancy, from health clinics of two states in the east and west coasts of Malaysia. The validated Malay version of Edinburgh Postnatal Depression Scale and the anxiety sub-scale of Depression, Anxiety and Stress Scale were used to measure the depressive and anxiety symptoms. Multiple logistic regression analyses identified the determinants of antepartum depressive and anxiety symptoms (ADS and AAS). RESULTS Prevalence of ADS was 12.2% in expectant mothers and 8.4% in expectant fathers, while AAS was 28.8% in expectant mothers and 13.3% in expectant fathers, and co-occurring significant symptoms was 8.0% in expectant mothers and 4.0% in expectant fathers. Expectant mothers and fathers having perceived social/family support were less likely to suffer from ADS. Intimate partner violence, poor relationship with husbands, depression in earlier pregnancy and husband's depression in current pregnancy in expectant mothers, and living in rented house, sex preference for the unborn child, stressful life events and wife's depression in current pregnancy in expectant fathers were associated with a greater likelihood of ADS. The determinants for AAS were living in rented house and with parents/in-laws, poor relationship with husbands, restrictions during pregnancy and stressful life events for expectant mothers, and stressful life events and being unsupportive towards wives in household chores for expectant fathers. CONCLUSION Both ADS and AAS are prevalent in expectant mothers and fathers, and largely an undetected problem in Malaysia. Administration of couple-based screening and referral program during antenatal check-up should be universal practices to identify and treat the psychiatric morbidities.
Collapse
Affiliation(s)
- Hashima E. Nasreen
- Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Jamalludin Ab Rahman
- Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Razman Mohd Rus
- Faculty of Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, 25200 Kuantan, Pahang Malaysia
| | - Mira Kartiwi
- Faculty of Information and Communication Technology, International Islamic University Malaysia, Jalan Gombak, 53100 Kuala Lumpur, Malaysia
| | - Rosnah Sutan
- Community Health Department, Universiti Kebangsaan Malaysia, Bandar Tun Razak Cheras, 56000 Kuala Lumpur, Malaysia
| | - Maigun Edhborg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, SE-141 83 Huddinge, Stockholm, Sweden
| |
Collapse
|
17
|
Chan L, Mohamad Adam B, Norazlin K, Siti Haida M, Lee V, Norazura A, Ek Zakuan K, Tan SM. Suicidal ideation among single, pregnant adolescents: The role of sexual and religious knowledge, attitudes and practices. J Adolesc 2016; 52:162-9. [DOI: 10.1016/j.adolescence.2016.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 08/06/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022]
|
18
|
Fletcher TM, Markley LA, Nelson D, Crane SS, Fitzgibbon JJ. Pregnant Adolescents Admitted to an Inpatient Child and Adolescent Psychiatric Unit: An Eight-Year Review. J Pediatr Adolesc Gynecol 2015; 28:477-80. [PMID: 26233293 DOI: 10.1016/j.jpag.2015.01.005] [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: 09/08/2014] [Revised: 12/03/2014] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To assess patient outcomes and describe demographic data of pregnant adolescents admitted to an inpatient child and adolescent psychiatric unit, as well as to determine if it is safe to continue to admit pregnant adolescents to such a unit. DESIGN, SETTING, AND PARTICIPANTS A descriptive retrospective chart review conducted at a free-standing pediatric hospital in northeast Ohio of all pregnant adolescents aged 13 to 17 years admitted to the inpatient child and adolescent psychiatric unit from July 2005 to April 2013. MAIN OUTCOME MEASURES Data collection included details on demographic, pregnancy status, and psychiatric diagnoses. RESULTS Eighteen pregnant adolescents were admitted to the psychiatric unit during the time frame. Sixteen of those were in the first trimester of pregnancy. Pregnancy was found to be a contributing factor to the adolescent's suicidal ideation and admission in 11 of the cases. Admission to an inpatient psychiatric facility did not lead to adverse effects in pregnancy. CONCLUSION Pregnant adolescents did not have negative pregnancy outcomes related to admission to an inpatient psychiatric unit. Results of this study suggest that it is safe to continue to admit uncomplicated pregnant adolescents in their first trimester to an inpatient child and adolescent psychiatric unit for an acute stay.
Collapse
Affiliation(s)
- Teresa M Fletcher
- Department of Adolescent Medicine, Akron Children's Hospital Medical Center of Akron, Akron, Ohio.
| | - Laura A Markley
- Department of Psychiatry, Akron Children's Hospital Medical Center of Akron, Akron, Ohio
| | - Dana Nelson
- Department of Maternal Fetal Medicine, Akron Children's Hospital Medical Center of Akron, Akron, Ohio
| | - Stephen S Crane
- Department of Maternal Fetal Medicine, Akron Children's Hospital Medical Center of Akron, Akron, Ohio
| | - James J Fitzgibbon
- Department of Adolescent Medicine, Akron Children's Hospital Medical Center of Akron, Akron, Ohio
| |
Collapse
|
19
|
Untreated depression during pregnancy: Short- and long-term effects in offspring. A systematic review. Neuroscience 2015; 342:154-166. [PMID: 26343292 DOI: 10.1016/j.neuroscience.2015.09.001] [Citation(s) in RCA: 252] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 08/28/2015] [Accepted: 09/01/2015] [Indexed: 01/22/2023]
Abstract
Aim of this systematic review is to assess short- and long-lasting effects of antenatal exposure to untreated maternal depressive symptoms. Pertinent articles were identified through combined searches of Science.gov, Cochrane library, and PubMed databases (through August 2015). Forty-three, selected articles revealed that untreated gestational depression and even depressive symptoms during pregnancy may have untoward effects on the developing fetus (hyperactivity, irregular fetal heart rate), newborns (increased cortisol and norepinephrine levels, decreased dopamine levels, altered EEG patterns, reduced vagal tone, stress/depressive-like behaviors, and increased rates of premature deaths and neonatal intensive care unit admission), and children (increased salivary cortisol levels, internalizing and externalizing problems, and central adiposity). During adolescence, an independent association exists between maternal antenatal mood symptoms and a slight increase in criminal behaviors. In contrast, the relationship between gestational depression and increased risks of prematurity and low birth weight remains controversial. Given this background, when making clinical decisions, clinicians should weigh the growing evidences suggesting the detrimental and prolonged effects in offspring of untreated antenatal depression and depressive symptoms during pregnancy against the known and emerging concerns associated with in utero exposure to antidepressants.
Collapse
|
20
|
Martins CDSR, Motta JVDS, Quevedo LA, Matos MBD, Pinheiro KAT, Souza LDDM, Silva RAD, Pinheiro RT, Coelho FMDC. Comparison of two instruments to track depression symptoms during pregnancy in a sample of pregnant teenagers in Southern Brazil. J Affect Disord 2015; 177:95-100. [PMID: 25754606 DOI: 10.1016/j.jad.2015.01.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 01/22/2015] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Depression during pregnancy in adolescents is increasing significantly. However, instruments for early depression screening during prenatal care are scarce. Faced this fact, the objective of this research is to identify the best cutoff points for the Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory (BDI) in a sample of pregnant adolescents. METHOD 807 pregnant adolescents, with a mean age of 17 years, met in public antenatal services were evaluated. Two screening scales for depression were analyzed, EPDS and the BDI. These scales had their accuracy measured by AUC of their ROC curve, as well as their respective sensitivity and specificity. RESULTS In the analysis, the best cutoff for the EPDS was≥10, in which the sensitivity was 81.1% and specificity 82.7%. For the BDI, it was with recognized the cutoff ≥11, sensitivity 86.7% and specificity 73.8%. In the analysis of the ROC AUC, values of 0.89 (CI 0.87-0.92) for the EPDS and BDI for 0.87 (CI 0.84-0.89) were identified compared to the MINI. LIMITATIONS The sample was composed majority by middle and low income adolescent and the study was performed only with pregnant women in the second trimester. CONCLUSIONS The results indicate that both scales have good accuracy in screening of depression in adolescent mothers. However, the EPDS scale shows higher AUC ROC and also better sensitivity and specificity values, the latter being more precise and effective for screening for depression in this population.
Collapse
Affiliation(s)
| | | | - Luciana Avila Quevedo
- Programa de Pós-Graduação em Saúde & Comportamento, Centro de Ciências da Vida e da Saúde, Universidade Católica de Pelotas
| | - Mariana Bonati de Matos
- Programa de Pós-Graduação em Saúde & Comportamento, Centro de Ciências da Vida e da Saúde, Universidade Católica de Pelotas
| | - Karen Amaral Tavares Pinheiro
- Programa de Pós-Graduação em Saúde & Comportamento, Centro de Ciências da Vida e da Saúde, Universidade Católica de Pelotas
| | - Luciano Dias de Mattos Souza
- Programa de Pós-Graduação em Saúde & Comportamento, Centro de Ciências da Vida e da Saúde, Universidade Católica de Pelotas
| | - Ricardo Azevedo da Silva
- Programa de Pós-Graduação em Saúde & Comportamento, Centro de Ciências da Vida e da Saúde, Universidade Católica de Pelotas
| | - Ricardo Tavares Pinheiro
- Programa de Pós-Graduação em Saúde & Comportamento, Centro de Ciências da Vida e da Saúde, Universidade Católica de Pelotas
| | - Fábio Monteiro da Cunha Coelho
- Programa de Pós-Graduação em Saúde & Comportamento, Centro de Ciências da Vida e da Saúde, Universidade Católica de Pelotas.
| |
Collapse
|
21
|
Guimarães MDC, Elkington KS, Gomes ALFM, Veloso C, McKinnon K. HIV sexual risk behavior among emerging adults in psychiatric treatment in Brazil. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2014; 13:451-472. [PMID: 25530731 PMCID: PMC4269266 DOI: 10.1080/15381501.2013.809042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
HIV infection among young populations is increasing worldwide. Adolescents in mental health treatment have demonstrated higher rates of HIV risk behavior than their peers. This first risk behavior study of youth in psychiatric treatment in Brazil reports findings from a cross-sectional national sample of emerging adult psychiatric patients (18-25 years old). The prevalence of lifetime unprotected sex was 65.9%. Multiple logistic regression indicated that being married/in union; sex under the influence of alcohol/drugs; physical violence; earlier sexual debut; and depressive/substance use disorders were associated with unsafe sex. Interventions and services that address these risks during this critical developmental window are urgently needed.
Collapse
Affiliation(s)
- Mark D C Guimarães
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Katherine S Elkington
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University ,New York, USA
| | - Ana Luiza F M Gomes
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Carolina Veloso
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Karen McKinnon
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, USA
| |
Collapse
|
22
|
Coelho FMDC, Pinheiro RT, Silva RA, de Ávila Quevedo L, de Mattos Souza LD, de Matos MB, Castelli RD, Pinheiro KAT. Parental bonding and suicidality in pregnant teenagers: a population-based study in southern Brazil. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1241-8. [PMID: 24562317 DOI: 10.1007/s00127-014-0832-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 02/03/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the associations of the perceived quality of parental bonding with suicidality in a sample of pregnant adolescents. METHODS A cross-sectional study with a sample size of 828 pregnant teenagers receiving prenatal medical assistance in the national public health system in the urban area of Pelotas, southern Brazil. Suicidality and psychiatric disorders were assessed using the Mini International Neuropsychiatric Interview (MINI), and the Parental Bonding Instrument (PBI) was employed to measure the perceived quality of parental bonding. A self-report questionnaire was used to collect sociodemographic, obstetric and other psychosocial data. RESULTS Forty-three (4.94 %) teenagers from a consecutive sample of 871 refused to participate, resulting in 828 participants. Prevalence of suicidality was 13.3 %, lifetime suicide attempts were 7.4 % with 1.3 % reporting attempting suicide within the last month. Significant associations of suicidality with the 18-19-year-old subgroup, low education, prior abortion, physical abuse within the last 12 months were present, and most psychiatric disorders were associated with a higher suicidality prevalence. Additionally, after adjustment in the multivariate analysis, the style of parental bonding was independently associated with suicidality in the pregnant adolescent, with a PR of 2.53 (95 % CI 1.14-5.59) for the maternal 'affectionless control' and a PR of 2.91 (95 % CI 1.10-7.70) for the paternal 'neglectful parenting.' CONCLUSIONS We found that maternal 'affectionless control' and paternal 'neglectful parenting' were independent predictors of suicidality in this sample of pregnant teenagers.
Collapse
Affiliation(s)
- Fábio Monteiro da Cunha Coelho
- Programa de Pós-Graduação em Saúde and Comportamento, Centro de Ciências da Vida e da Saúde, Universidade Católica de Pelotas, Rua Gonçalves Chaves, 373 sala 411C, Pelotas, RS, CEP: 96015-560, Brazil,
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Madigan S, Wade M, Tarabulsy G, Jenkins JM, Shouldice M. Association between abuse history and adolescent pregnancy: a meta-analysis. J Adolesc Health 2014; 55:151-9. [PMID: 25049043 DOI: 10.1016/j.jadohealth.2014.05.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 05/09/2014] [Accepted: 05/09/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Although a purported risk factor for early pregnancy is abuse history, the strength of this association has been inconsistent across studies and may vary as a function of abuse type. The purpose of this meta-analysis was to examine the extent to which sexual, physical, and emotional abuse, as well as neglect, increased the risk of adolescent pregnancy. METHODS A search of studies through MEDLINE, EMBASE, PsycINFO, Social Work Abstracts, and Web of Science was conducted. Studies were retained if they included (1) women who became pregnant before 20 years of age; (2) a comparison group of nonpregnant adolescents; and (3) abuse experience (<18 years of age). RESULTS Thirty-eight independent samples provided 70 estimates of effect sizes, derived from 75,390 participants. Both sexual and physical abuse were associated with an increased risk of adolescent pregnancy (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.75-2.38 and OR, 1.48; CI, 1.24-1.76, respectively). The strongest effect was for the co-occurrence of sexual and physical abuse (OR, 3.83; CI, 2.96-4.97]). Nonsignificant effect sizes were found for emotional abuse (OR, 1.01; CI, .70-1.47) and neglect (OR, 1.29; CI, .77-2.17]), although these were moderated by journal impact factor, that is, greater effect sizes were reported in higher impact journals. CONCLUSIONS The results of this meta-analysis reveal that the strength of the association between abuse and adolescent pregnancy varies as a function of abuse subtype. Sexual and physical abuse were associated with increased risk for adolescent pregnancy, whereas emotional abuse and neglect were not.
Collapse
Affiliation(s)
- Sheri Madigan
- Suspected Child Abuse and Neglect Program, The Hospital for Sick Children, Toronto, Ontario, Canada; Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada.
| | - Mark Wade
- Suspected Child Abuse and Neglect Program, The Hospital for Sick Children, Toronto, Ontario, Canada; Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| | - George Tarabulsy
- Department of Psychology, Laval University, Quebec City, Quebec, Canada
| | - Jennifer M Jenkins
- Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Shouldice
- Suspected Child Abuse and Neglect Program, The Hospital for Sick Children, Toronto, Ontario, Canada; Applied Psychology and Human Development, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
24
|
Siegel RS, Brandon AR. Adolescents, pregnancy, and mental health. J Pediatr Adolesc Gynecol 2014; 27:138-50. [PMID: 24559618 DOI: 10.1016/j.jpag.2013.09.008] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 09/11/2013] [Accepted: 09/12/2013] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE Pregnancy during adolescence is a risk factor for adverse medical and psychosocial outcomes, including psychiatric illness. Psychiatric illness is linked with obstetric complications along with impaired maternal functioning in the postpartum period. This article provides a comprehensive review of the research examining the intersection of psychopathology and adolescent pregnancy and the postpartum period. DESIGN A literature search was conducted using PubMed (Medline), PsycINFO, and CINAHL for articles published between 1990 and 2013 that examined depression, anxiety, bipolar disorder, and psychosis during pregnancy and the postpartum period in adolescents age 21 years or younger. Articles were selected that covered the following topics: Prevalence or incidence, comorbidity, psychosocial correlates, birth outcomes, parenting, child outcomes, and psychosocial treatment. Forty articles were found and reviewed. RESULTS There is a substantial research base examining self-reported depressive symptoms in adolescents during pregnancy and the postpartum period. Existing research suggests that pregnant and parenting adolescents are at greater risk for experiencing depressive symptoms than pregnant and postpartum adult women. Depression in the perinatal period is also a risk factor for substance and alcohol abuse and a harsher parenting style in adolescents. Areas for future research in this population include investigating the prevalence, psychosocial correlates, and outcomes of clinically diagnosed Major Depressive Disorder, developing and empirically validating psychotherapeutic treatments, and focusing upon other psychiatric diagnoses such as bipolar disorder, anxiety, and psychosis.
Collapse
Affiliation(s)
- Rebecca S Siegel
- The University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Anna R Brandon
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
25
|
Psychological health and life experiences of pregnant adolescent mothers in Jamaica. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:4729-44. [PMID: 24785743 PMCID: PMC4053888 DOI: 10.3390/ijerph110504729] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/03/2014] [Accepted: 04/17/2014] [Indexed: 11/17/2022]
Abstract
A recent Jamaican school-based survey revealed that 23.1% of 13–15 year-olds, had attempted suicide one or more times during the last 12 months. Research that links adolescent pregnancy and suicidal behaviour is lacking in Jamaica. Psychological distress and suicidal behaviours amongst pregnant adolescents elsewhere in the Americas has been documented at prevalence of between 13.3%–20%. The purpose of the study was to explore the experiences and the impact of pregnancy on pregnant adolescent psychological health. Individual interviews and focus groups were conducted with adolescents in two Jamaican antenatal clinics. One clinic was designed as a ‘Teen Pregnancy Clinic’ and the other used the standard antenatal clinic design. The following themes were identified: decision-making, resilience, social support, community support system, distress, and perceptions of service. Participants reported positively on the specific interventions tailored to their needs at the Teen Clinic. Although motherhood is valued, none of the pregnancies in this study were planned by the mother. Of the 30 adolescents interviewed, seven cases were referred for counseling due to their need for emotional and psychological support. One of the adolescents reported recent sexual violence and another reported having experienced childhood sexual abuse. Historically, Jamaican adolescent mothers faced barriers to education, self determination, and family planning. Empowering, adolescent-centred healthcare and comprehensive reproductive health education may mitigate psychosocial distress.
Collapse
|
26
|
Major depressive disorder during teenage pregnancy: socio-demographic, obstetric and psychosocial correlates. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35:51-6. [PMID: 23567600 DOI: 10.1016/j.rbp.2012.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 11/10/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To describe the prevalence of Major Depressive Disorder (MDD) during pregnancy in teenage mothers and to assess its association with socio-demographic characteristics, obstetric history and psychosocial variables. METHODS A cross-sectional study was conducted with a sample of pregnant teenagers enrolled in the national public health system in the urban area of Pelotas, southern Brazil. MDD was assessed with the Mini International Neuropsychiatric Interview, the Abuse Assessment Screen was used to identify physical abuse within the last 12 months and during pregnancy, and social support was assessed with the Medical Outcomes Survey Social Support Scale. RESULTS Forty-three (4.94%) potential subjects refused to participate, resulting in 828 total participants. The prevalence of MDD was 17.8%, 9.2% reported they had been subjected to violence within the last 12 months, while 5.8% had suffered violence during pregnancy, and the mean (SD) overall social support score was 87.40 (11.75). After adjustment, we found the highest incidence of MDD in adolescents with less than 8 years of education, followed by those with previous episodes of MDD and those with lower overall social support. CONCLUSIONS MDD is a relatively common condition in pregnant teenagers and appears to be more prevalent in young mothers who are both socioeconomically and psychosocially underprivileged.
Collapse
|
27
|
Tzilos GK, Zlotnick C, Raker C, Kuo C, Phipps MG. Psychosocial factors associated with depression severity in pregnant adolescents. Arch Womens Ment Health 2012; 15:397-401. [PMID: 22777309 PMCID: PMC4026299 DOI: 10.1007/s00737-012-0296-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 06/23/2012] [Indexed: 11/29/2022]
Abstract
Adolescent depression during pregnancy is associated with increased morbidity for the teen and her infant. This cross-sectional study explored the relationships among the independent histories of alcohol use, drug use, depression, and abuse (physical or sexual) on depression severity in a diverse group of 116 pregnant adolescents (mean age = 16) who attended an urban prenatal clinic. Ever having had an alcoholic drink was a significant predictor of higher depressive scores on Children's Depression Rating Scale-Revised, β = 3.3 (0.8, 5.7); p < 0.05. History of abuse was associated with a significant 4.3-point higher mean depressive score, β = 4.3 (1.8, 6.7), p < 0.001, and remained a statistically significant predictor of more severe depressive symptoms after adjustment for history of alcohol use, history of drug use, and history of depression. This study identified that a history of physical or sexual abuse is a significant factor related to the severity of depressive symptoms in pregnant adolescents, independent of a history of alcohol, drug use, or depression. These findings suggest that an assessment of history of alcohol use, as well as abuse history, may increase the likelihood of identifying adolescents at risk for antenatal depression.
Collapse
Affiliation(s)
- Golfo K. Tzilos
- Center for Alcohol and Addiction Studies, Alpert Medical School of Brown University, Box G-S121-4, Providence, RI 02912, USA
| | - Caron Zlotnick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02912, USA; Women and Infants Hospital of Rhode Island, Providence, RI, USA
| | - Christina Raker
- Women and Infants Hospital of Rhode Island, Providence, RI, USA; Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI 02912, USA
| | - Caroline Kuo
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02912, USA; Rhode Island Hospital, Providence, RI, USA
| | - Maureen G. Phipps
- Women and Infants Hospital of Rhode Island, Providence, RI, USA; Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI 02912, USA; Department of Epidemiology, Program in Public Health, Alpert Medical School of Brown University, Providence, RI 02912, USA
| |
Collapse
|
28
|
Panthumas S, Kittipichai W, Pitikultang S, Chamroonsawasdi K. Self-care behaviors among Thai primigravida teenagers. Glob J Health Sci 2012; 4:139-47. [PMID: 22980240 PMCID: PMC4776950 DOI: 10.5539/gjhs.v4n3p139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 04/19/2012] [Accepted: 03/30/2012] [Indexed: 11/12/2022] Open
Abstract
The purpose of this study was to investigate predictive factors of the self-care behaviors among Thai teenagers with primigravida. The samples of 206 primigravida teenagers attending ANC clinics of six hospitals in the North-Eastern region of Thailand were included. Data collection was done through self administered-questionnaire. Scales of the questionnaire had reliability coefficients ranging from 0.72 – 0.92. The data were analyzed by using descriptive and inferential statistics. The results revealed that the percentage-mean score of overall self-care behavior was 76.91. The percentage-mean scores of self-care behaviors in specific trimester were found that the score in the second trimester was lower than the scores in the first and third trimesters (57.58, 60.45, and 64.65, respectively). Factors associated with overall self-care behavior were perceived self-efficacy, perceived social support from family, knowledge on self-care during pregnancy, accessibility to health services, self-esteem and age (r = 0.47, 0.34, 0.28, 0.24, 0.19, and 0.15, respectively). Perceived self-efficacy and knowledge on self-care during pregnancy were the two considerable predictors accounted for 25% of the variance in the self-care behaviors of Thai teenagers with primigravida.
Collapse
Affiliation(s)
- Suphawadee Panthumas
- Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | | | | | | |
Collapse
|
29
|
Ely GE, Nugent WR, Cerel J, Vimbba M. The relationship between suicidal thinking and dating violence in a sample of adolescent abortion patients. CRISIS 2012; 32:246-53. [PMID: 21940248 DOI: 10.1027/0227-5910/a000082] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The relationship between suicidal thinking and adolescent dating violence has not been previously explored in a sample of adolescent abortion patients. AIMS This paper highlights a study where the relationship between dating violence and severity of suicidal thinking was examined in a sample of 120 young women ages 14-21 seeking to terminate an unintended pregnancy. METHODS The Multidimensional Adolescent Assessment Scale and the Conflict in Adolescent Relationships Scale was used to gather information about psychosocial problems and dating violence so that the relationship between the two problems could be examined, while controlling for the other psychosocial problems. RESULTS The results suggest that dating violence was related to severity of suicidal thinking, and that the magnitude of this relationship was moderated by the severity of problems with aggression. CONCLUSIONS Specifically, as the severity of participant's general problems with aggression increased, the magnitude of the relationship between dating violence and severity of suicidal thinking increased. Limitations of the study and implications for practice are discussed.
Collapse
Affiliation(s)
- Gretchen E Ely
- University of Kentucky, College of Social Work, Lexington, KY 40506, USA.
| | | | | | | |
Collapse
|
30
|
Pinheiro RT, da Cunha Coelho FM, da Silva RA, de Ávila Quevedo L, de Mattos Souza LD, Castelli RD, de Matos MB, Pinheiro KAT. Suicidal behavior in pregnant teenagers in southern Brazil: social, obstetric and psychiatric correlates. J Affect Disord 2012; 136:520-5. [PMID: 22119083 DOI: 10.1016/j.jad.2011.10.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 10/14/2011] [Accepted: 10/25/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Suicidal behavior and its correlates remain relatively understudied in pregnant teenagers. METHODS A cross-sectional study with a consecutive sample of pregnant teenagers recipient of prenatal medical assistance by the national public health system in the urban area of Pelotas, southern Brazil. Sample size was estimated in 871 participants. Suicidal behavior and psychiatric disorders were assessed with the Mini International Neuropsychiatric Interview; the Abuse Assessment Screen was used to identify physical or sexual abuse; social support was assessed with the Medical Outcomes Survey Social Support Scale; a self-report questionnaire was used to collect socio-demographic, obstetric and other psychosocial data. RESULTS Forty three (4.94%) teenagers refused to participate, resulting in 828 participants. Prevalence of suicidal behavior was 13.3%; lifetime suicide attempts were referred by 7.4%, with 1.3% reporting attempting suicide within the last month. After adjustment, we found significant associations of suicidal behavior with the 18-19 years old subgroup, low education, prior abortion, previous major depression, and physical abuse within the last 12 months. Pregnant teenagers with high social support showed prevalence ratios (PR) 67% lower (PR: 0.33; 95%CI: 0.19-0.56) than those with low social support. Furthermore, a wide range of psychiatric disorders, most notably major depressive disorder (PR: 2.75; 95%CI: 1.34-5.63) and panic disorder (PR: 6.36; 95%CI: 1.61-25.10), remained associated with suicidal behavior after adjustment. LIMITATIONS The cross-sectional design precludes causal inferences. CONCLUSIONS We found that suicidal behavior is a relatively common feature in pregnant teenagers, frequently associated with psychiatric disorders.
Collapse
Affiliation(s)
- Ricardo Tavares Pinheiro
- Programa de Pós-Graduação em Saúde & Comportamento, Centro de Ciências da Vida e da Saúde, Universidade Católica de Pelotas, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Maranhão TA, Gomes KRO, Oliveira DCD. Relações conjugais e familiares de adolescentes após o término da gestação. ACTA PAUL ENFERM 2012. [DOI: 10.1590/s0103-21002012000300009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Analisar as percepções de mães adolescentes a respeito das relações familiares e conjugais desenvolvidas, após o término da gestação. MÉTODOS: Estudo transversal com 202 adolescentes, 3 meses após internação em uma das quatro maternidades de Teresina-PI, incluídas no estudo. RESULTADOS: A maioria das adolescentes entrevistadas percebeu mudanças positivas nas relações familiares (60,4%) e conjugais (50,5%), após o término da gestação. Observou-se associação estatística entre o desejo do pai pelo recém-nascido e a predisposição para cuidá-lo (p<0,01) e entre as modificações nas relações conjugais e o apoio paterno durante os cuidados do filho (p<0,01). CONCLUSÕES: Embora o estudo tenha mostrado relacionamentos predominantemente favoráveis entre as jovens e sua família e com o cônjuge após a gestação, espera-se que tais resultados norteiem os profissionais de saúde para que possam estimular o aumento do vínculo entre a mãe adolescente e as pessoas de seu convívio durante e após a gestação.
Collapse
|
32
|
Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O, Rohde LA, Srinath S, Ulkuer N, Rahman A. Child and adolescent mental health worldwide: evidence for action. Lancet 2011; 378:1515-25. [PMID: 22008427 DOI: 10.1016/s0140-6736(11)60827-1] [Citation(s) in RCA: 1209] [Impact Index Per Article: 93.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Mental health problems affect 10-20% of children and adolescents worldwide. Despite their relevance as a leading cause of health-related disability in this age group and their longlasting effects throughout life, the mental health needs of children and adolescents are neglected, especially in low-income and middle-income countries. In this report we review the evidence and the gaps in the published work in terms of prevalence, risk and protective factors, and interventions to prevent and treat childhood and adolescent mental health problems. We also discuss barriers to, and approaches for, the implementation of such strategies in low-resource settings. Action is imperative to reduce the burden of mental health problems in future generations and to allow for the full development of vulnerable children and adolescents worldwide.
Collapse
Affiliation(s)
- Christian Kieling
- Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Pompili M, Serafini G, Innamorati M, Möller-Leimkühler AM, Giupponi G, Girardi P, Tatarelli R, Lester D. The hypothalamic-pituitary-adrenal axis and serotonin abnormalities: a selective overview for the implications of suicide prevention. Eur Arch Psychiatry Clin Neurosci 2010; 260:583-600. [PMID: 20174927 DOI: 10.1007/s00406-010-0108-z] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 02/05/2010] [Indexed: 12/11/2022]
Abstract
Suicidal behavior and mood disorders are one of the world's largest public health problems. The biological vulnerability for these problems includes genetic factors involved in the regulation of the serotonergic system and stress system. The hypothalamic-pituitary-adrenal (HPA) axis is a neuroendocrine system that regulates the body's response to stress and has complex interactions with brain serotonergic, noradrenergic and dopaminergic systems. Corticotropin-releasing hormone and vasopressin act synergistically to stimulate the secretion of ACTH that stimulates the biosynthesis of corticosteroids such as cortisol from cholesterol. Cortisol is a major stress hormone and has effects on many tissues, including on mineralocorticoid receptors and glucocorticoid receptors in the brain. Glucocorticoids produce behavioral changes, and one important target of glucocorticoids is the hypothalamus, which is a major controlling center of the HPA axis. Stress plays a major role in the various pathophysiological processes associated with mood disorders and suicidal behavior. Serotonergic dysfunction is a well-established substrate for mood disorders and suicidal behavior. Corticosteroids may play an important role in the relationship between stress, mood changes and perhaps suicidal behavior by interacting with 5-HT1A receptors. Abnormalities in the HPA axis in response to increased levels of stress are found to be associated with a dysregulation in the serotonergic system, both in subjects with mood disorders and those who engage in suicidal behavior. HPA over-activity may be a good predictor of mood disorders and perhaps suicidal behavior via abnormalities in the serotonergic system.
Collapse
Affiliation(s)
- Maurizio Pompili
- Department of Psychiatry, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
[SSRIs and pregnancy: a review of the literature]. Encephale 2010; 36:513-6. [PMID: 21130237 DOI: 10.1016/j.encep.2010.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 12/30/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A review of the consequences of maternal depression on fetal and infant development and the risk and benefits of SSRI use. METHOD We have reviewed the literature published on PubMed between January 1980 and February 2009 using the following keywords: SSRI, depression, pregnancy, abnormality, teratogenic effect. RESULTS Pregnancies complicated by the onset or recurrence of a major depressive disorder constitute a complex medical situation. The management of such situations is based on the principle of avoiding, as far as possible, the exposure of the developing foetus to both the maternal illness and the potential teratogenic effects of psychotropic drugs. Epidemiological studies show that maternal depression is a very frequent disease: 10 to 16% of pregnant women fulfill major depressive disorder diagnostic criteria and 15% suffer from postpartum depression. The consequences of such exposure on fetal and infant development are so harmful that a pharmacological treatment is highly recommended. Nowadays, the information available on the safety of SSRI use in pregnancy is abundant and these molecules are probably the most studied drugs in pregnant women. Their beneficial effects largely prevail over their potential fetal/neonatal risks and it is unlikely that any marked teratogenic effect occurs, with the possible exception of an increased risk for cardiovascular defects after maternal use of paroxetine. However, transient neonatal symptoms are common after SSRI use in late pregnancy. These include transient autonomic, gastrointestinal, somatic, and clinical respiratory manifestations in the immediate neonatal period. CONCLUSION Treatment of maternal depression during pregnancy and immediate neonatal period is uniformly recommended despite the potential side effects on the fetus and newborn. With a possible exception for paroxetine, maternal treatment with SSRIs during pregnancy is not associated with significantly increased risks of congenital defects.
Collapse
|
35
|
Botega NJ, Marín-León L, Oliveira HBD, Barros MBDA, Silva VFD, Dalgalarrondo P. Prevalências de ideação, plano e tentativa de suicídio: um inquérito de base populacional em Campinas, São Paulo, Brasil. CAD SAUDE PUBLICA 2009; 25:2632-8. [DOI: 10.1590/s0102-311x2009001200010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Accepted: 09/08/2009] [Indexed: 11/21/2022] Open
Abstract
O objetivo foi estimar as prevalências ao longo da vida de ideação, planos e tentativas de suicídio na população. Quinhentos e quinze indivíduos residentes em Campinas, São Paulo, Brasil, foram selecionados utilizando-se amostragem estratificada por conglomerados e avaliados por entrevista do Estudo Multicêntrico de Intervenção no Comportamento Suicida. Calculamos prevalências ponderadas, com os respectivos intervalos de 95% de confiança (IC95%). As prevalências foram de 17,1% (IC95%: 12,9;21,2) para ideação, 4,8% (IC95%: 2,8;6,8) para planos e 2,8% (IC95%: 0,09;4,6) para tentativas de suicídio. O comportamento suicida foi mais freqüente em mulheres e em adultos jovens. A existência de um plano de como tirar a própria vida, em termos de freqüência, situa-se próximo da tentativa (relação de 5:3). De cada três tentativas de suicídio, apenas uma chegou a ser atendida em um serviço médico. As prevalências se assemelham à maioria dos estudos de outros países. É essencial coletar diretamente na comunidade informações sobre o comportamento suicida, abarcando-o em sua abrangência.
Collapse
|
36
|
Gausia K, Fisher C, Ali M, Oosthuizen J. Antenatal depression and suicidal ideation among rural Bangladeshi women: a community-based study. Arch Womens Ment Health 2009; 12:351-8. [PMID: 19468825 DOI: 10.1007/s00737-009-0080-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 05/07/2009] [Indexed: 10/20/2022]
Abstract
Depression during pregnancy is a significant public health problem because of its negative effects on the health of both mother and infant. Data on its prevalence and determinants are lacking in Bangladesh. To estimate the prevalence of depression during pregnancy and to identify potential contributory factors among rural Bangladeshi women, a community-based study was conducted during 2005 in Matlab sub-district, a rural area of eastern Bangladesh. Three hundred and sixty-one pregnant women were identified through an existing health and demographic surveillance system covering a population of 110,000 people. The women were interviewed at home at 34-35 weeks of pregnancy. Information on risk factors was collected through structured questionnaires, with the Bangla version of the Edinburgh Postnatal Depression Scale (EPDS-B) used to measure their psychological status. Both univariate analysis and multivariate logistic regression were applied using the SPSS 15.0 statistical software. The prevalence of depression at 34-35 weeks pregnancy was 33% (95% CI, 27.6-37.5). After adjustment in a multivariate logistic regression model, a history of being beaten by her husband either during or before the current pregnancy had the highest association with depression followed by having an unhelpful or unsupportive mother-in-law or husband, and family preference for a male child. Of the antenatally depressed women, 17 (14%) admitted to thoughts of self-harm during the pregnancy. This paper further explores the reasons why women have considered some form of self-harm during pregnancy. Depression during pregnancy is common among Bangladeshi women, with about a third being affected. The study highlights the need to allocate resources and develop strategies to address depression in pregnancy.
Collapse
Affiliation(s)
- Kaniz Gausia
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh.
| | | | | | | |
Collapse
|
37
|
Chachamovich E, Stefanello S, Botega N, Turecki G. [Which are the recent clinical findings regarding the association between depression and suicide?]. BRAZILIAN JOURNAL OF PSYCHIATRY 2009; 31 Suppl 1:S18-25. [PMID: 19565147 DOI: 10.1590/s1516-44462009000500004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Suicide is one of the leading causes of mortality worldwide, especially among young subjects. Suicide is considered the outcome of a multidimensional and complex phenomenon, which is a result of the interaction between several factors. The association between psychopathology and suicide has been extensively investigated. Major depression plays an important role among the psychiatric diagnoses associated with suicide. This finding seems to be confirmed by different study designs, and in distinct populations. The present paper aims to briefly review the recent findings regarding the suicide-related clinical features of depression. Moreover, strategies for suicide prevention were also reviewed. REVIEW Recent references were identified and grouped in order to illustrate the main contributions about depression and suicide. Briefly, the literature review stresses the high prevalence of major depression among subjects presenting suicide behaviors. Psychopathological traits, such as aggression and impulsivity play a relevant role in triggering suicidal behaviors. Strategies for suicide prevention were also reviewed in Brazil and internationally. In general, detection and treatment are effective in reducing suicide rates. CONCLUSION Studies regarding suicide behaviors have had a pragmatic approach, and generated a large body of evidence about correlates of suicide. However, these studies have not been able to provide a consistent theoretical explanation for this phenomenon. The recent adoption of modern strategies represents a possibility of enhancing the research capability of such studies. In order to be clinically useful, findings should make it possible to deepen the understanding over the experience of a suicidal person, as well as to design specific strategies for prevention and treatment in population subgroups.
Collapse
Affiliation(s)
- Eduardo Chachamovich
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Montreal, Canada
| | | | | | | |
Collapse
|
38
|
Diehl A, Laranjeira R. Suicide attempts and substance use in an emergency room sample. JORNAL BRASILEIRO DE PSIQUIATRIA 2009. [DOI: 10.1590/s0047-20852009000200003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: Describe suicide attempts assisted in an emergency room (ER) and acute substance consumption or dependence on these individuals. METHODS: Descriptive epidemiologic study was carried out during one year, evaluating suicide attempts assisted at Embu das Artes ER, São Paulo, Brazil. Patients were scheduled to a non structured psychiatric interview. Main outcomes measures were: socio demographic data, suicide attempt method, drugs or alcohol acute use in the six hours prior to attempt, patients with ICD-10 substance dependence diagnosis. The descriptive analyses and chi-square test (p < 0.05) were used to verify associations between the variables studied. RESULTS: sample was formed of 80 patients, mean age of 26.9 years (SD = 8.91), predominantly female (72.5%) and 21.2% adolescents. Most suicide attempts were made through medicine ingestion (62.5%). Approximately 21.2% and 7.5% related to have used alcohol and an illicit drug respectively within 6 hours prior to attempt and 10% were found to be substance dependent. All substance dependents had attempted suicide previously (p-value = 0.4). There was a significant association between suicide attempt through medicine ingestion and psychiatric treatment history (p = 0.02). CONCLUSION: More national studies are necessary to consider the role of alcohol and drug in suicide attempts assisted in ER, especially in chemical dependents whose suicidal behavior is relevant.
Collapse
|