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Kofman YB, Selbe S, Szentkúti P, Horváth-Puhó E, Rosellini AJ, Lash TL, Schnurr PP, Sørensen HT, Galea S, Gradus JL, Sumner JA. Sex Differences in Psychopathology Following Potentially Traumatic Experiences. JAMA Netw Open 2024; 7:e240201. [PMID: 38386319 PMCID: PMC10884878 DOI: 10.1001/jamanetworkopen.2024.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Importance Various psychopathology may follow trauma; however, sex differences in these ranging manifestations of posttraumatic psychopathology remain understudied. Objective To investigate sex-specific incidence of posttraumatic psychopathology. Design, Setting, and Participants This population-based cohort study of Danish national health registries included a cohort of individuals who experienced a potentially traumatic event (PTE) from 1994 to 2016. Individuals were further categorized by presence of any pretrauma psychopathology. A comparison group of individuals who experienced a nontraumatic stressor (nonsuicide death of a first-degree relative) was examined as a reference cohort. Exposures At least 1 of 8 PTEs (eg, physical assault, transportation accident) derived through health registry International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes, with additional qualifiers to improve classification accuracy. Main Outcomes and Measures Incidence of 9 categories of ICD-10 psychiatric disorders recorded in registries within 5 years of PTEs. The standardized morbidity ratios (SMRs) for psychopathology outcomes were also calculated to compare individuals experiencing PTEs with those experiencing a nontraumatic stressor. Results This study included 1 398 026 individuals who had been exposed to trauma (475 280 males [34.0%]; 922 750 females [66.0%]). The group of males who had been exposed to trauma were evenly distributed across age, while most females in the trauma-exposed group were aged 16 to 39 years (592 385 [64.2%]). Males and females were equally distributed across income quartiles and predominantly single. Following PTEs, the most common diagnosis was substance use disorders for males (35 160 [7.4%]) and depressive disorders for females (29 255 [3.2%]); incidence proportions for these and other disorders were higher among males and females with any pretrauma psychopathology. Certain PTEs had elevated onset of various psychiatric disorders and some sex differences emerged. Following physical assault, associations were found with schizophrenia or psychotic disorders for males (SMR, 17.5; 95% CI, 15.9-19.3) and adult personality disorders for females (SMR, 16.3; 95% CI, 14.6-18.3). For noninterpersonal PTEs, males had larger SMRs for substance use, schizophrenia or psychotic disorders, and adult personality disorders (SMR, 43.4; 95% CI, 41.9-45.0), and females had larger SMRs for depressive disorders (SMR, 19.0; 95% CI, 18.6-19.4). Sex differences were also observed, particularly when considering pretrauma psychopathology. For example, among interpersonal PTEs, males were most likely to develop substance use disorders after physical assault, whereas females were more likely to develop various disorders, with stronger associations seen for females without pretrauma psychiatric diagnoses. Among noninterpersonal PTEs, exposure to toxic substance showed robust associations with psychopathology, particularly in those without pretrauma psychopathology, with sex-specific differences across psychiatric categories. Conclusions and Relevance Mental disorders after trauma were wide-ranging for males and females, and sex differences in patterns of posttraumatic psychopathology were more pronounced when accounting for pretrauma psychopathology. Findings provide new insights for sex-relevant PTEs and their mental health consequences. It also outlines future directions for advancing understanding of a constellation of posttraumatic psychopathology in males and females.
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Affiliation(s)
- Yasmin B Kofman
- Department of Psychology, University of California, Los Angeles
| | - Sophie Selbe
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Peter Szentkúti
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Anthony J Rosellini
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Paula P Schnurr
- National Center for PTSD Executive Division, White River Junction, Vermont
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Henrik Toft Sørensen
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
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Nanjundaswamy MH, Gowda SM, Ganjekar S, Thippeswamy H, Desai G, Chandra PS. Women with mental illness seeking conception counselling at a specialist perinatal psychiatry service in India. Asian J Psychiatr 2022; 78:103313. [PMID: 36356427 DOI: 10.1016/j.ajp.2022.103313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022]
Abstract
AIMS To study the clinical and sociodemographic profile of women with mental illness seeking conception counselling at perinatal psychiatry service. To compare women seeking preconception counselling (PCC) to that of those who sought help after unplanned pregnancy with exposure (UPE) to psychotropics. MATERIAL AND METHODS Data was extracted from the clinical records of women between the year 2014-2017 who attended perinatal outpatient services. The details collected included sociodemographic details, illness details, contraception, infertility treatment and detailed treatment history. RESULTS Of the 766 women who consulted perinatal psychiatry services (2014-17), 179 (23.37%) had consulted for conception counselling. Out of that 104 (58.1%) sought PCC, and 75 (41.9%) had UPE to psychotropics. PCC was sought by women with higher education, those having a severe mental illness, and a longer duration of illness. Women with medical comorbidities and receiving infertility treatment also sought PCC. Also, women who had earlier undergone PCC been more likely to seek PCC for further pregnancies. CONCLUSIONS Women with mental illness should be counselled regarding planned pregnancies, contraception, and the impact of psychotropics on pregnancy and foetus. Also, liaison with other specialities like obstetricians, sonologist and paediatricians is essential.
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Affiliation(s)
- Madhuri H Nanjundaswamy
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | | | - Sundarnag Ganjekar
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India.
| | - Harish Thippeswamy
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Geetha Desai
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Prabha S Chandra
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
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Dennis CL, Brown HK, Brennenstuhl S, Vigod S, Miller A, Castro RA, Marini FC, Birken C. Preconception risk factors and health care needs of pregnancy-planning women and men with a lifetime history or current mental illness: A nationwide survey. PLoS One 2022; 17:e0270158. [PMID: 35731809 PMCID: PMC9216596 DOI: 10.1371/journal.pone.0270158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/05/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives While depression and anxiety are common in women and men of reproductive age, preconception interventions to optimize the health of individuals with mental illness before pregnancy is limited and focuses primarily on psychotropic medication management. Comparing individuals with depression, anxiety, and comorbidity to those with neither condition, we identified areas of preconception care optimization related to psychosocial risk factors, general physical health, medication use, and uptake of high-risk health behaviours. We also investigated differences in preconception health care use, attitudes, and knowledge. Method We conducted a nationwide survey of 621 women (n = 529) and men (n = 92) across Canada who were planning a pregnancy within five years, including those with lifetime or current depression (n = 38), anxiety (n = 55), and comorbidity (n = 104) and those without mental illness (n = 413). Individuals with depression, anxiety, and comorbidity were compared to individuals without mental illness using logistic regression, adjusted for age, sex, and education level. Results Individuals with a lifetime or current mental illness were significantly more likely to have several risk factors for suboptimal reproductive and perinatal outcomes, including increased rates of obesity, stress, fatigue, loneliness, number of chronic health conditions, and medication use. Further, they were more likely to have high-risk health behaviours including increased substance use, internet addiction, poorer eating habits, and decreased physical activity. By assessing depression, anxiety, or both separately, we also determined there was variation in risk factors by mental illness type. Conclusion Our nationwide study is one of the first and largest to examine the preconception care needs of women and men with a lifetime or current mental illness who are pregnancy-planning. We found this population has many important reproductive and perinatal risk factors that are modifiable via preconception interventions which could have a significant positive impact on their health trajectories and those of their future children.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Hilary K. Brown
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Ainsley Miller
- School of Nursing, Lakehead University, Thunder Bay, Ontario, Canada
| | | | | | - Catherine Birken
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
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Lundin C, Wikman A, Bixo M, Gemzell-Danielsson K, Sundström Poromaa I. Towards individualised contraceptive counselling: clinical and reproductive factors associated with self-reported hormonal contraceptive-induced adverse mood symptoms. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:e8. [PMID: 33452056 DOI: 10.1136/bmjsrh-2020-200658] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 11/30/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The study aim was to establish which demographic, clinical, reproductive and psychiatric factors are associated with self-reported hormonal contraceptive (HC)-induced adverse mood symptoms. STUDY DESIGN We compiled baseline data from two Swedish studies: one cross-sectional study on combined oral contraceptive (COC)-induced adverse mood symptoms (n=118) and one randomised controlled trial on adverse mood symptoms on COC (n=184). Both included women eligible for COC use, aged over 18 years. All women answered a questionnaire on HC use and associated mood problems. The Mini-International Neuropsychiatric Interview (M.I.N.I.) was used to capture mood and anxiety disorders. Women who acknowledged HC-induced adverse mood symptoms, ongoing or previously (n=145), were compared with women without any such experience (n=157). RESULTS Compared with women without self-reported HC-induced adverse mood symptoms, women with these symptoms were younger at HC start (adjusted odds ratio (aOR) 0.83, 95% CI 0.72 to 0.95), had more often undergone induced abortion (OR 3.36, 95% CI 1.57 to 7.23), more often suffered from an ongoing minor depressive disorder (n=12 vs n=0) and had more often experienced any previous mental health problem (aOR 1.90, 95% CI 1.01 to 3.59). CONCLUSIONS In line with previous research, this study suggests that women with previous or ongoing mental health problems and women who are younger at HC start are more likely to experience HC-induced adverse mood symptoms. Former and current mental health should be addressed at contraceptive counselling, and ongoing mental health disorders should be adequately treated. IMPLICATIONS This study adds valuable knowledge for identification of women susceptible to HC-induced adverse mood symptoms. It should facilitate the assessment of whether or not a woman has an increased risk of such symptoms, and thus enable clinicians to adopt a more personalised approach to contraceptive counselling.
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Affiliation(s)
- Cecilia Lundin
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Wikman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marie Bixo
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
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Goldstein N, Davis C, Saliba Z. Reproductive health in an inpatient psychiatric unit: A retrospective chart review. Hum Psychopharmacol 2021; 36:e2784. [PMID: 33764582 DOI: 10.1002/hup.2784] [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: 02/27/2020] [Accepted: 11/02/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the degree to which reproductive health issues are discussed with women of child-bearing age on an inpatient psychiatric unit. We hypothesized that preconception care is limited, and that contraceptive status of patients is rarely elicited. For this sub-analysis, we focused on counseling related to potential impacts of psychotropic medications on pregnancy, and on contraceptive status, especially when prescribed teratogenic medications. METHODS A retrospective search was conducted for women between the ages of 18 to 49 years at the time of admission, over a 6-month period. One hundred and forty-eight unique encounters were identified, and electronic charts were reviewed for information regarding: discharge medications, medication counseling, contraceptive use, pregnancy and relationship status, pregnancy history, nature of obstetrics and gynecology consults, substance use, and diagnoses. RESULTS Almost a fifth (n = 29) of encounters included discharge on at least one potentially teratogenic medication and more than 50% had recent substance use. However, less than 10% of all encounters had documentation of contraceptive status and only one case had documented discussion of reproductive effects of medication; this despite the fact that roughly one third (33.8%) had at least one documented prior pregnancy and two patients were pregnant at the time of admission. CONCLUSION Few women of reproductive age admitted to the inpatient psychiatric unit had chart-documented counseling on reproductive health, including known side effects of teratogenic medications. This indicates an urgent need for inclusion of reproductive health, including counseling on the risks and benefits of taking psychotropics during the peripartum period, into inpatient mental health care.
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Affiliation(s)
- Naomi Goldstein
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Caitlin Davis
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Zeina Saliba
- Department of Psychiatry & Behavioral Sciences, Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Frayne J, Hauck Y, Nguyen T, Liira H, Morgan VA. Reproductive planning, vitamin knowledge and use, and lifestyle risks of women attending pregnancy care with a severe mental illness. Scand J Prim Health Care 2021; 39:60-66. [PMID: 33569975 PMCID: PMC7971324 DOI: 10.1080/02813432.2021.1882081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Women with severe mental illnesses are a vulnerable population and little is known about their reproductive planning needs. The aim of our study was to describe rates of unintended pregnancies, postpartum contraception, identify use and knowledge of prenatal/pregnancy vitamins and identify modifiable lifestyle risks. DESIGN Mixed methods study incorporating a cross-sectional survey and prospective pregnancy data collection. SETTING A multidisciplinary antenatal clinic in Australia. METHOD Thirty-eight pregnant women with severe mental illnesses: schizophrenia, schizoaffective, bipolar and severe post-traumatic stress disorder. MAIN OUTCOME MEASURES Unintended pregnancy rates, immediate postpartum contraception, use of prenatal and pregnancy vitamins and knowledge sources, obesity, and use and cessation rates for smoking, and substances, and comorbid medical conditions. RESULTS Overall 42% of women had unintended pregnancy, with those with schizophrenia at most risk (56%). A long acting reversible contraception was inserted in 5 women (13%), with 45% having no immediate contraception prescribed prior to postnatal discharge. Women's main source of vitamin supplementation for pregnancy was from general practitioners. Prenatal folic acid use occurred in 37%, with rates differing for those with a diagnosis of bipolar disorder (52%) and schizophrenia (25%). Vitamin deficiencies occurred in pregnancy, with iron deficiency (ferritin <30 ng/mL) (n = 27, 73%) the most frequent. Overall 21% of women smoked cigarettes and 35% were obese. DISCUSSION Addressing gaps in use of effective contraception, proactive reproductive planning and lifestyle management may improve outcomes for women with mental illnesses and their babies.Key pointsWomen with severe mental illnesses have complex health needs that require targeted reproductive counselling. This study adds to what is known by highlighting that:•Women with schizophrenia appear more likely to have unintended pregnancy.•Prenatal counselling for women with severe mental disorders should include recognition and optimisation of management for the high rates of pre-existing medical comorbidities, obesity and elevated nicotine and substance use.•Many women with severe mental illness need increased doses (5 mg) of prenatal folic acid due to psychotropic medication risk and obesity, as well as treatment for high rates of iron and vitamin D deficiency in pregnancy.
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Affiliation(s)
- Jacqueline Frayne
- Medical School, Division of General practice, The University of Western Australia, Crawley, WA, Australia
- Department of Obstetrics, Women and Newborn Health Service, Subiaco, WA, Australia
- CONTACT Jacqueline Frayne Division of General Practice, Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, M706, Perth, WA, 6009, Australia
| | - Yvonne Hauck
- Department of Nursing and Midwifery Education and Research, Women and Newborn Health Service, Subiaco, WA, Australia
- Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - Thinh Nguyen
- Medical School, Division of Psychiatry, The University of Western Australia, Crawley, WA, Australia
- Peel and Rockingham Kwinana Mental Health Services, Rockingham, WA, Australia
| | - Helena Liira
- Medical School, Division of General practice, The University of Western Australia, Crawley, WA, Australia
- General Practice, University of Helsinki, Helsinki, Finland
| | - Vera A. Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
- Centre for Clinical Research in Neuropsychiatry, Medical School, Division of Psychiatry, The University of Western Australia, Crawley, WA, Australia
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The pervasive effects of timing of parental mental health disorders on adolescent deliberate self-harm risk. PLoS One 2019; 14:e0220704. [PMID: 31412095 PMCID: PMC6693755 DOI: 10.1371/journal.pone.0220704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 07/22/2019] [Indexed: 11/28/2022] Open
Abstract
Children whose parents have mental health disorders are at increased risk for deliberate self-harm (DSH). However, the effect of timing of parental mental health disorders on adolescent DSH risk remains under-researched. The aim of this study was to investigate how parental hospital admissions for mental health disorders and/or DSH in different developmental periods impact on the child’s DSH risk in adolescence. A nested case-control sample was compiled from a total population cohort sample drawn from administrative health records in Western Australia. The sample comprised 7,151 adolescents who had a DSH-related hospital admission (cases), and 143,020 matched controls who hadn’t had a DSH-related hospital admission. The occurrence of parental hospital admissions related to mental health disorders and/or DSH behaviours was then analysed for the cases and controls. The timing of the parental hospital admissions was partitioned into four stages in the child’s life course: (1) pre-pregnancy, (2) pregnancy and infancy, (3) childhood, and (4) adolescence. We found that adolescents of a parent with mental health and/or DSH-related hospital admissions in all developmental periods except pregnancy and infancy were significantly more likely than controls to have a DSH-related hospital admission. Compared to parental hospital admissions that occurred during childhood and adolescence, those that occurred before pregnancy conferred a higher risk for adolescent DSH: adjusted odds ratio (aOR) = 1.25 for having only one parent hospitalised and 1.66 for having both parents hospitalised for mental health disorders; aOR = 1.97 for having any parent hospitalised for DSH, all being significant at the level of p < .001. This study shows that timing is important for understanding intergenerational transmission of DSH risk. The pre-pregnancy period is as critical as period after childbirth for effective intervention targeting adult mental health disorders and DSH, highlighting the important role of adult mental health services in preventing DSH risk in future generations.
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Erturk A, Aktoz F, Orgul G, Mutlu E, Demir B, Tuncer ZS. Administration of electroconvulsive therapy for major depression during pregnancy: a case report. J OBSTET GYNAECOL 2019; 40:277-278. [PMID: 31368383 DOI: 10.1080/01443615.2019.1628727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Anil Erturk
- Department of Obstetrics and Gynecology, Hacettepe Universitesi Tip Fakultesi, Hacettepe University, Ankara, Turkey
| | - Fatih Aktoz
- Department of Obstetrics and Gynecology, Hacettepe Universitesi Tip Fakultesi, Hacettepe University, Ankara, Turkey
| | - Gokcen Orgul
- Department of Obstetrics and Gynecology, Hacettepe Universitesi Tip Fakultesi, Hacettepe University, Ankara, Turkey
| | - Emre Mutlu
- Department of Psychiatry, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Basaran Demir
- Department of Psychiatry, Hacettepe Universitesi Tip Fakultesi, Ankara, Turkey
| | - Zafer Selcuk Tuncer
- Department of Obstetrics and Gynecology, Hacettepe Universitesi Tip Fakultesi, Hacettepe University, Ankara, Turkey
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Hemsing N, Greaves L, Poole N. Preconception health care interventions: A scoping review. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 14:24-32. [PMID: 29195631 DOI: 10.1016/j.srhc.2017.08.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 10/19/2022]
Abstract
Pregnancy is often framed as a "window of opportunity" for intervening on a variety of health practices such as alcohol and tobacco use. However, there is evidence that interventions focusing solely on the time of pregnancy can be too narrow and potentially stigmatizing. Indeed, health risks observed in the preconception period often continue during pregnancy. Using a scoping review methodology, this study consolidates knowledge and information related to current preconception and interconception health care interventions published in the academic literature. We identified a total of 29 intervention evaluations, and summarized these narratively. Findings suggest that there has been some progress in intervening on preconception health, with the majority of interventions offering assessment or screening followed by brief intervention or counselling. Overall, these interventions demonstrated improvements in at least some of the outcomes measured. However, further preconception care research and intervention design is needed. In particular, the integration of gender transformative principles into preconception care is needed, along with further intervention design for partners/ men, and more investigation on how best to deliver preconception care.
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Affiliation(s)
- Natalie Hemsing
- Centre of Excellence for Women's Health, 4500 Oak Street, Box 48, Vancouver, BC V6H 3N1, Canada.
| | - Lorraine Greaves
- Centre of Excellence for Women's Health, 4500 Oak Street, Box 48, Vancouver, BC V6H 3N1, Canada
| | - Nancy Poole
- Centre of Excellence for Women's Health, 4500 Oak Street, Box 48, Vancouver, BC V6H 3N1, Canada
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Rosener SE, Barr WB, Frayne DJ, Barash JH, Gross ME, Bennett IM. Interconception Care for Mothers During Well-Child Visits With Family Physicians: An IMPLICIT Network Study. Ann Fam Med 2016; 14:350-5. [PMID: 27401423 PMCID: PMC4940465 DOI: 10.1370/afm.1933] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 01/04/2016] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Interconception care (ICC) is recommended to improve birth outcomes by targeting maternal risk factors, but little is known about its implementation. We evaluated the frequency and nature of ICC delivered to mothers at well-child visits and maternal receptivity to these practices. METHODS We surveyed a convenience sample of mothers accompanying their child to well-child visits at family medicine academic practices in the IMPLICIT (Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques) Network. Health history, behaviors, and the frequency of the child's physician addressing maternal depression, tobacco use, family planning, and folic acid supplementation were assessed, along with maternal receptivity to advice. RESULTS Three-quarters of the 658 respondents shared a medical home with their child. Overall, 17% of respondents reported a previous preterm birth, 19% reported a history of depression, 25% were smoking, 26% were not using contraception, and 58% were not taking folic acid. Regarding advice, 80% of mothers who smoked were counseled to quit, 59% reported depression screening, 71% discussed contraception, and 44% discussed folic acid. Screening for depression and family planning was more likely when the mother and child shared a medical home (P <.05). Most mothers, nearly 95%, were willing to accept health advice from their child's physician regardless of whether a medical home was shared (P >.05). CONCLUSIONS Family physicians provide key elements of ICC at well-child visits, and mothers are highly receptive to advice from their child's physician even if they receive primary care elsewhere. Routine integration of ICC at these visits may provide an opportunity to reduce maternal risk factors for adverse subsequent birth outcomes.
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Affiliation(s)
- Stephanie E Rosener
- Middlesex Hospital Family Medicine Residency Program, Middletown, Connecticut
| | - Wendy B Barr
- Lawrence Family Medicine Residency Program, Lawrence, Massachusetts
| | - Daniel J Frayne
- MAHEC Family Medicine Residency Program, Asheville, North Carolina
| | - Joshua H Barash
- Department of Family & Community Medicine, Jefferson Medical College, Philadelphia, Pennsylvania
| | | | - Ian M Bennett
- Department of Family Medicine, University of Washington, Seattle, Washington
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Nguyen T, Brooks J, Frayne J, Watt F, Fisher J. The preconception needs of women with severe mental illness: a consecutive clinical case series. J Psychosom Obstet Gynaecol 2016; 36:87-93. [PMID: 25830510 DOI: 10.3109/0167482x.2015.1029448] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Women with severe mental illness (SMI) are having babies at an increasing rate, but continue to face many challenges across the perinatal period. There is little research into the preconception needs of women with SMI and the aim of this study was to investigate the social circumstances, general health, mental health and reproductive health care needs in these at risk women. METHOD Women with SMI referred for specialist preconception counselling at a tertiary obstetric hospital in 2012 were eligible to participate. The data source was a semi-structured study-specific interview schedule with open-ended questions incorporated into the routine assessment protocol. RESULTS In a one-year period, 23 women were referred to the service and 22 consented to data from the interview being pooled for the study. All women were taking at least one psychotropic medication at the time of referral. Overall, 40% (n = 9) were aged at least 35 years, 36% (n = 8) smoked cigarettes daily and over half (54.5% n = 12) reported their body mass index as being in the overweight or obese range. Thematic analysis revealed the importance of maternal desire, and concerns relating to age and biological time pressure, the impact of the illness and medication on pregnancy and motherhood. CONCLUSION Our data indicate that preconception counselling should be routine in the care of women with SMI of reproductive age, and should take into account the potential centrality of motherhood in the woman's rehabilitation, as well as the complex appraisals of risks, general health and support.
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Affiliation(s)
- Thinh Nguyen
- a School of Psychiatry and Clinical Neurosciences, University of Western Australia , Australia .,b Peel and Rockingham Kwinana Mental Health Services , Australia
| | - Janette Brooks
- c Women and Newborn Health Service , Western Australia , Australia .,d School of Women and Infant Health, University of Western Australia , Australia
| | - Jacqueline Frayne
- c Women and Newborn Health Service , Western Australia , Australia .,e School of Primary, Aboriginal and Rural Health Care, The University of Western Australia , Australia , and
| | - Felice Watt
- c Women and Newborn Health Service , Western Australia , Australia
| | - Jane Fisher
- f Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University , Australia
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Abstract
Preconception care is designed to identify and reduce biomedical, behavioral, and social risks to the health of a woman or her baby before pregnancy occurs. Few women present requesting preconception care; however, 1 in 10 US women of childbearing age will become pregnant each year. As primary care physicians (PCPs) care for reproductive-aged women before, between, and after their pregnancies, they are ideally positioned to help women address health risks before conception, including optimizing chronic conditions, to prevent adverse pregnancy and longer-term health outcomes. PCPs can help women make informed decisions both about preparing for pregnancy and about using effective contraception when pregnancy is not desired.
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Affiliation(s)
- Lisa S Callegari
- Department of Obstetrics & Gynecology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA; Health Services Research and Development (HSR&D), Department of Veterans Affairs, VA Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA 98108, USA.
| | - Erica W Ma
- Health Services Research and Development (HSR&D), Department of Veterans Affairs, VA Puget Sound Health Care System, 1660 S. Columbian Way S-152, Seattle, WA 98108, USA
| | - Eleanor Bimla Schwarz
- Department of Medicine, University of California, Davis, 4150 V Street, Suite 3100, Sacramento, CA 95817, USA
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Dunlop AL, Logue KM, Thorne C, Badal HJ. Change in women's knowledge of general and personal preconception health risks following targeted brief counseling in publicly funded primary care settings. Am J Health Promot 2013; 27:S50-7. [PMID: 23286664 DOI: 10.4278/ajhp.120116-quan-39] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To explore knowledge of general and personal preconception health risks among women in publicly funded clinics and whether brief counseling can improve knowledge. DESIGN Interventional cohort study. SETTING Five publicly funded primary care clinics. SUBJECTS Two cohorts of low-income, nonpregnant African-American and Hispanic women of reproductive age (300 in each cohort). INTERVENTION Targeted brief counseling based upon risks identified via preconception health risk assessment. MEASURES Correct responses on test of women's knowledge of general and personal preconception health risks pre-encounter vs. 3 to 6 months post-encounter. ANALYSIS McNemar's test to compare proportion of women in each cohort who correctly answer questions of preconception health knowledge pre-encounter vs. 3 to 6 months post-encounter. RESULTS Women in the intervention cohort experienced a significant increase in knowledge related to preconception health from baseline to 3 to 6 months post-encounter, including recognition of the importance of folic acid supplementation, seeking medical care for chronic conditions, and review of medication in the preconception period that was not observed for the comparison cohort. Among women with chronic medical conditions, those in the intervention cohort significantly increased their knowledge that the condition could lead to problems in pregnancy (+43%) relative to the lesser improvement in knowledge observed for those in the comparison cohort (+4%) (p < .05). CONCLUSIONS Women's knowledge of general and personal preconception health risks improved following screening and brief counseling in publicly funded primary care clinics.
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Affiliation(s)
- Anne L Dunlop
- Department of Family & Preventive Medicine, Emory University School of Medicine, 1256 Briarcliff Road, Atlanta, GA30322, USA.
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Karsnitz DB, Ward S. Spectrum of anxiety disorders: diagnosis and pharmacologic treatment. J Midwifery Womens Health 2011; 56:266-81. [PMID: 21535374 DOI: 10.1111/j.1542-2011.2011.00045.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nearly 30% of women experience an anxiety disorder at some time during their lives, and there is increasing evidence that anxiety disorders are associated with adverse pregnancy outcomes. Despite increased media coverage regarding anxiety disorders, women are reluctant to discuss signs and symptoms of anxiety with family or health care providers. Additionally, despite ongoing research and improved educational curricula, primary care and women's health care providers find diagnosis and treatment of mental health disorders challenging. This article reviews the diagnostic features and pharmacologic treatment options for the most common anxiety disorders including generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, and posttraumatic stress disorder. The impact of anxiety disorders on pregnancy and guidelines for management are presented.
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Affiliation(s)
- Deborah Brandt Karsnitz
- Frontier School of Midwifery and Family Nursing, 2230 Taylor Wood Road, Simpsonville, KY 40205, USA.
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Tormoehlen K, Lessick M. Schizophrenia in women: implications for pregnancy and postpartum. Nurs Womens Health 2010; 14:482-495. [PMID: 21122083 DOI: 10.1111/j.1751-486x.2010.01595.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Farr SL, Bitsko RH, Hayes DK, Dietz PM. Mental health and access to services among US women of reproductive age. Am J Obstet Gynecol 2010; 203:542.e1-9. [PMID: 20817143 DOI: 10.1016/j.ajog.2010.07.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 05/21/2010] [Accepted: 07/06/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of the study was to estimate prevalence of depression and serious psychological distress (SPD) and mental health service receipt among reproductive-age women. STUDY DESIGN We used 2006-2007 nationally representative data to estimate the prevalence of depression and SPD among nonpregnant women aged 18 to 44 years. Using logistic regression, we individually examined predictors of depression and SPD and characteristics associated with clinical diagnosis and current treatment. RESULTS More than 14% of women had current depression and 2.7% had current SPD. Risk factors for major depression and SPD included older age, less education, being unmarried, inability to work/unemployed, and low income. Among depressed women, 18-24 year-olds, nonwhite women, those with children, the employed, and urban women had lower odds of clinical diagnosis. Among women with SPD, Hispanic, employed, and those without health insurance had lower odds of receiving treatment. CONCLUSION Mental health conditions are prevalent among women of reproductive age and a substantial proportion goes untreated.
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Abstract
PURPOSE OF REVIEW Significant sex differences have been described for mental disorders in terms of prevalence, symptom presentation and prescription of psychotropic medication. Most of the published studies and reviews emphasize the impact of female-specific reproductive events on the course of the mental illness or sex difference of the adverse effects of psychotropic medication or the concerns about treatment of female patients during the perinatal period. Different from other reviews, we will summarize the effects of current mental disorder/psychotropic medication on the female-specific reproduction-related events (such as menstrual regularity, pregnancy, postpartum period and menopause). RECENT FINDINGS A number of recent studies have highlighted the adverse effects of psychotropic agents on the female reproductive system, especially on the regularity of the menstrual cycle or on the female gonadal hormones. Without any medication, disturbances of the female gonadal system are observed especially among severely mentally ill female patients. In the studies, the prevalence of female-specific gonadal abnormalities and their mechanism of action, prevention and recommendations are given in detail. SUMMARY The field of reproductive psychiatry is rapidly evolving. There is increasing evidence that clinicians should be aware of female medical health while treating severely mentally ill female patients. Analyzing the present data will further advance our understanding of treatment safety and impact of untreated mental illness in women.
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