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Li Y, Yu H, Shen K, Long J. Women's mental health during late pregnancy: A survey conducted in Shandong Province, China. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024. [PMID: 38959946 DOI: 10.1055/a-2337-4336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
BACKGROUND The study aimed to investigate the general mental health status and its associated factors in women during late pregnancy. The objective was to provide a scientific basis for developing psychological interventions tailored to this specific population. METHODS The research was conducted from May 2021 to July 2022, involving the recruitment of 200 women attending maternal and child health clinics for their late-pregnancy checkups. Data collection was carried out using a comprehensive approach, involving several validated tools. The participants completed a general demographic and sociological questionnaire along with four standardized psychological assessment scales: the 12-item General Health Questionnaire (GHQ-12), the Athens Insomnia Scale (AIS-8), the Generalized Anxiety Disorder 7 (GAD-7), and the 9-question Patient Health Questionnaire (PHQ-9). A total of 200 valid questionnaires were collected for analysis. RESULTS The study revealed that the overall prevalence of positive detection of general mental health problems in women during late pregnancy was 11%. Significant differences were observed in the positive detection rate of general mental health status based on various factors such as the quality of relationships with husbands, pregnancy intentions, insomnia, anxiety, and depression (p<0.01). Furthermore, participants with general mental health problems displayed notably higher scores on the AIS-8, PHQ-9, and GAD-7 scales compared to those without such problems (p<0.01). Regression analysis indicated that pregnancy intention and PHQ-9 scores were influential factors affecting the general mental health of women during late pregnancy (p<0.05). CONCLUSION The study highlights high rates of general mental health problems during late pregnancy, with unplanned pregnancy and elevated depression scores as key risk factors. Regular mental health screening and targeted interventions are essential to support women during this critical period and enhance the well-being of both mothers and babies.
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Affiliation(s)
- Yijie Li
- Psychological Clinic, Tianjin Anding Hospital, Tianjin, China
| | - Huihui Yu
- Department of outpatient psychology, Tianjin Anding Hospital, Tianjin, China
| | - Kaifang Shen
- Department of Maternal Medicine, Linyi Maternal and Child Health Hospital, Linyi, China
| | - Jing Long
- Tianjin Anding Hospital, Tianjin, China
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2
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Rajić I, Klikovac T, Petrušić I. Role of sensory processing sensitivity and high sensation seeking in migraine with typical aura. Acta Neurol Belg 2023; 123:2243-2249. [PMID: 37217743 DOI: 10.1007/s13760-023-02292-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
The psychological differences between migraine with aura (MwA) patients and healthy controls (HCs) have not been sufficiently investigated in the current scientific literature. Taking this into account, the present study aimed to examine differences between MwA patients and HCs in sensory processing sensitivity factors, high sensation seeking factors, depression, and anxiety. Mentioned variables were also used to determine their predictive role in predicting the group membership (MwA patients vs HCs). The Highly Sensitive Person Scale, the revised High Sensation Seeking Test, and the Hospital Anxiety and Depression Scale were administered to a sample of seventy-one respondents (39 MwA patients and 32 HCs). MwA patients had a significantly higher score for the low sensory threshold (sensory processing sensitivity factor) in comparison with HCs (4.36 ± 1.4 vs 3.45 ± 1.1, p = 0.003). There was no significant difference in other subscales of sensory processing sensitivity, as well as regarding the high sensation seeking, anxiety, and depression scores, between those two groups. The logistic regression model correctly classified 79.5% MwA patients and 66.7% HCs. The low sensory threshold was a statistically significant predictor for MwA patients (p = 0.001). Our results indicate a certain similarity in the brain sensitivities of MwA patients and people with sensory processing sensitivity trait. Moreover, this shows that the constructs of sensitivity in migraine patients and highly sensitive people overlap to an extent, suggesting the similarity between the conceptualization of sensitivity in the psychological literature and the conceptualization of sensitivity in the medical literature.
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Affiliation(s)
- Isidora Rajić
- Union University, Faculty of Law and Business Studies Dr Lazar Vrkatić, Department of Psychology, Novi Sad, Serbia
| | - Tamara Klikovac
- University of Belgrade, Faculty of Philosophy, Department of Psychology, Belgrade, Serbia
| | - Igor Petrušić
- University of Belgrade, Faculty of Physical Chemistry, Laboratory for Advanced Analysis of Neuroimages, Belgrade, Serbia.
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3
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Lanssens D, Vandenberk T, Storms V, Thijs I, Grieten L, Bamelis L, Gyselaers W, Tang E, Luyten P. Changes in Intrapersonal Factors of Participants in the Pregnancy Remote Monitoring Study Who Are at Risk for Pregnancy-Induced Hypertension: Descriptive Quantitative Study. J Med Internet Res 2023; 25:e42686. [PMID: 37672324 PMCID: PMC10512113 DOI: 10.2196/42686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/25/2023] [Accepted: 06/23/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND The peripartum period, defined as the period from the beginning of the gestation until 1 year after the delivery, has long been shown to be potentially associated with increased levels of stress and anxiety with regard to one's transition to the status of parent and the accompanying parental tasks. Yet, no research to date has investigated changes in intrapersonal factors during the peripartum period in women at risk for pregnancy-induced hypertension (PIH). OBJECTIVE The aim of this study is to explore and describe changes in intrapersonal factors in participants at risk for PIH. METHODS We used an explorative design in which 3 questionnaires were sent by email to 110 participants the day following enrollment in the Pregnancy Remote Monitoring program for pregnant women at risk for PIH. Women were invited to complete the questionnaires at the beginning of their participation in the Pregnancy Remote Monitoring project (mostly at 14 weeks of gestation) and after approaching 32 weeks of gestational age (GA). The Generalized Anxiety Disorder-7 Scale (GAD-7) and the Patient Health Questionnaire-9 were used to assess anxiety and depression, and adaptation of the Pain Catastrophizing Scale was used to measure trait pain catastrophizing. RESULTS Scores were significantly higher at 32 weeks of GA than at the moment of enrollment (GAD-7 score=7, range 4-11 vs 5, range 3-8; P=.01; and Patient Health Questionnaire-9 score=6, range 4-10 vs 4, range 2-7; P<.001). The subscale scores of the Pain Catastrophizing Scale were all lower at 32 weeks of GA compared with 14 weeks of GA (rumination: 4, range 1-6 vs 5, range 2-9.5; P=.11; magnification: 3, range 1-5.5 vs 4, range 3-7; P=.04; and helplessness: 5, range 2-9 vs 6, range 3.5-12; P=.06). The proportion of women with a risk for depression (GAD-7 score >10) was 13.3% (10/75) at enrollment and had increased to 35.6% (26/75) at 32 weeks of GA. CONCLUSIONS This study shows that pregnant women at risk for PIH have higher levels of stress and anxiety at 32 weeks of GA than at the moment of enrollment. Further research is recommended to investigate potential strategies to help pregnant women at risk for PIH manage feelings of stress and anxiety. TRIAL REGISTRATION ClinicalTrials.gov NCT03246737; https://clinicaltrials.gov/study/NCT03246737.
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Affiliation(s)
- Dorien Lanssens
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty Medicine and Life Sciences, Department of Physiology, Hasselt University, Diepenbeek, Belgium
| | - Thijs Vandenberk
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Valerie Storms
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Inge Thijs
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Lars Grieten
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Lotte Bamelis
- Centre for Translational Psychological Research TRACE, Ziekenhuis Oost Liburg, Genk, Belgium
| | - Wilfried Gyselaers
- Limburg Clinical Research Center/Mobile Health Unit, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Obstetrics and Gynaecology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty Medicine and Life Sciences, Department of Physiology, Hasselt University, Diepenbeek, Belgium
| | - Eileen Tang
- Faculty of Psychology and Educational Sciences, KULeuven, Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KULeuven, Leuven, Belgium
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussel, Belgium
- Educational and Health Psychology, Research Department of Clinical, University College London, London, United Kingdom
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4
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Ashi K, Levey E, Friedman LE, Sanchez SE, Williams MA, Gelaye B. Association of morningness-eveningness with psychiatric symptoms among pregnant women. Chronobiol Int 2022; 39:984-990. [PMID: 35296206 DOI: 10.1080/07420528.2022.2053703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
In the present study, we examined associations between circadian preference and psychiatric symptoms among 1,796 pregnant women from Lima, Peru. One quarter were classified as evening types. Compared to morning types, evening type pregnant women had increased odds of generalized anxiety (OR = 1.44; 95%CI: 1.12-1.86) and posttraumatic stress disorder (OR = 1.38; 95%CI: 1.07-1.78). Although there was a positive trend, evening chronotype was not significantly associated with elevated odds of depression (OR = 1.23; 95%CI: 0.94-1.61). Future studies are warranted to help understand the underlying behavioral, biological, and genetic pathways of these associations. Assessing circadian preference may help clinicians identify pregnant women at risk for psychiatric symptoms.
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Affiliation(s)
- Kevin Ashi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth Levey
- The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren E Friedman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sixto E Sanchez
- Asociación Civil Proyectos en Salud (PROESA), Lima, Peru.,Facultad de Medicina, Universidad de San Martin de Porres, Lima, Peru
| | - Michelle A Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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5
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Bublitz MH, Freeburg T, Sharp M, Salameh M, Bourjeily G. Childhood adversity, prenatal depression, and maternal inflammation across pregnancy. Obstet Med 2022; 15:25-30. [PMID: 35444718 PMCID: PMC9014541 DOI: 10.1177/1753495x211011910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/04/2021] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
Background To examine whether change in neutrophil-lymphocyte ratio, a marker of systemic inflammation, differs by childhood adversity and prenatal depression. Methods Prenatal complete blood count data were used to calculate neutrophil-lymphocyte ratio in first and third trimesters. The Adverse Childhood Experiences scale measured childhood adversity, and the Patient Health Questionnaire-9 measured depression. This is a secondary analysis of a study of predictors of risk for sleep-disordered breathing. Results Participants were 98 pregnant women, mean age 30 years (SD = 5), mean body mass index of 35 kg/m2 (SD = 7), 61% identified as white, and 28% identified as Hispanic. Women who reported childhood sexual abuse history displayed greater increase in neutrophil-lymphocyte ratio over pregnancy relative to women without childhood sexual abuse. Change in neutrophil-lymphocyte ratio across pregnancy did not differ by prenatal depression. Conclusion Experiences of sexual abuse in childhood may impact markers of systemic inflammation in pregnancy.
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Affiliation(s)
- Margaret H Bublitz
- Department of Psychiatry and Human Behavior, The Warren Alpert
Medical School of Brown University, Providence, RI, USA,Department of Medicine, The Warren Alpert Medical School of
Brown University, Providence, RI, USA,Women’s Medicine Collaborative, The Miriam Hospital, Providence,
RI, USA,Margaret H Bublitz Department of Psychiatry
and Human Behavior, The Warren Alpert Medical School of Brown University, 146
West River Street, Providence, RI 02904, USA.
| | - Taylor Freeburg
- Department of Medicine, The Warren Alpert Medical School of
Brown University, Providence, RI, USA
| | - Meghan Sharp
- Department of Psychiatry and Human Behavior, The Warren Alpert
Medical School of Brown University, Providence, RI, USA,Women’s Medicine Collaborative, The Miriam Hospital, Providence,
RI, USA
| | - Myriam Salameh
- Women’s Medicine Collaborative, The Miriam Hospital, Providence,
RI, USA
| | - Ghada Bourjeily
- Department of Medicine, The Warren Alpert Medical School of
Brown University, Providence, RI, USA,Women’s Medicine Collaborative, The Miriam Hospital, Providence,
RI, USA
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6
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Migraine as a risk factor for mixed symptoms of peripartum depression and anxiety in late pregnancy: A prospective cohort study. J Affect Disord 2021; 295:733-739. [PMID: 34517247 DOI: 10.1016/j.jad.2021.08.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/25/2021] [Accepted: 08/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Migraine has been identified as a risk factor for peripartum depression. However, little is known about the contribution of anxiety to this association or potential changes throughout the peripartum period. METHODS In a sample of 4,831 women from the Biology, Affect, Stress, Imaging and Cognition cohort in Sweden, participants were asked about history of migraine prior to pregnancy. The participants completed the Edinburgh Postnatal Depression Scale (EPDS) at gestational weeks 17 and 32 and postpartum week 6. Multinomial logistic regression analyses were used to assess associations between migraine and symptoms of depression, anxiety or mixed depression and anxiety, while adjusting for potential confounders. RESULTS In crude estimates, migraine was associated with separate and mixed symptoms of depression and anxiety at most time points. After adjustments, migraine was associated with anxiety at week 17 (adjusted odds ratio: 1.69; 95% confidence interval: 1.11-2.54) and with mixed depression and anxiety at week 32 (adjusted odds ratio: 1.45; 95% confidence interval: 1.06-1.99). None of the other associations remained statistically significant after adjustments. LIMITATIONS Migraine history was self-reported. Symptoms of depression and anxiety were based on the screening tool EPDS and not on clinical diagnoses. CONCLUSIONS The results demonstrate that migraine may be a risk factor for anxiety in mid- pregnancy and mixed symptoms of peripartum depression and anxiety in late pregnancy. Inflammatory and hormonal factors may underlie the association between migraine, depression and anxiety across the peripartum period.
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7
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Comparison of DASS-21, PHQ-8, and GAD-7 in a virtual behavioral health care setting. Heliyon 2021; 7:e06473. [PMID: 33817367 PMCID: PMC8010403 DOI: 10.1016/j.heliyon.2021.e06473] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/23/2021] [Accepted: 03/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Validated depression and anxiety symptom screeners are commonly used in clinical settings. How results from different brief depression and anxiety symptom assessment tools compare to each other is not well established, especially in real world healthcare settings. This study aimed to compare the Depression Anxiety Stress Scales 21 Depression scale (DASS-Depression) and Anxiety (DASS-Anxiety) scale to the Patient Health Questionnaire 8 (PHQ-8) and Generalized Anxiety Disorder 7 (GAD-7) respectively, in a real-world virtual behavioral healthcare setting. Methods This was a retrospective comparison study of clinical data from a population of adults who completed a consultation via telephone or secure video with a licensed therapist as part of a standardized, evidence-based, virtual behavioral therapy program for individuals with comorbid medical and behavioral health conditions. The joint distributions and correlations between scores yielded by each depression and anxiety scale were assessed using descriptive and Spearman correlation statistics. Results The DASS-Depression and PHQ-8 were highly correlated (r = .71; p=<.001); the DASS-Anxiety and GAD-7 correlation was also high (r = .61; p=<.001). The PHQ-8 categorized more individuals as having above-threshold depression scores versus the DASS-Depression (71.5% vs. 43.5%; p < .001). The GAD-7 categorized more individuals as having above-threshold anxiety scores versus the DASS-Anxiety (59.0% vs. 45.0%; p < .001). Limitations This study compared results yielded by validated screeners, precluding conclusions related to the validity of screener results. Conclusions The DASS-Depression and PHQ-8 and the DASS-Anxiety and GAD-7 similarly ranked symptom severity. The PHQ-8 and GAD-7 were more likely than the DASS-21 Depression or Anxiety scales to classify individuals as having above-threshold symptom severity.
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8
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Karimi L, Wijeratne T, Crewther SG, Evans AE, Ebaid D, Khalil H. The Migraine-Anxiety Comorbidity Among Migraineurs: A Systematic Review. Front Neurol 2021; 11:613372. [PMID: 33536997 PMCID: PMC7848023 DOI: 10.3389/fneur.2020.613372] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Migraine is recognized as a neurological condition that is often associated with comorbid psychiatric symptoms such as anxiety, depression, bipolar disorder and/or panic disorder. Though some studies have demonstrated the link between migraine and anxiety disorders, there are no systematic reviews that have been published in this area to summarize the evidence. The aim of the present study is to systematically review the literature associated with comorbidity of migraine and anxiety disorders among migraineurs compared to non-migraineurs. Methods: The present systematic review included population-based, cohort and cross-sectional studies if they were reporting the frequency of migraine with either anxiety or depression as diagnosed by a medical practitioner according to the International Classification of Headache Disorders (ICHD-2/3). Results: Eight eligible studies from 2060 relevant citations were included in the review. All participants were migraine patients from both primary care and outpatient settings, as well as tertiary headache and anxiety centers, and were compared to non-migraineurs. The results of the systematic review showed that there is a strong and consistent relationship between migraine and anxiety. The co-morbidity of co-occurrence for migraine and anxiety has an average OR of 2.33 (2.20–2.47) among the prevalence and cross sectional studies and an average RR of 1.63 (1.37–1.93) for two cohort studies; The major limitations of included studies were small sample sizes and a lack of adjusting of confounding factors. Conclusion: The results highlight the need for inclusion of an anxiety screening tool during initial assessments of migraine patients by medical practitioners and/or physicians and may explain why some anxiolytic medications work better than others for migraine mitigation.
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Affiliation(s)
- Leila Karimi
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Tissa Wijeratne
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia.,Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, Melbourne, VIC, Australia.,Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Sheila Gillard Crewther
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | | | - Deena Ebaid
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Hanan Khalil
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
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9
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Wensu Z, Xidi Z, Shaojie L, Baohua Z, Yunhan Y, Huilan X, Zhao H, Xiyue X. Does the Presence of Anxiety and Depression Symptoms Mediate the Association Between Family Functions and Self-Efficacy in Pregnant Women in the Third Trimester?: A Community-Based Cross-Sectional Survey. Front Psychiatry 2021; 12:726093. [PMID: 34803756 PMCID: PMC8599816 DOI: 10.3389/fpsyt.2021.726093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Pregnant women in the third trimester can be more vulnerable to adverse mental health outcomes, but there is limited research on the association between family function and self-efficacy and potential mediation by symptoms of anxiety and depression. Methods: The cross-sectional study enrolled 813 pregnant women in the third trimester from 14 communities of Hengyang city, Hunan province of China. All of the participants completed a battery of self-report measures of family function (Family Adaptation Partnership Growth and Resolve Index, APGAR-family), self-efficacy (General Self-Efficacy Scale, GSES), anxiety (measured by Generalized Anxiety Disorder scale with seven items, GAD-7), and depression symptoms (Patient Health Questionnaire with nine items, PHQ-9). The correlation analysis was performed using Spearman's correlation coefficient. Baron and Kenny's method and multiple mediation models with bootstrapping were used to determine whether the symptoms of anxiety and depression mediated the association between family functions and self-efficacy. Results: There were 22.6% pregnant women in the low level of self-efficacy, with 60.9% in the moderate level and 16.5% of respondents in the high level. Self-efficacy had significant correlations with both anxiety symptoms (r = -0.19, p < 0.05), depression symptoms (r = -0.22, p < 0.05), and family function (r = 0.31, p < 0.05). Anxiety symptoms were significantly associated with self-efficacy (β = -0.016, p < 0.05). Depression symptoms were significantly associated with self-efficacy (β = -0.024, p < 0.05). Anxiety and depression symptoms partly mediated the association between family function and self-efficacy, accounting for 11.4 and 16.4% of total effect, respectively. It was indicated that pregnant women with a high degree of family function are less likely to have emotional symptoms and predicted to have higher levels of self-efficacy. Conclusions: Anxiety and depression show mediating effects in the association between family function and self-efficacy. Improved family function can have a positive impact on pregnant women in the third trimester.
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Affiliation(s)
- Zhou Wensu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhu Xidi
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Li Shaojie
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zheng Baohua
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yu Yunhan
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xu Huilan
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Hu Zhao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xiong Xiyue
- NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China.,Department of Child Rehabilitation, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
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10
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Wang L, Kroenke K, Stump TE, Monahan PO. Screening for perinatal depression with the Patient Health Questionnaire depression scale (PHQ-9): A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 68:74-82. [PMID: 33360526 PMCID: PMC9112666 DOI: 10.1016/j.genhosppsych.2020.12.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/13/2020] [Accepted: 12/13/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Perinatal depression (PND) is a prevalent and disabling problem both during pregnancy and the postpartum period. The legacy screening measure has been the Edinburgh Postnatal Depression Scale (EPDS). This systematic review examines the validity of the PHQ-9 as a screener for PND. METHODS The following databases were searched from January 2001 (when the PHQ-9 was first published) through June 2020: MEDLINE, Embase, and PsychInfo. Studies that compared the PHQ-9 to a criterion standard psychiatric interview were used to determine the operating characteristics of sensitivity, specificity and area under the curve (AUC). Studies comparing the PHQ-9 to the EPDS and other depression scales evaluated convergent validity. RESULTS A total of 35 articles were eligible for criterion (n = 10) or convergent (n = 25) validity. Meta-analysis of the 7 criterion validity studies using the standard PHQ-9 cut point ≥10 showed a pooled sensitivity, specificity and AUC of 0.84, 0.81 and 0.89, respectively. Operating characteristics of the PHQ-9 and EPDS were nearly identical in head-to-head comparison studies. The median correlation between the PHQ-9 and EPDS was 0.59, and categorical agreement was moderate. CONCLUSIONS The PHQ-9 appears to be a viable option for perinatal depression screening with operating characteristics similar to the legacy EPDS.
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Affiliation(s)
- Larry Wang
- Indiana University, School of Medicine, Indianapolis, IN, United States.
| | - Kurt Kroenke
- Indiana University, School of Medicine, Indianapolis, IN, United States; Regenstrief Institute Inc, Indianapolis, IN, United States.
| | - Timothy E Stump
- Department of Biostatistics, Indiana University, Fairbanks School of Public Health and School of Medicine, Indianapolis, IN, USA
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University, Fairbanks School of Public Health and School of Medicine, Indianapolis, IN, USA
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11
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Gordon-Smith K, Ridley P, Perry A, Craddock N, Jones I, Jones L. Migraine associated with early onset postpartum depression in women with major depressive disorder. Arch Womens Ment Health 2021; 24:949-955. [PMID: 33881600 PMCID: PMC8585813 DOI: 10.1007/s00737-021-01131-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/03/2021] [Indexed: 11/25/2022]
Abstract
Major depressive disorder (MDD) and migraine are both more common among women than men. Women's reproductive years are associated with increased susceptibility to recurrence of both conditions, suggesting a potential role of sex hormones in aetiology. We examined associations between comorbid migraine and clinical features of MDD in women, including relationships with lifetime reproductive events such as childbirth. Lifetime clinical characteristics and reproductive events in a well-characterised sample of 222 UK women with recurrent MDD, with (n = 98) and without (n = 124) migraine were compared. Women had all been recruited as part of a UK-based ongoing programme of research into the genetic and non-genetic determinants of mood disorders. Multivariate analysis showed a specific association between the lifetime presence of migraine and postpartum depression (PPD) within 6 weeks of delivery (OR = 2.555; 95% CI: 1.037-6.295, p = 0.041). This association did not extend to a broader definition of PPD with onset up to 6 months postpartum. All other factors included in the analysis were not significantly associated with the presence of migraine: family history of depression, younger age at depression onset, history of suicide attempt and severe premenstrual syndrome symptoms. The finding that women with MDD and comorbid migraine may be particularly sensitive to hormonal changes early in the postpartum period leads to aetiological hypotheses and suggests this group may be useful for future studies attempting to characterise PPD and MDD phenotypes. The refinement of such phenotypes has implications for individualising risk and treatment and for future biological and genetic studies.
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Affiliation(s)
| | - Paul Ridley
- GP Speciality School, Health Education North West, North West, UK
| | - Amy Perry
- Psychological Medicine, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, UK
| | - Nicholas Craddock
- Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Ian Jones
- Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Lisa Jones
- Psychological Medicine, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, UK.
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12
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Abstract
OBJECTIVE This study aimed to study the association between maternal history of childhood adversity and blood pressure in pregnancy. METHODS A total of 127 pregnant women completed measures of adverse childhood experiences (ACE) and prenatal stress between June 2015 and April 2019. At 11 weeks' gestation (range, 6-17 weeks), we measured 24-hour ambulatory blood pressure. All women were considered to be at risk for pregnancy complications due to elevated body mass index and self-reporting snoring in pregnancy. RESULTS Women were, on average, 30 years old (range, 19-40 years), and average (standard deviation) body mass index in this sample was 34 (7) kg/m (range, 27-55 kg/m). Higher ACE scores were associated with higher nighttime blood pressure (systolic blood pressure: β = 0.23, p = .013; diastolic blood pressure: β = 0.22, p = .028). There were no significant associations between the ACE score and daytime blood pressure. Women with four or more ACEs were more likely to display nocturnal blood pressure nondipping (odds ratio = 3.97, 95% confidence interval = 1.38-11.40). Associations between ACE and nocturnal blood pressure remained significant after adjusting for symptoms of prenatal stress. CONCLUSIONS Results indicate that experiences of childhood adversity are associated with elevated nocturnal blood pressure and loss of a typical decline in blood pressure between day and night.
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Karpova MI, Zariada AA, Dolgushina VF, Korotkova DG, Ekusheva EV, Osipova VV. [Migraine in women: clinical and therapeutical aspects]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:98-107. [PMID: 31089104 DOI: 10.17116/jnevro201911903198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Migraine is one of the most common neurological disorders, affecting women. Physiological changes in the hormonal status can modulate the functional status of pain and analgesic systems of the brain and, by involving different pathophysiological mechanisms, change the course of migraine. In addition to an analysis of epidemiological data, the review provides current views on the clinical features of the disease in women population at different periods of life, particular attention was focused on menstrual migraine. It has certain features, such as acute and long attacks and treatment difficulties. One of main issues is the use of oral contraceptives in women with migraine according to the ratio of potential benefit to cardiovascular risk. The problems of treatment headaches in pregnant and breastfeeding women are also considered. An influence of migraine on the course and outcome of pregnancy was shown. The authors analysed the results of the studies on the course of migraine during perimenopause and postmenopause and recommendations for women with migraine attacks and climacteric syndrome. The data presented in the review are useful for clinicians, because this information represents new views on pathogenetic mechanisms, clinical features and treatment of migraine in women.
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Affiliation(s)
- M I Karpova
- South Ural State Medical University, Russian Ministry of Health, Chelyabinsk
| | - A A Zariada
- South Ural State Medical University, Russian Ministry of Health, Chelyabinsk
| | - V F Dolgushina
- South Ural State Medical University, Russian Ministry of Health, Chelyabinsk
| | - D G Korotkova
- South Ural State Medical University, Russian Ministry of Health, Chelyabinsk
| | - E V Ekusheva
- Academy of Postgraduate Education under FSBU FSCC of FMBA of Russia, Moscow, Russia
| | - V V Osipova
- Research Department of Neurology, Research-technological park of Biomedicine, Sechenov First Moscow State Medical University; Moscow Research Clinical Centre for Neuropsychiatry, Moscow Health Department, Moscow, Russia
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Hudon Thibeault AA, Sanderson JT, Vaillancourt C. Serotonin-estrogen interactions: What can we learn from pregnancy? Biochimie 2019; 161:88-108. [PMID: 30946949 DOI: 10.1016/j.biochi.2019.03.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/28/2019] [Indexed: 02/07/2023]
Abstract
We have reviewed the scientific literature related to four diseases in which to serotonin (5-HT) is involved in the etiology, herein named 5-HT-linked diseases, and whose prevalence is influenced by estrogenic status: depression, migraine, irritable bowel syndrome and eating disorders. These diseases all have in common a sex-dimorphic prevalence, with women more frequently affected than men. The co-occurrence between these 5-HT-linked diseases suggests that they have common physiopathological mechanisms. In most 5-HT-linked diseases (except for anorexia nervosa and irritable bowel syndrome), a decrease in the serotonergic tone is observed and estrogens are thought to contribute to the improvement of symptoms by stimulating the serotonergic system. Human pregnancy is characterized by a unique 5-HT and estrogen synthesis by the placenta. Pregnancy-specific disorders, such as hyperemesis gravidarum, gestational diabetes mellitus and pre-eclampsia, are associated with a hyperserotonergic state and decreased estrogen levels. Fetal programming of 5-HT-linked diseases is a complex phenomenon that involves notably fetal-sex differences, which suggest the implication of sex steroids. From a mechanistic point of view, we hypothesize that estrogens regulate the serotonergic system, resulting in a protective effect against 5-HT-linked diseases, but that, in turn, 5-HT affects estrogen synthesis in an attempt to retrieve homeostasis. These two processes (5-HT and estrogen biosynthesis) are crucial for successful pregnancy outcomes, and thus, a disruption of this 5-HT-estrogen relationship may explain pregnancy-specific pathologies or pregnancy complications associated with 5-HT-linked diseases.
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Affiliation(s)
- Andrée-Anne Hudon Thibeault
- INRS-Institut Armand-Frappier, 531, boulevard des Prairies, Laval, QC, H7V 1B7, Canada; Center for Interdisciplinary Research on Well-Being, Health, Society and Environment (Cinbiose), Université du Québec à Montréal, C.P.8888, succ. Centre-Ville, Montréal, QC, H3C 3P8, Canada.
| | - J Thomas Sanderson
- INRS-Institut Armand-Frappier, 531, boulevard des Prairies, Laval, QC, H7V 1B7, Canada.
| | - Cathy Vaillancourt
- INRS-Institut Armand-Frappier, 531, boulevard des Prairies, Laval, QC, H7V 1B7, Canada; Center for Interdisciplinary Research on Well-Being, Health, Society and Environment (Cinbiose), Université du Québec à Montréal, C.P.8888, succ. Centre-Ville, Montréal, QC, H3C 3P8, Canada.
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Amiri S, Behnezhad S, Azad E. Migraine headache and depression in adults: a systematic Review and Meta-analysis. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2019; 33:131-140. [PMID: 30666527 DOI: 10.1007/s40211-018-0299-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 12/17/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Migraines have adverse psychological consequences, one of which is the tendency towards depression. This study aimed to investigate the effects of migraine on adults' depression in the form of a systematic review and meta-analysis METHODS: Several scientific databases were searched using relevant keywords until the end of January 2018. After reviewing the titles and abstracts and the full texts, the researchers eventually included 16 eligible articles. Major and sub-group analyses were carried out using random effects. Publication bias was also measured. RESULTS Pooled Odd Ratio (PR) = 1.95; and 95% confidence interval (CI) = CI = 1.61-2.35 were obtained in studying the effects of migraine on depression. This effect was equal to OR = 1.81 (95% CI = 1.20-2.72) in cohort studies, and OR = 2.00; 95% CI = 1.64-2.43 in cross sectional studies. The heterogeneity was high, and no publication bias was found. CONCLUSIONS Migraine can play an important role in increasing the incidence of depression in affected patients. Therefore, identifying and ultimately treating the disease can be beneficial in reducing the negative psychological effects of this disease.
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Affiliation(s)
| | | | - Esfandiar Azad
- Behavioral Sciences Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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16
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Utilization of complementary and alternative medicine and conventional medicine for headache or migraine during pregnancy: A cross-sectional survey of 1,835 pregnant women. Complement Ther Med 2018; 41:192-195. [DOI: 10.1016/j.ctim.2018.09.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/28/2018] [Accepted: 09/28/2018] [Indexed: 01/11/2023] Open
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Sociodemographic, obstetric characteristics, antenatal morbidities, and perinatal depressive symptoms: A three-wave prospective study. PLoS One 2018; 13:e0188365. [PMID: 29420535 PMCID: PMC5805167 DOI: 10.1371/journal.pone.0188365] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/06/2017] [Indexed: 11/30/2022] Open
Abstract
Objectives This study aimed (1) to investigate the pattern of perinatal depressive symptoms, and (2) to determine the relationships between sociodemographic characteristics, obstetric factors, antenatal morbidities, postnatal conditions, and perinatal depressive symptoms using a structural equation model (SEM). Method A three-wave prospective longitudinal design was used for 361 women in their second trimester, third trimester, and at six weeks postpartum. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess the depressive symptoms. Results The intensity of depressive symptoms was the highest in the second trimester among the three waves. The SEM showed that unmarried status, unplanned pregnancy, gestational diabetes, and headache were significantly associated with EPDS in the first and second waves. The EPDS in the first wave was able to predict the EPDS in the second and third waves. The SEM has satisfactorily fit with the data (chi-square/degree of freedom = 1.42, incremental fit index = 0.91, Tucker-Lewis index = 0.90, comparative fit index = 0.91, and root mean square error of approximation = 0.03). Conclusion The findings highlight the significance of monitoring depressive symptoms in the second trimester. Findings from this study could be useful in the design of effective intervention among women with unmarried status, unplanned pregnancy, gestational diabetes, and headache in order to reduce risk of perinatal depressive symptoms.
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Qiu C, Lawrence W, Gelaye B, Stoner L, Frederick IO, Enquobahrie DA, Sorensen TK, Williams MA. Risk of glucose intolerance and gestational diabetes mellitus in relation to maternal habitual snoring during early pregnancy. PLoS One 2017; 12:e0184966. [PMID: 28926639 PMCID: PMC5605003 DOI: 10.1371/journal.pone.0184966] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 09/04/2017] [Indexed: 12/02/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) or habitual snoring is known to be associated with impaired glucose tolerance and type 2 diabetes among both men and non-pregnant women. We examined the association of habitual snoring during early pregnancy with risk of impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM). Methods A cohort of 1,579 women was interviewed during early pregnancy. We collected information about snoring frequency during early pregnancy. Results from screening and diagnostic tests for IGT and GDM were abstracted from medical records. Multivariate logistic regression models were fitted to estimate odds ratios (OR) and 95% confidence intervals (95% CI) of IGT and GDM associated with snoring in early pregnancy. Results Overall, women who snored “most or all of the time” had a 2.1-fold increased odds of IGT (OR 2.10; 95% CI 1.31–3.35) and a 2.5-fold increased odds of GDM (OR 2.50; 95% CI 1.34–4.67) as compared with women who never snored. Compared with lean women (pre-pregnancy body mass index (BMI) <25 kg/m2) who did not snore, lean snorers had a 2-fold increased odds of GDM (OR = 1.99, 95% CI: 1.07–3.68). The odds of GDM risk was particularly elevated among overweight women (BMI ≥ 25 kg/m2) who snored (OR = 5.01; 95% CI 2.71–9.26). However, there was no evidence of an interaction between overweight and snoring with GDM risk (p-value = 0.144). Conclusions These findings, if confirmed, may have important implications for tailoring prenatal care for overweight pregnant women, and /or those with a history of habitual snoring in early pregnancy.
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Affiliation(s)
- Chunfang Qiu
- Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington, United States of America
- * E-mail:
| | - Wayne Lawrence
- Department of Epidemiology, Harvard T. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Lee Stoner
- Department of Sport and Exercise Science, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Ihunnaya O. Frederick
- Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington, United States of America
| | - Daniel A. Enquobahrie
- Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, United States of America
| | - Tanya K. Sorensen
- Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington, United States of America
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T. Chan School of Public Health, Boston, Massachusetts, United States of America
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Friedman LE, Aponte C, Perez Hernandez R, Velez JC, Gelaye B, Sánchez SE, Williams MA, Peterlin BL. Migraine and the risk of post-traumatic stress disorder among a cohort of pregnant women. J Headache Pain 2017; 18:67. [PMID: 28685258 PMCID: PMC5500599 DOI: 10.1186/s10194-017-0775-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/07/2017] [Indexed: 01/03/2023] Open
Abstract
Background Individually both migraine and post-traumatic stress disorder (PTSD) prevalence estimates are higher among women. However, there is limited data on the association of migraine and PTSD in women during pregnancy. Methods We examined the association between migraine and PTSD among women attending prenatal clinics in Peru. Migraine was characterized using the International Classification of Headache Disorders (ICHD)-III beta criteria. PTSD was assessed using the PTSD Checklist-Civilian Version (PCL-C). Multivariable logistic regression analyses were performed to estimate odds ratios (OR) and 95% confidence intervals (CI) after adjusting for confounders. Results Of the 2922 pregnant women included, 33.5% fulfilled criteria for any migraine (migraine 12.5%; probable migraine 21.0%) and 37.4% fulfilled PTSD criteria. Even when controlling for depression, women with any migraine had almost a 2-fold increased odds of PTSD (OR: 1.97; 95% CI: 1.64–2.37) as compared to women without migraine. Specifically, women with migraine alone (i.e. excluding probable migraine) had a 2.85-fold increased odds of PTSD (95% CI: 2.18–3.74), and women with probable migraine alone had a 1.61-fold increased odds of PTSD (95% CI: 1.30–1.99) as compared to those without migraine, even after controlling for depression. In those women with both migraine and comorbid depression, the odds of PTSD in all migraine categories were even further increased as compared to those women without migraine. Conclusion In a cohort of pregnant women, irrespective of the presence or absence of depression, the odds of PTSD is increased in those with migraine. Our findings suggest the importance of screening for PTSD, specifically in pregnant women with migraine. Electronic supplementary material The online version of this article (doi:10.1186/s10194-017-0775-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren E Friedman
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, K501, Boston, MA, 02115, USA.
| | - Christina Aponte
- Multidisciplinary International Research Training Program, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Rigoberto Perez Hernandez
- Multidisciplinary International Research Training Program, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Juan Carlos Velez
- Departamento de Rehabilitación, Hospital del Trabajador, Santiago, Chile
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, K501, Boston, MA, 02115, USA.,Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Sixto E Sánchez
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,Asociación Civil PROESA, Lima, Peru
| | - Michelle A Williams
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, K501, Boston, MA, 02115, USA
| | - B Lee Peterlin
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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20
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Wells RE, Turner DP, Lee M, Bishop L, Strauss L. Managing Migraine During Pregnancy and Lactation. Curr Neurol Neurosci Rep 2016; 16:40. [PMID: 27002079 DOI: 10.1007/s11910-016-0634-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
While over half of women with migraine report improvement during pregnancy, having a history of migraine may increase the chance of negative health outcomes. The state of pregnancy increases the risk of several dangerous secondary headache disorders, especially those associated with hypertensive disorders of pregnancy, and providers need to know the red flags to diagnose and treat emergently. Non-pharmacological migraine treatments can be instituted in advance of pregnancy as many are considered the safest options during pregnancy, but understanding the safety of medications and dietary supplements ensures appropriate care for the refractory migraine patient. New controversy exists over the safety of several historically routine and safe migraine treatment options in pregnancy, such as magnesium, acetaminophen, ondansetron, and butalbital. While it is not clear if breastfeeding decreases the postpartum recurrence of migraine, understanding safe treatment options during lactation can allow women to continue breastfeeding while achieving migraine relief.
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Affiliation(s)
- Rebecca Erwin Wells
- Department of Neurology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
| | - Dana P Turner
- Department of Anesthesiology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Michelle Lee
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Laura Bishop
- Department of Neurology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Lauren Strauss
- Department of Neurology, Wake Forest Baptist Health, Medical Center Blvd, Winston-Salem, NC, 27157, USA
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Aguila MER, Rebbeck T, Leaver AM, Lagopoulos J, Brennan PC, Hübscher M, Refshauge KM. The Association Between Clinical Characteristics of Migraine and Brain GABA Levels: An Exploratory Study. THE JOURNAL OF PAIN 2016; 17:1058-1067. [PMID: 27369186 DOI: 10.1016/j.jpain.2016.06.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 06/07/2016] [Accepted: 06/18/2016] [Indexed: 01/01/2023]
Abstract
UNLABELLED Migraine is prevalent and disabling yet is poorly understood. One way to better understand migraine is to examine its clinical characteristics and potential biomarkers such as gamma-aminobutyric acid (GABA). The primary objective of this study was to explore whether relevant disease characteristics of migraine are associated with brain GABA levels. Twenty adults fulfilling the established diagnostic criteria for migraine and 20 age- and gender-matched controls completed this cross-sectional study. Pain, central sensitization, negative emotional state, and perceived disability were measured using Short-form McGill Pain Questionnaire-2, Central Sensitization Inventory, Depression Anxiety Stress Scales-21, and Headache Impact Test-6, respectively. Secondary analysis of brain GABA levels of the same cohort measured using proton magnetic resonance spectroscopy was conducted. The migraine group had significantly higher scores than the control group on pain, central sensitization, and disability. Correlation analyses showed fair positive association between GABA levels and pain and central sensitization scores. No association was found between GABA levels and emotional state and disability. These findings are preliminary evidence supporting the use of questionnaires and GABA levels in characterizing migraine better and broadening the diagnostic process. These findings also strengthen the rationale for the role of GABA in migraine pathophysiology and corroborate the potential of GABA as a migraine biomarker. PERSPECTIVE Higher pain and central sensitization scores were associated with increased brain GABA levels in individuals with migraine. These findings offer preliminary evidence for the usefulness of measuring pain and central sensitization in migraine and provide some support for the possible role of GABA in migraine pathophysiology and its potential as a diagnostic marker.
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Affiliation(s)
- Maria-Eliza R Aguila
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia; University of the Philippines College of Allied Medical Professions, Manila, Philippines.
| | - Trudy Rebbeck
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - Andrew M Leaver
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - Jim Lagopoulos
- Brain and Mind Centre, Sydney Medical School, Camperdown, New South Wales, Australia; Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Patrick C Brennan
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - Markus Hübscher
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia; Neuroscience Research Australia and The University of New South Wales, Randwick, New South Wales, Australia
| | - Kathryn M Refshauge
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia
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