Patterns of separation anxiety symptoms amongst pregnant women in conflict-affected Timor-Leste: Associations with traumatic loss, family conflict, and intimate partner violence

The unseen aspect of negative birth experience: Blues of birth

The purpose of the authors in this paper is to investigate the effects of negative experiences during delivery and postpartum period on the relationship between the mother. The quantitative part of this study was conducted with 289 mothers and the qualitative part with 40 mothers. It was found that experiencing upsetting problems during delivery (p = 0.006) and in the postpartum period (p = 0.002) had an effect on separation anxiety. Based on the examination of the feelings experienced during annoying or distressing situations in the postpartum period, it was determined that there was a significant correlation between guilt (p = 0.000), fear of not being a good mother (p = 0.035), and feeling weak (p = 0.001) and separation anxiety. Blues of birth is fear and anxiety that the baby will be harmed if the mother is separated from it, and it is attributed to negative experiences during delivery and the postpartum period.

Short-term effects of extreme meteorological factors on daily outpatient visits for anxiety in Suzhou, Anhui Province, China: a time series study

Anxiety disorders are a major public health concern in China. Previous studies have provided evidence for associations between ambient temperature and anxiety outpatient visits, but no studies have examined short-term effects of other meteorological factors such as sunshine duration, wind speed, and precipitation on increased anxiety outpatient visits. We aimed to assess the association between climatic factors and outpatient visits for anxiety in Suzhou, a city with a temperate climate in Anhui Province, China. Daily anxiety outpatient visits, meteorological factors, and air pollutants from 2017 to 2019 were collected. A quasi-Poisson generalized linear regression model combined with distributed lag non-linear model (DLNM) was used to quantify the effects of extreme meteorological factors (sunshine duration, wind speed, and precipitation) on anxiety outpatient visits. All effects were presented as relative risk (RR), with the 90th and 10th percentiles of meteorological factors compared to the median. Subgroup analyses by age and gender were performed to identify susceptible subgroups. A total of 11,323 anxiety outpatient visits were reported. Extremely low sunshine duration and low and high wind speed increased the risk of anxiety outpatient visits. The strongest cumulative effects occurred at lag 0-14 days, and the corresponding RRs of extremely low sunshine duration and low and high wind speed were 1.417 (95% CI: 1.056-1.901), 1.529 (95% CI: 1.028-2.275), and 1.396 (95% CI: 1.007-1.935), respectively. Subgroup analyses showed that males and people aged ≥45 years appeared to be more susceptible to the cumulative effects of extremely low sunshine duration. In addition, the adverse effects of extreme wind speed were more pronounced in the cold season. This study provides evidence that extreme climatic factors have a lagged effect on anxiety outpatient visits. In the context of climate change, these findings may help develop weather-based early warning systems to minimize the effects of extreme meteorological factors on anxiety.

Factors Affecting Quality of Care in Maternal and Child Health in Timor-Leste: A Scoping Review

Timor-Leste faces many challenges implementing quality maternal, newborn and child health (MNCH) services due to resource constraints and socio-cultural factors that disproportionately affect the health of women and children. A scoping review was conducted to map the quality of MNCH services against WHO quality standards on: 1. Provision of care, 2. Experiences of care, and 3. Cross-cutting standards. The literature search identified 1058 citations, from which 28 full-text articles met the inclusion criteria. The findings highlight health workers’ limited capacity to provide quality services and referrals. The major reasons for this are: a lack of essential supplies, poor infrastructure and transport, limited opportunities for ongoing learning, and gaps in health information systems. Provision of care standards and cross-cutting standards require attention at a broad systems level. Findings related to experiences of care highlight the importance of effective communication, respect, and emotional support, particularly for vulnerable women and children who have difficulty accessing services, and for those who have experienced violence. These experience-related standards could be addressed at an individual health worker and health service level, as well as at a systems level. This review provides direction to focus quality-improvement initiatives within local health facilities, as well as at municipal and national level.

Anxiety disorders

Anxiety disorders form the most common group of mental disorders and generally start before or in early adulthood. Core features include excessive fear and anxiety or avoidance of perceived threats that are persistent and impairing. Anxiety disorders involve dysfunction in brain circuits that respond to danger. Risk for anxiety disorders is influenced by genetic factors, environmental factors, and their epigenetic relations. Anxiety disorders are often comorbid with one another and with other mental disorders, especially depression, as well as with somatic disorders. Such comorbidity generally signifies more severe symptoms, greater clinical burden, and greater treatment difficulty. Reducing the large burden of disease from anxiety disorders in individuals and worldwide can be best achieved by timely, accurate disease detection and adequate treatment administration, scaling up of treatments when needed. Evidence-based psychotherapy (particularly cognitive behavioural therapy) and psychoactive medications (particularly serotonergic compounds) are both effective, facilitating patients' choices in therapeutic decisions. Although promising, no enduring preventive measures are available, and, along with frequent therapy resistance, clinical needs remain unaddressed. Ongoing research efforts tackle these problems, and future efforts should seek individualised, more effective approaches for treatment with precision medicine.

Associations between bride price stress and intimate partner violence amongst pregnant women in Timor-Leste

BACKGROUND

Reducing violence against women is a global public health priority, particularly in low-income and conflict-affected societies. However, more needs to be known about the causes of intimate partner violence (IPV) in these settings, including the stress of bride price obligations.

METHODS

The representative study of women attending ante-natal clinics in Dili, Timor-Leste was conducted between June, 2013 and September, 2014 with 1672 pregnant women, a response rate of 96%. We applied contextually developed measures for the stress of bride price and poverty, and the World Health Organisation measure for intimate partner violence.

RESULTS

Compared to those with no problems with bride price, women with moderate or serious problems with that custom reported higher rates of IPV (18.0% vs. 43.6%). Adjusting for socio-demographic factors, multivariate analysis revealed that ongoing poverty (OR = 1.75, 95% CI: 1.20-2.56) was significantly associated with IPV. Importantly, the strongest association with IPV was problems with bride price (OR = 2.73, 95% CI: 1.86-4.01).

CONCLUSIONS

This is the first large consecutively sampled study to demonstrate a strong association between the stressors of bride price and poverty with IPV. Notably, bride price stress had the strongest association with IPV. Revealing this hitherto unrecognized factor of bride price stress may prove pivotal in guiding policy and interventions aimed at reducing IPV, and thereby improve the health and psychosocial status of women in low income and conflict-affected settings.