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Luoma I, Korhonen M, Salmelin RK, Siirtola A, Mäntymaa M, Valkonen-Korhonen M, Puura K. Mothers' and their children's emotional and behavioral symptom trajectories and subsequent maternal adjustment: Twenty-seven years of motherhood. J Affect Disord 2024; 361:299-309. [PMID: 38876318 DOI: 10.1016/j.jad.2024.06.027] [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: 10/25/2023] [Revised: 04/30/2024] [Accepted: 06/11/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND This study aims to describe maternal depressive symptoms (MDS) trajectories in a longitudinal study extending from pregnancy to 27 years after the birth of the firstborn child. We also explored the associations of both MDS trajectories and child internalizing and externalizing problem trajectories with maternal adjustment (adaptive functioning, emotional and behavioral problems). METHODS The population-based study was conducted in Tampere, Finland, and the sample comprised 356 first-time mothers. MDS were screened with the Edinburgh Postnatal Depression Scale during pregnancy, first week after delivery, 2 and 6 months postnatally, and when the child was 4-5, 8-9, 16-17, and 26-27 years of age. The internalizing and externalizing problems of the children were assessed with the Child Behavior Checklist when the child was 4-5, 8-9, and 16-17 years of age. Maternal adaptive functioning and internalizing and externalizing problems were assessed with the Adult Self Report at 26-27 years after the birth of the first child. Complete follow-up data were available for 168 mothers. RESULTS We describe a three-group trajectory model of MDS (High Stable, Low Stable, Very Low). Elevated depressive symptom patterns were associated with less optimal maternal outcomes regarding both adaptive and problem dimensions. The child's internalizing and externalizing problem trajectories were associated with maternal internalizing and externalizing problems but not with maternal adaptive functioning. LIMITATIONS Maternal and child measures were based on maternal reports only. CONCLUSIONS The interconnectedness of the well-being of the mother and child should be noted in health and mental health services for adults and children.
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Affiliation(s)
- Ilona Luoma
- University of Eastern Finland, Faculty of Health Sciences, Kuopio, Finland; Kuopio University Hospital, Department of Child Psychiatry, Kuopio, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Marie Korhonen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Helsinki University Hospital, Department of Child Psychiatry, Helsinki, Finland
| | - Raili K Salmelin
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Tampere University Hospital, Department of Child Psychiatry, Tampere, Finland
| | - Arja Siirtola
- Tampere University Hospital, Department of Child Psychiatry, Tampere, Finland
| | - Mirjami Mäntymaa
- University of Oulu, Faculty of Medicine, Oulu, Finland; Oulu University Hospital, Department of Child Psychiatry, Oulu, Finland
| | - Minna Valkonen-Korhonen
- University of Eastern Finland, Faculty of Health Sciences, Kuopio, Finland; Kuopio University Hospital, Department of Psychiatry, Kuopio, Finland
| | - Kaija Puura
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Tampere University Hospital, Department of Child Psychiatry, Tampere, Finland
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Fuente-Moreno M, Garcia-Terol C, Domínguez-Salas S, Rubio-Valera M, Motrico E. Maternity care changes and postpartum mental health during the COVID-19 pandemic: a Spanish cross-sectional study. J Reprod Infant Psychol 2024; 42:753-768. [PMID: 36710435 DOI: 10.1080/02646838.2023.2171375] [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: 09/29/2022] [Accepted: 01/17/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic led to abrupt changes in maternity care, but the impact of these changes has not yet been deeply evaluated. This study aimed to assess the impact of the unexpected changes in maternity care due to the COVID-19 pandemic on postpartum mental health (depression, anxiety and posttraumatic stress disorder). METHODS A cross-sectional, web-based study was conducted in Spain during the second half of 2020. The eligibility criteria were women≥18 years with a child≤6 months. The Edinburgh Postnatal Depression Scale (EPDS), the Generalized Anxiety Disorder-7 Screener (GAD-7) and a subset of the PTSD checklist (PCL-5) were used to assess postpartum mental health. Information regarding sociodemographic characteristics and maternity care changes was collected, and multivariate regression models were used. RESULTS Among 1781 participants, 29.3% and 33% had clinically significant depressive and anxiety symptoms, respectively. The most prevalent unexpected changes reported were related to the exclusion of supportive relatives during birth and postpartum. Changes reported during birth showed a minor association with PTSD symptomatology, and those that occurred during the postpartum period were associated with clinical depression, anxiety and PTSD symptoms. CONCLUSIONS The unexpected changes in maternity care due to the COVID-19 pandemic, especially those that occurred during the postpartum period, increased the risk of mental health problems.
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Affiliation(s)
- Marina Fuente-Moreno
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Clara Garcia-Terol
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Spain
| | | | - María Rubio-Valera
- Health Technology Assessment in Primary Care and Mental Health (PRISMA) Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Parc Sanitari Sant Joan de Déu,Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
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Harrison S, Quigley MA, Fellmeth G, Stein A, Ayers S, Alderdice F. The impact of the Covid-19 pandemic on postnatal anxiety and posttraumatic stress: Analysis of two population-based national maternity surveys in England. J Affect Disord 2024; 356:122-136. [PMID: 38574867 DOI: 10.1016/j.jad.2024.04.003] [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: 10/16/2023] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Few studies have evaluated postnatal anxiety and posttraumatic stress (PTS) before and during the Covid-19 pandemic using comparable data across time. We used data from two national maternity surveys in England to explore the impact of the pandemic on prevalence and risk factors for postnatal anxiety and PTS. METHODS Analysis was conducted using population-based surveys carried out in 2018 (n = 4509) and 2020 (n = 4611). Weighted prevalence estimates for postnatal anxiety and PTS were compared across surveys. Adjusted risk ratios (aRR) were estimated for the association between risk factors and postnatal anxiety and PTS. FINDINGS Prevalence of postnatal anxiety increased from 13.7 % in 2018 to 15.1 % in 2020 (+1.4 %(95%CI:-0.4-3.1)). Prevalence of postnatal PTS increased from 9.7 % in 2018 to 11.5 % in 2020 (+1.8 %(95%CI:0.3-3.4)), due to an increase in PTS related to birth trauma from 2.5 % to 4.3 % (+1.8 %(95%CI:0.9-2.6); there was no increase in PTS related to non-birth trauma. Younger age (aRR = 1.31-1.51), being born in the UK (aRR = 1.29-1.59), long-term physical or mental health problem(s) (aRR = 1.27-1.94), and antenatal anxiety (aRR = 1.97-2.22) were associated with increased risk of postnatal anxiety and PTS before and during the pandemic, whereas higher satisfaction with birth (aRR = 0.92-0.94) and social support (aRR = 0.81-0.82) were associated with decreased risk. INTERPRETATION Prevalence of postnatal PTS was significantly higher during the pandemic, compared to before the pandemic, due to an increase in PTS related to birth trauma. Prevalence of postnatal anxiety was not significantly higher during the pandemic. Risk factors for postnatal anxiety and PTS were similar before and during the pandemic.
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Affiliation(s)
- S Harrison
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - M A Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - G Fellmeth
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - A Stein
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; African Health Research Institute, Durban, KwaZulu-Natal, South Africa
| | - S Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - F Alderdice
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
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Becker E, Atkinson L, Gonzalez A, Khoury J. Social support buffers the impact of pregnancy stress on perceptions of parent-infant closeness during the COVID-19 pandemic. Infant Ment Health J 2024; 45:328-340. [PMID: 38196240 DOI: 10.1002/imhj.22096] [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: 07/21/2022] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
Pregnant individuals and parents have experienced elevated mental health problems and stress during COVID-19. Stress during pregnancy can be harmful to the fetus and detrimental to the parent-child relationship. However, social support is known to act as a protective factor, buffering against the adverse effects of stress. The present study examined whether (1) prenatal stress during COVID-19 was associated with parent-infant closeness at 6 months postpartum, and (2) social support moderated the effect of prenatal stress on the parent-infant relationship. In total, 181 participants completed questionnaires during pregnancy and at 6 months postpartum. A hierarchical linear regression analysis was conducted to assess whether social support moderated the effect of stress during pregnancy on parent-infant closeness at 6 months postpartum. Results indicated a significant interaction between prenatal stress and social support on parents' perceptions of closeness with their infants at 6 months postpartum (β = .805, p = .029); parents who experienced high prenatal stress with high social support reported greater parent-infant closeness, compared to those who reported high levels of stress and low social support. Findings underscore the importance of social support in protecting the parent-infant relationship, particularly in times of high stress, such as during the COVID-19 pandemic.
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Affiliation(s)
- Emma Becker
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Leslie Atkinson
- Department of Psychology, Metropolitan Toronto University, Toronto, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Khoury
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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Jackson L, Greenfield M, Payne E, Burgess K, Oza M, Storey C, Davies SM, De Backer K, Kent-Nye FE, Pilav S, Worrall S, Bridle L, Khazaezadeh N, Rajasingam D, Carson LE, De Pascalis L, Fallon V, Hartley JM, Montgomery E, Newburn M, Wilson CA, Harrold JA, Howard LM, Sandall J, Magee LA, Sheen KS, Silverio SA. A consensus statement on perinatal mental health during the COVID-19 pandemic and recommendations for post-pandemic recovery and re-build. Front Glob Womens Health 2024; 5:1347388. [PMID: 38449695 PMCID: PMC10915094 DOI: 10.3389/fgwh.2024.1347388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction The COVID-19 pandemic posed a significant lifecourse rupture, not least to those who had specific physical vulnerabilities to the virus, but also to those who were suffering with mental ill health. Women and birthing people who were pregnant, experienced a perinatal bereavement, or were in the first post-partum year (i.e., perinatal) were exposed to a number of risk factors for mental ill health, including alterations to the way in which their perinatal care was delivered. Methods A consensus statement was derived from a cross-disciplinary collaboration of experts, whereby evidence from collaborative work on perinatal mental health during the COVID-19 pandemic was synthesised, and priorities were established as recommendations for research, healthcare practice, and policy. Results The synthesis of research focused on the effect of the COVID-19 pandemic on perinatal health outcomes and care practices led to three immediate recommendations: what to retain, what to reinstate, and what to remove from perinatal mental healthcare provision. Longer-term recommendations for action were also made, categorised as follows: Equity and Relational Healthcare; Parity of Esteem in Mental and Physical Healthcare with an Emphasis on Specialist Perinatal Services; and Horizon Scanning for Perinatal Mental Health Research, Policy, & Practice. Discussion The evidence base on the effect of the pandemic on perinatal mental health is growing. This consensus statement synthesises said evidence and makes recommendations for a post-pandemic recovery and re-build of perinatal mental health services and care provision.
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Affiliation(s)
- Leanne Jackson
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Mari Greenfield
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, United Kingdom
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Elana Payne
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Karen Burgess
- Petals: The Baby Loss Counselling Charity, Cambridge, United Kingdom
| | - Munira Oza
- The Ectopic Pregnancy Trust, London, United Kingdom
| | - Claire Storey
- International Stillbirth Alliance, Bristol, United Kingdom
| | - Siân M. Davies
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Kaat De Backer
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Flora E. Kent-Nye
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Sabrina Pilav
- Centre for Research in Psychology and Sport Sciences, Health and Wellbeing Research, The University of Hertfordshire, Hatfield, United Kingdom
| | - Semra Worrall
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Laura Bridle
- HELIX Service, Maternal Mental Health Services, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Nina Khazaezadeh
- Chief Midwifery Office, NHS England—London Region, London, United Kingdom
| | - Daghni Rajasingam
- Maternity Services, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lauren E. Carson
- Section of Women’s Mental Health, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Research Development, UK Biobank, Manchester, United Kingdom
| | - Leonardo De Pascalis
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Julie M. Hartley
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Elsa Montgomery
- Division of Methodologies, Department of Midwifery, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, United Kingdom
| | - Mary Newburn
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Claire A. Wilson
- Section of Women’s Mental Health, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Joanne A. Harrold
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Louise M. Howard
- Section of Women’s Mental Health, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jane Sandall
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Laura A. Magee
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Kayleigh S. Sheen
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- School of Social Sciences, College of Health, Science and Society, University of the West of England Bristol, Bristol, United Kingdom
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
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Costa R, Mesquita A, Motrico E, Domínguez-Salas S, Dikmen-Yildiz P, Saldivia S, Vousoura E, Osorio A, Wilson CA, Bina R, Levy D, Christoforou A, González MF, Hancheva C, Felice E, Pinto TM. Unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety during the COVID-19 pandemic. Acta Psychiatr Scand 2024. [PMID: 38342101 DOI: 10.1111/acps.13664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVE/BACKGROUND Unmet needs in perinatal mental healthcare are an important public health issue particularly in the context of a stressful life event such as the COVID-19 pandemic but data on the extent of this problem are needed. AIM The aim of this study is to determine the (1) proportion of women with clinically significant symptoms of perinatal depression, anxiety or comorbid symptoms of depression and anxiety, receiving mental healthcare overall and by country and (2) factors associated with receiving mental healthcare. METHOD Women in the perinatal period (pregnancy or up to 6 months postpartum) participating in the Riseup-PPD-COVID-19 cross-sectional study, reported on sociodemographic, social support health-related factors, and COVID-19 related factors, and on symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (Generalised Anxiety Disorder [GAD-7]) using self-report questionnaires. Clinically significant symptoms were defined as EPDS ≥ 13 for depression and GAD-7 ≥ 10 for anxiety. Mental healthcare was defined as self-reported current mental health treatment. RESULTS Of the 11 809 participants from 12 countries included in the analysis, 4 379 (37.1%) reported clinically significant symptoms of depression (n = 1 228; 10.4%; EPDS ≥ 13 and GAD-7 ⟨ 10), anxiety (n = 848; 7.2%; GAD-7 ≥ 10 and EPDS ⟨ 13) or comorbid symptoms of depression and anxiety (n = 2 303; 19.5%; EPDS ≥ 13 and GAD-7 ≥ 10). Most women with clinically significant symptoms of depression, anxiety, or comorbid symptoms of depression and anxiety were not receiving mental healthcare (89.0%). Variation in the proportion of women with clinically significant symptoms of depression and/or anxiety reporting mental healthcare was high (4.7% in Turkey to 21.6% in Brazil). Women in the postpartum (vs. pregnancy) were less likely (OR 0.72; 95% CI 0.59-0.88), whereas women with previous mental health problems (vs. no previous mental health problems) (OR 5.56; 95% CI 4.41-7.01), were more likely to receive mental healthcare. CONCLUSION There are high unmet needs in mental healthcare for women with clinically significant symptoms of perinatal depression and/or anxiety across countries during the COVID-19 pandemic. Studies beyond the COVID-19 pandemic and covering the whole range of mental health problems in the perinatal period are warranted to understand the gaps in perinatal mental healthcare.
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Affiliation(s)
- Raquel Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Hei-Lab: Digital Human-Environment Interaction Lab, Faculty of Psychology, Education and Sports, Lusófona University, Porto, Portugal
| | - Ana Mesquita
- School of Psychology, University of Minho, Braga, Portugal
- ProChild CoLab Against Poverty and Social Exclusion - Association (ProChild CoLAB) Campus de Couros R, Guimarães
| | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucia, Spain
| | | | | | - Sandra Saldivia
- Department of Psychiatry and Mental Health, Faculty of Medicine. Universidad de Concepción, Chile
| | - Eleni Vousoura
- Department of Psychology, School of Philosophy, National & Kapodistrian University of Athens, Greece
| | - Ana Osorio
- Graduate Program on Developmental Disorders and Mackenzie Center for Research in Childhood and Adolescence, Center for Biological and Health Sciences, Mackenzie Presbyterian University, São Paulo, SP, Brazil
| | - Claire A Wilson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Rena Bina
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Israel
| | - Drorit Levy
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Israel
| | - Andri Christoforou
- Department of Social and Behavioral Sciences, European University Cyprus, Cyprus
| | | | | | | | - Tiago Miguel Pinto
- Hei-Lab: Digital Human-Environment Interaction Lab, Faculty of Psychology, Education and Sports, Lusófona University, Porto, Portugal
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Caffieri A, Gómez‐Gómez I, Barquero‐Jimenez C, De‐Juan‐Iglesias P, Margherita G, Motrico E. Global prevalence of perinatal depression and anxiety during the COVID-19 pandemic: An umbrella review and meta-analytic synthesis. Acta Obstet Gynecol Scand 2024; 103:210-224. [PMID: 38113292 PMCID: PMC10823409 DOI: 10.1111/aogs.14740] [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: 06/27/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION The prevalence of depression and anxiety symptoms in pregnant and postpartum women during the COVID-19 pandemic was assessed by several systematic reviews (SRs) and meta-analyses which provided contrasting and different results. We aimed to summarize the evidence relating to the global prevalence of anxiety and depression among pregnant and postpartum women during the COVID-19 pandemic. MATERIAL AND METHODS An umbrella review of SRs and meta-analyses was performed. Searches were conducted in electronic databases up to April 2023. SRs and meta-analyses reporting the prevalence of perinatal anxiety and depression during the COVID-19 pandemic were selected for eligibility. Primary studies extracted from eligible meta-analyses were included in the quantitative synthesis. The research protocol was registered on PROSPERO (CRD42020173125). RESULTS A total of 25 SRs (198 primary studies) and 12 meta-analyses (129 primary studies) were included in the qualitative and quantitative synthesis, respectively. Studies involved data from five continents and 45 countries. The pooled prevalence of antenatal and postpartum depression was 29% (n = 55; 95% CI: 25%-33%) and 26% (n = 54; 95% CI: 23%-30%), respectively. In the case of anxiety, the pooled antenatal and postnatal prevalence was 31% (n = 44; 95% CI: 26%-37%; n = 16; 95% CI: 24%-39%). Differences emerged between continents, with Africa having the highest prevalence of perinatal depression and Oceania and Europe having the highest prevalence of antenatal and postnatal anxiety. The prevalence also varied depending on the assessment tools, especially for antenatal anxiety. A medium-high quality of the studies was observed. One SR assessed strength-of-evidence, reporting very low strength. CONCLUSIONS During the COVID-19 pandemic, depression and anxiety were common, affecting almost one in three perinatal women globally. A high heterogeneity and a risk of publication bias were found, partially due to the variety of assessment tools and cut-offs. The results may not be generalized to minorities. Studies on the prevalence of clinical diagnoses are needed. Based on our results it is not possible to firmly affirm that the COVID-19 pandemic was the main factor that directly increased perinatal depression and anxiety during the past few years. Future studies should study other factors' impact.
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Affiliation(s)
- Alessia Caffieri
- Department of Humanistic StudiesUniversity of Naples Federico IINaplesItaly
| | | | | | | | - Giorgia Margherita
- Department of Humanistic StudiesUniversity of Naples Federico IINaplesItaly
| | - Emma Motrico
- Department of PsychologyUniversidad Loyola AndalucíaSevilleSpain
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Gomà M, Gordo L, Cozodoy E, Iriarte L, Prims E, Ferrer J, Sánchez C, Llairó A, Arias-Pujol E. Validation of the anxiety subscale of the Spanish version of the Edinburgh Postnatal Depression Scale (EPDS-A). Front Psychiatry 2023; 14:1294206. [PMID: 38152353 PMCID: PMC10752612 DOI: 10.3389/fpsyt.2023.1294206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/24/2023] [Indexed: 12/29/2023] Open
Abstract
Introduction There is a need to implement routine perinatal mental health screening in Spain. Therefore, it is necessary to systematise the detection of depressive and anxious symptoms in pregnancy and postpartum using the same instrument. The Edinburgh Postnatal Stress Depression Scale (EPDS) is frequently used as a rapid, effective and cross-culturally validated screening tool for perinatal depression. In several countries, an Anxiety subscale, the EPDS-A, was identified within the EPDS. Although the factorial structure of the EPDS has been investigated in Spanish population, the EPDS-A has not yet been validated. This study aimed to validate the EPDS-A as a measure of perinatal anxiety in Spanish population. Methods 161 women were evaluated with the EPDS and the State-Trait Anxiety Inventory (STAI) during pregnancy and postpartum. Confirmatory factor analysis (CFA) was used to confirm the trifactorial structure of the EPDS, comprising the dimensions of Depression, Anhedonia and Anxiety. Likewise, the invariance of the trifactorial model between pregnancy and postpartum was tested. Finally, the correlations between the EPDS-A and the STAI subscales (State Anxiety and Trait Anxiety) were calculated. Results The Exploratory factor analysis (EFA) driven three-factor structure of the EPDS, consisting of an Anhedonia factor (Items 1, 2, and 10), an Anxiety factor (Items 3, 4, 5, and 6) and a Depression factor (Items 7, 8, and 9), was the best measurement model for the current data compared to the alternative model tested [χ2 = 34.592, df = 32, p = 0.34; χ2/df = 1.08; RMSEA = 0.023, 90% Confidence Interval [CI] [0.000, 0.064], CFI = 0.996, GFI = 0.960]. The model's invariance between pregnant and postpartum women was confirmed. The existence of an Anxiety subscale within the EPDS was also confirmed. The scores obtained with the EPDS-A correlated moderately with scores on both subscales of the STAI during pregnancy and after delivery. Using the STAI as a criterion and prioritising the instrument's sensitivity, a cut-off point of 4 points was established for the EPDS-A. Conclusion Our results confirm the trifactorial structure of the EPDS in Spanish population. The Anxiety subscale was validated for routine perinatal mental health screening.
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Affiliation(s)
| | - Leire Gordo
- Deusto FamilyPsych, Facultad de Ciencias de la Salud, Universidad de Deusto, Bilbao, Spain
| | - Eric Cozodoy
- Bruc Salut, Barcelona, Spain
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Leire Iriarte
- Deusto FamilyPsych, Facultad de Ciencias de la Salud, Universidad de Deusto, Bilbao, Spain
| | - Emma Prims
- CAP Roquetes-Canteres, Institut Català de la Salut, Barcelona, Spain
| | - Josep Ferrer
- CAP Roquetes-Canteres, Institut Català de la Salut, Barcelona, Spain
| | - Carmen Sánchez
- CAP Roquetes-Canteres, Institut Català de la Salut, Barcelona, Spain
| | | | - Eulàlia Arias-Pujol
- Facultat de Psicologia, Ciències de l’Educació i de l’Esport Blanquerna, Universitat Ramon Llull, Barcelona, Spain
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9
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Mariño-Narvaez C, Puertas-Gonzalez JA, Romero-Gonzalez B, Kraneis MC, Peralta-Ramirez MI. Pregnant women's mental health during the COVID-19 pandemic according to the trimester of pregnancy. J Reprod Infant Psychol 2023:1-16. [PMID: 37942780 DOI: 10.1080/02646838.2023.2279039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
AIM This study aimed to analyse the psychological impact of the COVID-19 pandemic on pregnant women according to the pregnancy trimester, comparing their psychopathological symptomatology, pregnancy-specific stress, resilience and perceived stress to those of women pregnant before the pandemic. METHODS A total of 797 pregnant women participated in the study, one group of 393 women pregnant before the pandemic and the other of 404 women pregnant during the pandemic. Student-t test was used to analyse continuous data and the Chi-square test was used for categorical data. RESULTS Psychopathological symptomatology was significantly higher in six subscales of the SCL-90-R in pregnant women during COVID-19: somatisation, interpersonal sensitivity, depression, anxiety, phobic anxiety, obsessions-compulsions, mainly on the first two trimesters. There is also a higher level of pregnancy-specific stress in pregnant women during the pandemic on the first two trimesters, most likely due to the hypervigilance and fears related to the COVID-19 disease. Nevertheless, perceived stress, usually elevated during pregnancy, was lower in women pregnant during the pandemic in comparison to those pregnant before, as a positive consequence of being on lockdown and diminishing the exposure to daily stressful situations. CONCLUSIONS Knowing the struggles these women go through during each trimester of pregnancy can be the key to a better health professional-patient relationship, consequently having a positive impact on their mental and physical health.
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Affiliation(s)
| | - Jose A Puertas-Gonzalez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Granada, Spain
| | - Borja Romero-Gonzalez
- Department of Psychology, Faculty of Education, University of Valladolid, Soria, Spain
| | - Marie-Christin Kraneis
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Maria Isabel Peralta-Ramirez
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Granada, Spain
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10
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Roddy Mitchell A, Gordon H, Atkinson J, Lindquist A, Walker SP, Middleton A, Tong S, Hastie R. Prevalence of Perinatal Anxiety and Related Disorders in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2343711. [PMID: 37976063 PMCID: PMC10656650 DOI: 10.1001/jamanetworkopen.2023.43711] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Anxiety disorders are associated with poor maternal and neonatal outcomes. Women in low- and middle-income countries (LMICs) are thought to be disproportionally burdened by these disorders, yet their prevalence is unclear. Objective To conduct a systematic review and meta-analysis to determine the prevalence of 6 anxiety and related disorders among perinatal women in LMICs. Data Sources Embase, MEDLINE, PsycINFO, Cochrane Library, CINAHL, and Web of Science databases were searched from inception until September 7, 2023. Study Selection Studies conducted in World Bank-defined LMICs and reporting prevalence of generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder, posttraumatic stress disorder, panic disorder, or adjustment disorder during the perinatal period (conception to 12 months post partum) using a validated method were included. Data Extraction and Synthesis This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Study eligibility, extracted data, and risk of bias of included studies were assessed by 2 independent reviewers. Random-effects meta-analysis was used to estimate pooled point prevalence. Subgroup analyses were performed by specific anxiety disorder. Main Outcomes and Measures Main outcomes were prevalence estimates of each anxiety disorder, measured as percentage point estimates and corresponding 95% CIs. Results At total of 10 617 studies were identified, 203 of which met the inclusion criteria and reported the outcomes of 212 318 women from 33 LMICs. Generalized anxiety disorder was the most reported (184 studies [90.6%]) and most prevalent disorder at 22.2% (95% CI, 19.4%-25.0%; n = 173 553). Posttraumatic stress disorder was the second most prevalent (8.3%; 95% CI, 5.0%-12.2%; 33 studies; n = 22 452). Adjustment disorder was least prevalent (2.9%; 95% CI, 0.0%-14.1%; 2 studies; n = 475). The prevalence of generalized anxiety varied by country income status, with the highest prevalence among lower-middle-income countries (27.6%; 95% CI, 21.6%-33.9%; 59 studies; n = 25 109), followed by low-income (24.0%; 95% CI, 15.3%-33.8%; 11 studies; n = 4961) and upper-middle-income (19.1%; 95% CI, 16.0%-22.4%; 110 studies; n = 138 496) countries. Conclusions and Relevance These findings suggest that 1 in 5 women living in LMICs experience anxiety disorders during pregnancy and post partum. Targeted action is needed to reduce this high burden.
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Affiliation(s)
- Alexandra Roddy Mitchell
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Hannah Gordon
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Jessica Atkinson
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Anthea Lindquist
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan P. Walker
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Anna Middleton
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Stephen Tong
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Roxanne Hastie
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
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11
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Costa R, Pinto TM, Conde A, Mesquita A, Motrico E, Figueiredo B. Women's perinatal depression: Anhedonia-related symptoms have increased in the COVID-19 pandemic. Gen Hosp Psychiatry 2023; 84:102-111. [PMID: 37419029 PMCID: PMC10287182 DOI: 10.1016/j.genhosppsych.2023.06.007] [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: 01/15/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND The prevalence of perinatal depression increased during the COVID-19 pandemic, which may be due to changes in the profile of specific depressive symptoms. AIMS To analyze the impact of the COVID-19 pandemic on the (1) prevalence and severity of specific depressive symptoms; and on the (2) prevalence of clinically significant symptoms of depression during pregnancy and postpartum. METHODS Pregnant and postpartum women recruited before (n = 2395) and during the COVID-19 pandemic (n = 1396) completed a sociodemographic and obstetric questionnaire and the Edinburgh Postnatal Depression Scale (EPDS). For each item, scores ≥1 and ≥ 2 were used to calculate the prevalence and severity of depressive symptoms, respectively. RESULTS The prevalence and severity of symptoms of depression were significantly higher during the COVID-19 pandemic. The prevalence of specific symptoms increased by >30%, namely "being able to laugh and see the funny side of things" (pregnancy 32.6%, postpartum 40.6%), "looking forward with enjoyment to things" (pregnancy 37.2%, postpartum 47.2%); and "feelings of sadness/miserable" or "unhappiness leading to crying" during postpartum (34.2% and 30.2%, respectively). A substantial increase was observed in the severity of specific symptoms related to feelings that "things have been getting on top of me" during pregnancy and the postpartum period (19.4% and 31.6%, respectively); "feeling sad or miserable" during pregnancy (10.8%); and "feeling scared/panicky" during postpartum (21.4%). CONCLUSION Special attention should be paid to anhedonia-related symptoms of perinatal depression to ensure that they are adequately managed in present and future situations of crisis.
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Affiliation(s)
- Raquel Costa
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; Lusófona University, HEI-Lab: Digital Human-Environment Interaction Labs, Portugal.
| | - Tiago Miguel Pinto
- Lusófona University, HEI-Lab: Digital Human-Environment Interaction Labs, Portugal; School of Psychology, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal.
| | - Ana Conde
- I2P - Portucalense Institute for Psychology, Portucalense University, Porto, Portugal.
| | - Ana Mesquita
- School of Psychology, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal; Prochild CoLAB Against Poverty And Social Exclusion - Association. Campus de Azurém, 4800-058, Guimarães. Portugal.
| | - Emma Motrico
- Psychology Department, Universidad Loyola Andalucia, Avenida de las Universidades s/n, Dos Hermanas, Sevilla, Spain.
| | - Bárbara Figueiredo
- School of Psychology, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal.
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12
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Abstract
Perinatal depression is a common psychiatric condition that has negative effects on pregnancy and infant outcomes. Screening for the condition is relatively easy and should be done routinely in all medical care of the pregnant and postpartum woman and her infant. The risk-benefit analysis favors the use of antidepressant medications during pregnancy and lactation compared with the risk of untreated maternal depression. Other, nonpharmacological treatments will be discussed as well as new treatments, including a new class of medications that act on the inhibitory GABAergic neurotransmitter system.
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Affiliation(s)
- Anne Louise Stewart
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, PO Box 800548, Charlottesville, VA 22908, USA
| | - Jennifer L Payne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, PO Box 800548, Charlottesville, VA 22908, USA.
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13
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Zhang T, Liu M, Min F, Wei W, Liu Y, Tong J, Meng Q, Sun L, Chen X. Fear of childbirth and its determinants in pregnant women in the third trimester: a cross-sectional study. BMC Psychiatry 2023; 23:574. [PMID: 37553654 PMCID: PMC10408108 DOI: 10.1186/s12888-023-05070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Fear of childbirth (FOC) is a prevalent issue among pregnant women and significantly relates to adverse outcomes for the mother and child. However, it is not clear the prevalence and risk factors of FOC among pregnant women in a region with a moderate level of economic development in China. The aim of this study was to investigate the prevalence and risk factors of FOC among pregnant women in the third trimester of pregnancy in Lianyungang city, Eastern China. METHODS A cross-sectional survey was conducted from December 2022 to February 2023 among pregnant women in the third trimester who met the inclusion criteria and visited Lianyungang Maternal and Child Health Hospital in Jiangsu Province, Eastern China. A structured questionnaire including sociodemographic characteristics, clinical characteristics, FOC, family function, doctor-patient communication, social support, general self-efficacy, anxiety, depression, insomnia symptoms, and quality of life was used to collect data. A multiple linear regression model was used to identify predictors of FOC. RESULTS This study included 535 pregnant women in the third trimester. The mean score of FOC was 30.67 ± 10.18, and the median score was 29.00. The prevalence of FOC was 56.64%. Multiple linear regression analysis revealed that pregnant women with electronic screen exposure time more than 5 h per day (β = 2.02, 95%CI: 0.50-3.53, P < 0.05), no history of cesarean section (β = 2.66, 95%CI: 0.61-4.71, P < 0.05), likes sour food or hates greasy food (β = 1.75, 95%CI: 0.00-3.50, P < 0.05), anxiety (β = 0.50, 95%CI: 0.21-0.80, P < 0.05) and depression (β = 0.30, 95%CI: 0.04-0.57, P < 0.05) were more likely to have a greater level of FOC than their counterparts. However, a significantly lower level of FOC was observed in pregnant women who were multipara (β=-1.64, 95%CI: -3.27-0.01, P < 0.05), not worrying about delivery without family members (β=-3.75, 95%CI: -5.26-2.25, P < 0.001), had good family function (β=-0.32, 95%CI: -0.64-0.00, P < 0.05) and doctor-patient communication (β=-0.33, 95%CI: -0.64-0.02, P < 0.05). CONCLUSIONS The prevalence of FOC was high in Lianyungang city, Eastern China. FOC is influenced by multiple factors. There is an urgent need to develop interventions to reduce the prevalence of FOC in the third trimester of pregnancy, and to pay attention to pregnant women with risk factors for FOC.
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Affiliation(s)
- Teng Zhang
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China
| | - Meilin Liu
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China
| | - Fanli Min
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China
| | - Wei Wei
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China
| | - Yuan Liu
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China
| | - Jiao Tong
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China
| | - Qian Meng
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China
| | - Lizhou Sun
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xu Chen
- Department of Obstetrics, Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, Lianyungang, 222000, Jiangsu, P.R. China.
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14
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MacBeth A, Christie H, Golds L, Morales F, Raouna A, Sawrikar V, Gillespie-Smith K. Thinking about the next generation: The case for a mentalization-informed approach to perinatal and intergenerational mental health. Psychol Psychother 2023. [PMID: 37534856 DOI: 10.1111/papt.12483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/30/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND There has been substantial progress made across multiple disciplines to emphasize the importance of perinatal mental health both for parents and offspring. This focuses on what has been termed the 'First 1000 Days' from conception to the child's second birthday. We argue that our understanding of this issue can go further to create an intergenerational approach to mental health. Despite the existence of theoretical frameworks and practical approaches to implementation, there are gaps in the understanding of perinatal and intergenerational mental health including which psychological mechanisms are implicated in the transmission of risk and resilience within the perinatal period; and how to leverage these into treatment approaches. AIMS AND METHODS In this paper, we explore the potential for mentalization as a candidate psychological approach to intergenerational mental health. RESULTS We contextualize this issue in terms of the points of contact between mentalization and broader theoretical models such as the social determinants of health and the Developmental Origins of Health and Disease (DoHaD) model. Further, we provide an overview of the existing evidence base for the relevance of mentalization to perinatal mental health. DISCUSSION Finally, we sketch out an outline model for integrating mentalization into perinatal and intergenerational mental health, highlighting several areas of opportunity to develop research and practice from diverse geographies and demographics. Here, we suggest that integration of mentalization with other conceptual frameworks such as DoHaD can mutually enrich the understanding of each model, pointing the way towards more effective early and preventative interventions.
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Affiliation(s)
- Angus MacBeth
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Hope Christie
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Lisa Golds
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Francisca Morales
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Aigli Raouna
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Vilas Sawrikar
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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15
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Huang Y, Alvernaz S, Kim SJ, Maki P, Dai Y, Bernabé BP. Predicting prenatal depression and assessing model bias using machine learning models. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.17.23292587. [PMID: 37503225 PMCID: PMC10371186 DOI: 10.1101/2023.07.17.23292587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Perinatal depression (PND) is one of the most common medical complications during pregnancy and postpartum period, affecting 10-20% of pregnant individuals. Black and Latina women have higher rates of PND, yet they are less likely to be diagnosed and receive treatment. Machine learning (ML) models based on Electronic Medical Records (EMRs) have been effective in predicting postpartum depression in middle-class White women but have rarely included sufficient proportions of racial and ethnic minorities, which contributed to biases in ML models for minority women. Our goal is to determine whether ML models could serve to predict depression in early pregnancy in racial/ethnic minority women by leveraging EMR data. We extracted EMRs from a hospital in a large urban city that mostly served low-income Black and Hispanic women (N=5,875) in the U.S. Depressive symptom severity was assessed from a self-reported questionnaire, PHQ-9. We investigated multiple ML classifiers, used Shapley Additive Explanations (SHAP) for model interpretation, and determined model prediction bias with two metrics, Disparate Impact, and Equal Opportunity Difference. While ML model (Elastic Net) performance was low (ROCAUC=0.67), we identified well-known factors associated with PND, such as unplanned pregnancy and being single, as well as underexplored factors, such as self-report pain levels, lower levels of prenatal vitamin supplement intake, asthma, carrying a male fetus, and lower platelet levels blood. Our findings showed that despite being based on a sample mostly composed of 75% low-income minority women (54% Black and 27% Latina), the model performance was lower for these communities. In conclusion, ML models based on EMRs could moderately predict depression in early pregnancy, but their performance is biased against low-income minority women.
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Affiliation(s)
- Yongchao Huang
- Department of Biomedical Engineering, Colleges of Engineering and Medicine, University of Illinois, Chicago, IL, USA
| | - Suzanne Alvernaz
- Department of Biomedical Engineering, Colleges of Engineering and Medicine, University of Illinois, Chicago, IL, USA
| | - Sage J Kim
- Division of Health Policy and Administration, School of Public Health, University of Illinois, Chicago, IL, USA
| | - Pauline Maki
- Department of Psychiatry, College of Medicine, University of Illinois, Chicago, IL, USA
- Department of Psychology, College of Medicine, University of Illinois, Chicago, IL, USA
- Department of Obstetrics and Gynecology, College of Medicine, University of Illinois, Chicago, IL, USA
| | - Yang Dai
- Department of Biomedical Engineering, Colleges of Engineering and Medicine, University of Illinois, Chicago, IL, USA
- Center of Bioinformatics and Quantitative Biology, University of Illinois, Chicago, IL, USA
| | - Beatriz Penñalver Bernabé
- Department of Biomedical Engineering, Colleges of Engineering and Medicine, University of Illinois, Chicago, IL, USA
- Center of Bioinformatics and Quantitative Biology, University of Illinois, Chicago, IL, USA
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16
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Chen X, Liu M, Min F, Tong J, Liu Y, Meng Q, Zhang T. Effect of biological, psychological, and social factors on maternal depressive symptoms in late pregnancy: a cross-sectional study. Front Psychiatry 2023; 14:1181132. [PMID: 37346902 PMCID: PMC10281506 DOI: 10.3389/fpsyt.2023.1181132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction Depression commonly occurs during pregnancy and has become a major public health concern. Depression not only affects the individual but also causes adverse consequences for families and children. However, little is known regarding the depression status and its influencing factors in women during late pregnancy in China. This study aimed to assess the prevalence of maternal depressive symptoms in late pregnancy during the coronavirus disease 2019 (COVID-19) pandemic and further explore the effect of biological, psychological, and social factors on depressive symptoms. Methods An institution-based cross-sectional survey was conducted among eligible women in the late pregnancy stage and underwent prenatal examination at Lianyungang Maternal and Child Health Hospital in Jiangsu Province, Eastern China from December 2022 to February 2023. Data regarding depressive symptoms and biological, psychological, and social factors of the pregnant women were collected via a structured questionnaire. Chi-square test, Fisher's exact tests, and binary logistics regression were used to analyze the data. Results In total, 535 women in the late pregnancy stage were included in this study, 75 (14.0%) of whom exhibited depressive symptoms. A binary logistic regression analysis revealed that pregnant women who were multiparous (OR: 2.420, 95% CI: 1.188-4.932) and had moderate or severe insomnia symptoms (OR: 4.641, 95% CI: 1.787-12.057), anxiety (OR: 8.879, 95% CI: 4.387-17.971), high fear of COVID-19 (OR: 2.555, 95% CI: 1.255-5.199), moderate or severe family dysfunction (OR: 2.256, 95% CI: 1.141-4.461), and poor social support (OR: 2.580, 95% CI: 1.050-6.337) tended to show depressive symptoms. Conversely, pregnant women who received regular prenatal care (OR: 0.481, 95% CI: 0.243-0.951) and had good drinking water quality at home (OR: 0.493, 95% CI: 0.247-0.984) were more likely to avoid developing depressive symptoms. Conclusion This study found that the prevalence of maternal depressive symptoms during late pregnancy was high and had multiple influencing factors. Thus, screening for depressive symptoms in women in the late pregnancy stage and providing special intervention programs are necessary, especially for those with risk factors.
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17
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Conneely M, Packer KC, Bicknell S, Janković J, Sihre HK, McCabe R, Copello A, Bains K, Priebe S, Spruce A, Jovanović N. Exploring Black and South Asian women's experiences of help-seeking and engagement in perinatal mental health services in the UK. Front Psychiatry 2023; 14:1119998. [PMID: 37077277 PMCID: PMC10109459 DOI: 10.3389/fpsyt.2023.1119998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/06/2023] [Indexed: 04/21/2023] Open
Abstract
Background and aims In the United Kingdom (UK), Black and South Asian women are less likely than White British women to access support from perinatal mental health services, despite experiencing similar, or higher, levels of distress. This inequality needs to be understood and remedied. The aim of this study was to answer two questions: how do Black and South Asian women experience (1) access to perinatal mental health services and (2) care received from perinatal mental health services? Method Semi-structured interviews were conducted with Black and South Asian women (n = 37), including four women who were interviewed with an interpreter. Interviews were recorded and transcribed line-by-line. Data were analyzed using framework analysis, by an ethnically diverse multidisciplinary team of clinicians, researchers and people with lived experience of perinatal mental illness. Results Participants described a complex interplay of factors that impacted on seeking, and receiving help, and benefiting from services. Four themes emerged that captured the highly varied experiences of individuals: (1) Self-identity, social expectations and different attributions of distress deter help-seeking; (2) Hidden and disorganized services impede getting support; (3) The role of curiosity, kindness and flexibility in making women feel heard, accepted and supported by clinicians; (4) A shared cultural background may support or hinder trust and rapport. Conclusion Women described a wide range of experiences and a complex interplay of factors impacting access to, and experience of, services. Women described services as giving them strength and also leaving them disappointed and confused about where to get help. The main barriers to access were attributions related to mental distress, stigma, mistrust and lack of visibility of services, and organizational gaps in the referral process. These findings describe that many women feel heard, and supported by services, reporting that services provide a high quality of care that was inclusive of diverse experiences and understandings of mental health problems. Transparency around what PMHS are, and what support is available would improve the accessibility of PMHS.
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Affiliation(s)
- Maev Conneely
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Katy C. Packer
- Camden and Islington NHS Foundation Trust, London, United Kingdom
- North East London NHS Foundation Trust, London, United Kingdom
| | - Sarah Bicknell
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
| | - Jelena Janković
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Harpreet Kaur Sihre
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Rosemarie McCabe
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Alex Copello
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Kiren Bains
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
| | - Amy Spruce
- Action on Postpartum Psychosis, London, United Kingdom
| | - Nikolina Jovanović
- Unit for Social and Community Psychiatry, WHO Collaborating Centre, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
- East London NHS Foundation Trust, London, United Kingdom
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Qin X, Zhang W, Xu S, Ma M, Fan X, Nie X, Liu J, Ju Y, Zhang L, Li L, Zhang Y, Liu B. Prevalence and risk factors of anxious and depressive symptoms in first-trimester females and their partners: a study during the pandemic era of COVID-19 in China. BMC Psychiatry 2023; 23:134. [PMID: 36869299 PMCID: PMC9982791 DOI: 10.1186/s12888-023-04621-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND The pandemic of coronavirus disease 2019 lastingly affects public mental health. Many studies have described symptoms of anxiety and depression in pregnant women before the pandemic. However, the limited study focuses on the prevalence and risk factors of mood symptoms among first-trimester females and their partners during the pandemic in China, which was the aim of the study. METHODS One hundred and sixty-nine first-trimester couples were enrolled. The Edinburgh Postnatal Depression Scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-Item, Family Assessment Device-General Functioning (FAD-GF), and Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF) were applied. Data were mainly analyzed through logistic regression analysis. RESULTS 17.75% and 5.92% of first-trimester females had depressive and anxious symptoms, respectively. Among partners, 11.83% and 9.47% had depressive and anxious symptoms, respectively. In females, higher scores of FAD-GF (OR = 5.46 and 13.09; P < 0.05) and lower scores of Q-LES-Q-SF (OR = 0.83 and 0.70; P < 0.01) were related to the risk of depressive and anxious symptoms. Higher scores of FAD-GF were associated with the risk of depressive and anxious symptoms in partners (OR = 3.95 and 6.89; P < 0.05). A history of smoking was also related to males' depressive symptoms (OR = 4.49; P < 0.05). CONCLUSION This study prompted prominent mood symptoms during the pandemic. Family functioning, quality of life, and smoking history increased risks of mood symptoms among early pregnant families, which facilitated the updating of medical intervention. However, the current study did not explore interventions based on these findings.
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Affiliation(s)
- Xuemei Qin
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.,China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Mental Health Institute of Central South University, Changsha, Hunan, 410011, China
| | - Weiling Zhang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.,China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Mental Health Institute of Central South University, Changsha, Hunan, 410011, China
| | - Shuyin Xu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.,China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Mental Health Institute of Central South University, Changsha, Hunan, 410011, China
| | - Mohan Ma
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.,China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Mental Health Institute of Central South University, Changsha, Hunan, 410011, China
| | - Xing Fan
- Changsha Hospital for Maternal & Child Health Care, Changsha, Hunan, 410007, China
| | - Xueqing Nie
- Changsha Hospital for Maternal & Child Health Care, Changsha, Hunan, 410007, China
| | - Jin Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.,China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Mental Health Institute of Central South University, Changsha, Hunan, 410011, China
| | - Yumeng Ju
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.,China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Mental Health Institute of Central South University, Changsha, Hunan, 410011, China
| | - Li Zhang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.,China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Mental Health Institute of Central South University, Changsha, Hunan, 410011, China
| | - Lingjiang Li
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.,China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Mental Health Institute of Central South University, Changsha, Hunan, 410011, China
| | - Yan Zhang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.,China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Mental Health Institute of Central South University, Changsha, Hunan, 410011, China
| | - Bangshan Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China. .,China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Mental Health Institute of Central South University, Changsha, Hunan, 410011, China.
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Mesquita A, Costa R, Bina R, Cadarso-Suárez C, Gude F, Díaz-Louzao C, Dikmen-Yildiz P, Osorio A, Mateus V, Domínguez-Salas S, Vousoura E, Levy D, Alfayumi-Zeadna S, Wilson CA, Contreras-García Y, Carrasco-Portiño M, Saldivia S, Christoforou A, Hadjigeorgiou E, Felice E, Buhagiar R, Hancheva C, Ajaz E, Uka A, Motrico E. A cross-country study on the impact of governmental responses to the COVID-19 pandemic on perinatal mental health. Sci Rep 2023; 13:2805. [PMID: 36797263 PMCID: PMC9933810 DOI: 10.1038/s41598-023-29300-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
This study aimed to analyse the role of governmental responses to the coronavirus disease 2019 (COVID-19) outbreak, measured by the Containment and Health Index (CHI), on symptoms of anxiety and depression during pregnancy and postpartum, while considering the countries' Inequality-adjusted Human Development Index (IHDI) and individual factors such as age, gravidity, and exposure to COVID-19. A cross-sectional study using baseline data from the Riseup-PPD-COVID-19 observational prospective international study (ClinicalTrials.gov: NCT04595123) was carried out between June and October 2020 in 12 countries (Albania, Brazil, Bulgaria, Chile, Cyprus, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom). Participants were 7645 pregnant women or mothers in the postpartum period-with an infant aged up to 6 months-who completed the Edinburgh Postnatal Depression Scale (EPDS) or the Generalised Anxiety Disorder Assessment (GAD-7) during pregnancy or the postpartum period. The overall prevalence of clinically significant depression symptoms (EPDS ≥ 13) was 30%, ranging from 20,5% in Cyprus to 44,3% in Brazil. The prevalence of clinically significant anxiety symptoms (GAD-7 ≥ 10) was 23,6% (ranging from 14,2% in Israel and Turkey to 39,5% in Brazil). Higher symptoms of anxiety or depression were observed in multigravida exposed to COVID-19 or living in countries with a higher number of deaths due to COVID-19. Furthermore, multigravida from countries with lower IHDI or CHI had higher symptoms of anxiety and depression. Perinatal mental health is context-dependent, with women from more disadvantaged countries at higher risk for poor mental health. Implementing more restrictive measures seems to be a protective factor for mental health, at least in the initial phase of the COVID-19.
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Affiliation(s)
- Ana Mesquita
- School of Psychology, University of Minho, Campus Gualtar, 4710-057, Braga, Portugal.
- ProChild CoLAB, Campus de Azurém, Guimarães, Portugal.
| | - Raquel Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas,n° 135, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Hei-Lab: Digital Human-Environment Interaction Lab, Faculty of Psychology, Education and Sports, Lusófona University, Porto, Portugal
| | - Rena Bina
- School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Carmen Cadarso-Suárez
- Department of Statistics, Mathematical Analysis, and Optimization, Group of Biostatistics and Biomedical Data Science, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco Gude
- Department of Epidemiology, Research Group On Epidemiology of Common Diseases, University Clinical Hospital of Santiago, Santiago de Compostela Health Research Institute (IDIS), Santiago de Compostela, Spain
| | - Carla Díaz-Louzao
- Department of Statistics, Mathematical Analysis, and Optimization, Group of Biostatistics and Biomedical Data Science, University of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Epidemiology, Research Group On Epidemiology of Common Diseases, University Clinical Hospital of Santiago, Santiago de Compostela Health Research Institute (IDIS), Santiago de Compostela, Spain
| | | | - Ana Osorio
- Graduate Program on Developmental Disorders and Mackenzie Center for Research in Childhood and Adolescence, Center for Biological and Health Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Vera Mateus
- Graduate Program on Developmental Disorders and Mackenzie Center for Research in Childhood and Adolescence, Center for Biological and Health Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
| | | | - Eleni Vousoura
- Department of Psychology, School of Philosophy, National and Kapodestrian University of Athens, Athens, Greece
| | - Drorit Levy
- School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Samira Alfayumi-Zeadna
- The Center for Women's Health Studies and Promotion, Ben-Gurion University of the Negev, Beersheba, Israel
- Nursing Department, School of Health Sciences, Ashkelon Academic College, 78682, Ashkelon, Israel
| | - Claire A Wilson
- Section of Women's Mental Health, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - Yolanda Contreras-García
- Department of Obstetrics and Puericulture. Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - Mercedes Carrasco-Portiño
- Department of Obstetrics and Puericulture. Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - Sandra Saldivia
- Department of Psychiatry and Mental Health. Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - Andri Christoforou
- Department of Social and Behavioral Sciences, European University Cyprus, Engomi, Cyprus
| | - Eleni Hadjigeorgiou
- Department of Nursing, School of Health Science, Cyprus University of Technology, Limassol, Cyprus
| | - Ethel Felice
- Department of Psychiatry, University of Malta, Msida, Malta
| | | | | | - Erilda Ajaz
- Department of Education and English Language, Beder University College, Tirana, Albania
| | - Ana Uka
- Department of Education and English Language, Beder University College, Tirana, Albania
| | - Emma Motrico
- Psychology Department, Universidad Loyola Andalucia, Sevilla, Spain.
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20
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Chrzan-Dętkoś M, Walczak-Kozłowska T. Postpartum depression crisis since the second lockdown and 'screening paradox': many women identified, very few treated. BMC Public Health 2022; 22:2387. [PMID: 36539811 PMCID: PMC9763806 DOI: 10.1186/s12889-022-14705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Exposure to stressful situations, such as emergencies, infectious diseases, and natural disasters, may lead to a heightened risk of perinatal mental health problems. Declared on March 11th, 2020, the global COVID-19 pandemic triggered an additional burden on women in the perinatal period. Safety recommendations, such as social distancing and isolation, were opposite to the usual advice given to new mothers. Besides fear, changes in financial stability and daily life reorganization contributed to increased depressive symptoms. As the periods of epidemic waves and lockdowns were associated with a more significant burden for young families, we aimed to assess the intensification of depressive and anxiety symptoms during the pandemic concerning the time intervals of the three lockdowns introduced in Poland. METHODS 1588 postpartum women took part in the online self-assessment with the Edinburgh Postnatal Depression Scale (EPDS) and General Anxiety Disorder 2 (GAD-2) questionnaire between January 1, 2020, and March 31, 2021. This self-screening is a part of a prevention program The Next Stop: Mum, implemented in the North of Poland. RESULTS The highest severity of PPD symptoms and anxiety were observed during the second lockdown in Poland: the mean score in the EPDS and anxiety assessment was significantly higher than the mean scores from previous pandemic periods. Since the second lockdown, the average EPDS and GAD-2 scores remained similarly high. Moreover, with the duration of the COVID-19 pandemic, the percentage of women with elevated symptoms of postpartum depression and anxiety began to increase. However, the Polish National Health Fund data indicate that only 0,7% of women giving birth in the northern macro-region of Poland received diagnosis and help from public funds. In The Next Stop: Mum project, 250 women benefited from psychological consultations. CONCLUSION Increased severity of depression and anxiety symptoms during the pandemic indicates the need for additional psychological support for postpartum women. However, very few women are diagnosed in health facilities in the first year postpartum and thus are rarely referred for further treatment. The study shows that the availability of services and the focus on social and individual barriers may be critical factors in implementing perinatal mental health programs and practices. This may be especially needed in a country where the screening obligation is new. In case of a further pandemic, policymakers and health care professionals should be aware that the duration of the restrictions and the repetition of lockdowns are associated with the aggravation of symptoms. The online screening without the possibility to discuss the results is only partially effective in increasing referrals for possibly affected women.
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Affiliation(s)
- Magdalena Chrzan-Dętkoś
- grid.8585.00000 0001 2370 4076Division of Developmental Psychology and Psychopathology, Institute of Psychology, Department of the Social Sciences, University of Gdańsk, Gdańsk, Poland
| | - Tamara Walczak-Kozłowska
- grid.8585.00000 0001 2370 4076Division of Neuropsychology, Institute of Psychology, Department of the Social Sciences, University of Gdańsk, Gdańsk, Poland
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