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Peng Z, Luo Y, Qi R, Cao Z, Ge J, Wu L, Liu J, Zhang L. Influencing factors of posttraumatic stress disorder in Shidu parents who have lost their only child: a cross-sectional survey. BMC Psychiatry 2024; 24:612. [PMID: 39261892 PMCID: PMC11391783 DOI: 10.1186/s12888-024-06059-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 09/04/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND In China, parents who have lost their only child are referred to as Shidu parents (SDPs). This study aimed to investigate the prevalence and risk factors of post-traumatic stress disorder (PTSD) and investigate the influence of depressive and anxiety symptoms on the development of PTSD. METHOD Four hundred and thirty-six SDPs completed assessments of PTSD (Structured Clinical Interview for DSM-IV Disorders, SCID-IV; The Clinician-Administered PTSD Scale-IV, CAPS-IV), depression (Hamilton depression scale), and anxiety (Hamilton Anxiety Scale) via in-person interviews. Logistic regression and hierarchical multiple linear regression analyses were used to explore the association of demographic characteristics, depression, and anxiety symptoms with PTSD. RESULTS The prevalence of PTSD in SDPs was 14.45%. The comorbidity of depression and anxiety symptoms was 87.30% in the SDPs with PTSD. The logistic regression model, which included factors of gender, age, education, depression, and anxiety, which contributed to the development of PTSD, was significant [χ² (11) = 122.47, p < 0.001]. The hierarchical multiple linear regression analysis indicated that female gender and the severity of comorbidities (depression and anxiety) were positively associated with the severity of PTSD. CONCLUSION This study found that the severity of depression and anxiety was closely related to the severity of PTSD, supporting that SDPs are highly prone to the co-occurrence of PTSD, depression, and anxiety after bereavement. Our findings may provide more insights into the development of individualized interventions for parents who have experienced the loss of their only child.
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Affiliation(s)
- Zhuo Peng
- Department of Psychiatry, National Center for Mental Disorders, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yifeng Luo
- Department of Radiology, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, China
| | - Rongfeng Qi
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhihong Cao
- Department of Radiology, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, China
| | - Jiyuan Ge
- Department of Radiology, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, China
| | - Luoan Wu
- Department of Psychiatry, Yixing Mental Health Center, Wuxi, China
| | - Jin Liu
- Department of Psychiatry, National Center for Mental Disorders, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Li Zhang
- Department of Psychiatry, National Center for Mental Disorders, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Kiyak S. The relationship of depression, anxiety, and stress with pregnancy symptoms and coping styles in pregnant women: A multi-group structural equation modeling analysis. Midwifery 2024; 136:104103. [PMID: 38986391 DOI: 10.1016/j.midw.2024.104103] [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: 01/27/2024] [Revised: 05/11/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND The changes during pregnancy can increase susceptibility to mental health problems such as depression, anxiety and stress, which is why coping strategies are so important. The aim of this study is to investigate the relationships between depression, anxiety, stress, pregnancy symptoms and coping styles in pregnant women across trimesters, using a multigroup structural equation model. METHODS This cross-sectional and correlational study was conducted with 301 pregnant women who applied to the prenatal clinic of a state university's medical faculty. A hypothetical model was created based on transactional stress and coping theory and literature reviews. Data were collected using a participant information form, the Depression Anxiety Stress Scale, the Pregnancy Symptom Inventory and the Stress Coping Styles Scale. RESULTS Among pregnant women, 40.9 % had symptoms of stress, 52.8 % of anxiety and 37.2 % of depression. Pregnancy symptoms and emotion-focused coping are positively associated with depression, anxiety, and stress (β = 0.468-0.590; β = 0.222-0.373 respectively). Problem-focused coping is negatively associated with depression, anxiety, and stress. (β = -0.255:-0.389). Problem-focused coping is negatively associated with pregnancy symptoms in the whole sample (β = -0.121) and in the third trimester (β = -0.124). The model explained 51 % of the variance in the 1st, 42 % in the 2nd, and 64 % in the 3rd trimesters. CONCLUSION This study showed that problem-focused coping strategies are negatively associated with depression, anxiety and stress and play an important protective role in this context. These findings contribute to understanding the factors affecting mental health during pregnancy and emphasize the importance of developing problem-focused coping skills for pregnant women.
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Affiliation(s)
- Sibel Kiyak
- Necmettin Erbakan University, Seydişehir Kamil Akkanat Faculty of Health Sciences, Department of Obstetrics and Gynecology Nursing, Anabağlar District, Prof. Dr. Necmettin Erbakan Street No:19 /3 postal code: 42370, Seydişehir Konya Turkey
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Çelebi EZ, Tozkır E, Çayır G, Murat M, Beji NK, Avcı N, Sinesi A. The Stirling Antenatal Anxiety Scale (SAAS): Turkish validity and reliability study. Midwifery 2024; 136:104073. [PMID: 38941783 DOI: 10.1016/j.midw.2024.104073] [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: 09/18/2023] [Revised: 06/16/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Abstract
AIMS To examine the psychometric properties of the Stirling Antenatal Anxiety Scale (SAAS), developed by Sinesi et al., which assesses the level of anxiety of pregnant women in the prenatal period, in the Turkish culture, and to conduct a validity and reliability study. METHODS This study had a methodological approach, with a cross-sectional and descriptive research design. Reporting was in accordance with the STROBE checklist. The sample included 160 pregnant women who were followed up in the maternity outpatient clinics of a public hospital and a private hospital in Istanbul. Data were collected face-to-face using a personal information form, the Turkish version of the SAAS, and the Generalized Anxiety Disorder-7 scale between June and August 2023. In the data analysis, validity analyses were performed with content and construct validity and multiple fit indices for confirmatory factor analysis. Item-total score analysis was conducted using Cronbach's alpha coefficient and Pearson's correlation analysis to assess reliability. Descriptive and reliability analyses were undertaken using SPSS v.28.0.1.0, and validity analyses were performed using SPSS AMOS v.26.0.0.0. FINDINGS Based on expert opinions on the items in the Turkish version of the SAAS, the content validity ratio was 0.96. The decision was made to exclude Item 9 from the Turkish version because the item factor load was low. The Turkish version had a single factor, as did the original version. The Cronbach alpha coefficient was 0.87, so the Turkish version was determined to have high reliability. CONCLUSION The Turkish version of the SAAS, originally produced in English, has high levels of validity and reliability. In addition, it is short and easy to apply in clinical and research settings. As such, the Turkish version of the SAAS is recommended for use to evaluate the level of anxiety in pregnant women.
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Affiliation(s)
- Elif Zahide Çelebi
- Department of Nursing, Faculty of Health Sciences, Istanbul Bilgi University, Istanbul, Turkey.
| | - Elif Tozkır
- Department of Obstetrics and Gynaecology, University of Health Sciences Zeynep Kamil Women and Children Diseases Training and Research Hospital, Istanbul, Turkey
| | - Gülsen Çayır
- Department of Nursing, Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| | - Merve Murat
- Department of Psychiatric Nursing, Hamidiye Faculty of Nursing, University of Health Sciences, Istanbul, Turkey
| | - Nezihe Kızılkaya Beji
- Department of Nursing, Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| | - Nilgün Avcı
- Department of Nursing, Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| | - Andrea Sinesi
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Chua JYX, Choolani M, Chee CYI, Yi H, Chan YH, Lalor JG, Chong YS, Shorey S. Parents' Perceptions of Their Parenting Journeys and a Mobile App Intervention (Parentbot-A Digital Healthcare Assistant): Qualitative Process Evaluation. J Med Internet Res 2024; 26:e56894. [PMID: 38905628 PMCID: PMC11226932 DOI: 10.2196/56894] [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: 01/29/2024] [Revised: 03/16/2024] [Accepted: 04/18/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Parents experience many challenges during the perinatal period. Mobile app-based interventions and chatbots show promise in delivering health care support for parents during the perinatal period. OBJECTIVE This descriptive qualitative process evaluation study aims to explore the perinatal experiences of parents in Singapore, as well as examine the user experiences of the mobile app-based intervention with an in-built chatbot titled Parentbot-a Digital Healthcare Assistant (PDA). METHODS A total of 20 heterosexual English-speaking parents were recruited via purposive sampling from a single tertiary hospital in Singapore. The parents (control group: 10/20, 50%; intervention group: 10/20, 50%) were also part of an ongoing randomized trial between November 2022 and August 2023 that aimed to evaluate the effectiveness of the PDA in improving parenting outcomes. Semistructured one-to-one interviews were conducted via Zoom from February to June 2023. All interviews were conducted in English, audio recorded, and transcribed verbatim. Data analysis was guided by the thematic analysis framework. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to guide the reporting of data. RESULTS Three themes with 10 subthemes describing parents' perceptions of their parenting journeys and their experiences with the PDA were identified. The main themes were (1) new babies, new troubles, and new wonders; (2) support system for the parents; and (3) reshaping perinatal support for future parents. CONCLUSIONS Overall, the PDA provided parents with informational, socioemotional, and psychological support and could be used to supplement the perinatal care provided for future parents. To optimize users' experience with the PDA, the intervention could be equipped with a more sophisticated chatbot, equipped with more gamification features, and programmed to deliver personalized care to parents. Researchers and health care providers could also strive to promote more peer-to-peer interactions among users. The provision of continuous, holistic, and family-centered care by health care professionals could also be emphasized. Moreover, policy changes regarding maternity and paternity leaves, availability of infant care centers, and flexible work arrangements could be further explored to promote healthy work-family balance for parents.
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Affiliation(s)
- Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Cornelia Yin Ing Chee
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Yap Seng Chong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Osório FL, Borges MM. Posttraumatic stress disorder prevalence and childbirth: update meta-analysis after the introduction of the DSM-5 and COVID-19 pandemic. Arch Womens Ment Health 2024; 27:337-357. [PMID: 38265513 DOI: 10.1007/s00737-024-01423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Meta-analyses were previously performed to estimate PTSD prevalence in the postpartum period. Significant events that could impact this outcome occurred in the last decade, such as the publication of the DSM-5 in 2013 and the COVID-19 pandemic in 2020. This systematic literature review with a meta-analysis addressed studies published after 2014 to estimate PTSD prevalence after childbirth. METHOD The methodological guidelines recommended by PRISMA were followed. The meta-analysis estimate was the proportion of PTSD cases. The restricted maximum likelihood (REML) was the method adopted for estimation in addition to multilevel random effect models. Subgroup analyses were performed to assess the impact of interest variables. RESULTS The estimated prevalence was 0.10 (95%CI: 0.8-0.13; I2 = 98.5%). No significant differences were found regarding the introduction of the DSM-5 (p = 0.73) or COVID-19 (p = 0.97), but instead, between low- and middle-income countries, e.g., the Middle East presents a higher prevalence (p < 0.01) than European countries. CONCLUSIONS There is a potential increase in PTSD prevalence rates after childbirth in the last decade not associated with the pandemic or the current diagnostic classification. Most studies showed a methodological fragility that must be overcome to understand this phenomenon better and support preventive actions and treatment for puerperal women.
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Affiliation(s)
- Flávia L Osório
- Medical School of Ribeirão Preto. São Paulo University, Avenida Dos Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil.
- National Institute of Science and Technology (INCT-TM, CNPq), Brasília, Brazil.
| | - Maira Morena Borges
- Medical School of Ribeirão Preto. São Paulo University, Avenida Dos Bandeirantes, 3900, Ribeirão Preto, SP, 14048-900, Brazil
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Ozcalik HB, Aksoy YE. The relationship between maternal functioning and birth memory and trauma. Midwifery 2024; 132:103974. [PMID: 38503117 DOI: 10.1016/j.midw.2024.103974] [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: 11/02/2023] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
AIM This study aimed to determine the relationship between birth memory and trauma and maternal functioning in the postpartum period. METHODS This cross-sectional study included 584 mothers in the postpartum period between 1 January 2022 and 1 April 2022. Data were collected using a personal information form, the Barkin Index of Maternal Functioning (BIMF), the Birth Memories and Recall Questionnaire (BirthMARQ) and the City Birth Trauma Scale (CityBiTS). RESULTS The participants' mean scores for the overall BIMF, BirthMARQ and CityBiTS were 81.41 ± 9.28, 80.30 ± 21.21 and 15.85 ± 11.30, respectively. Their sociodemographic characteristics did not affect their maternal functioning; however, maternal functioning improved with the number of pregnancies. While emotional memory (BirthMARQ subscale) negatively affected maternal functioning (p < 0.001), the centrality of memory (BirthMARQ subscale) positively affected maternal functioning (p < 0.001). The hyperarousal (CityBiTS subscale) score significantly and negatively affected the total maternal functioning score, explaining 6 % of its variance (F = 9.176, p = 0.001). CONCLUSION This study demonstrated that birth memory and trauma affected maternal functioning. The mother's functional status in the postpartum period reflects the physical and psychosocial changes associated with pregnancy and birth. Therefore, for women to have positive birth memories and emotions when recalling the birth, their emotional health and physical care should be supported during labour and the postpartum period.
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Affiliation(s)
- Habibe Bay Ozcalik
- Selcuk University Faculty of Health Science, Midwifery Department, Konya, Turkey.
| | - Yasemin Erkal Aksoy
- Selcuk University Faculty of Health Science, Midwifery Department, Konya, Turkey
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7
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Ayers S, Horsch A, Garthus-Niegel S, Nieuwenhuijze M, Bogaerts A, Hartmann K, Karlsdottir SI, Oosterman M, Tecirli G, Turner JD, Lalor J. Traumatic birth and childbirth-related post-traumatic stress disorder: International expert consensus recommendations for practice, policy, and research. Women Birth 2024; 37:362-367. [PMID: 38071102 DOI: 10.1016/j.wombi.2023.11.006] [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: 10/23/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Research suggests 1 in 3 births are experienced as psychologically traumatic and about 4% of women and 1% of their partners develop post-traumatic stress disorder (PTSD) as a result. AIM To provide expert consensus recommendations for practice, policy, and research and theory. METHOD Two consultations (n = 65 and n = 43) with an international group of expert researchers and clinicians from 33 countries involved in COST Action CA18211; three meetings with CA18211 group leaders and stakeholders; followed by review and feedback from people with lived experience and CA18211 members (n = 238). FINDINGS Recommendations for practice include that care for women and birth partners must be given in ways that minimise negative birth experiences. This includes respecting women's rights before, during, and after childbirth; and preventing maltreatment and obstetric violence. Principles of trauma-informed care need to be integrated across maternity settings. Recommendations for policy include that national and international guidelines are needed to increase awareness of perinatal mental health problems, including traumatic birth and childbirth-related PTSD, and outline evidence-based, practical strategies for detection, prevention, and treatment. Recommendations for research and theory include that birth needs to be understood through a neuro-biopsychosocial framework. Longitudinal studies with representative and global samples are warranted; and research on prevention, intervention and cost to society is essential. CONCLUSION Implementation of these recommendations could potentially reduce traumatic births and childbirth-related PTSD worldwide and improve outcomes for women and families. Recommendations should ideally be incorporated into a comprehensive, holistic approach to mental health support for all involved in the childbirth process.
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Affiliation(s)
- Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, EC1V 0HB, UK.
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland; Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Susan Garthus-Niegel
- Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands; CAPHRI, Maastricht University, 6229 ER Maastricht, the Netherlands
| | - Annick Bogaerts
- REALIFE research group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | | | | | - Mirjam Oosterman
- Faculty of Behavioral and Movement Sciences, Department of Clinical Child & Family Studies, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, the Netherlands
| | - Gulcan Tecirli
- Health Technology Assessment Department, Republic of Turkiye Ministry of Health, Bilkent, Çankaya, Ankara, Turkiye
| | - Jonathan D Turner
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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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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O'Brien J, Gregg L, Wittkowski A. A systematic review of clinical psychological guidance for perinatal mental health. BMC Psychiatry 2023; 23:790. [PMID: 37904101 PMCID: PMC10614401 DOI: 10.1186/s12888-023-05173-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/08/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Guidelines on psychological and/or psychosocial assessment and intervention in the perinatal period can provide beneficial practice guidance for healthcare professions to reduce maternal distress and potential mortality. As little is known about the similarities in recommendations across guidelines, which could impact the quality of therapeutic intervention women receive, this systematic review was conducted to draw out the consistent guidance for perinatal psychological and/or psychosocial therapeutic input. METHOD Eight literature and two guideline databases were searched alongside guideline development institutions, and organisations of maternity or perinatal mental health care. All relevant guidance was searched for and extracted before guideline quality was assessed using the AGREE-II instrument. Included guidelines had a primary or secondary focus on psychological assessment and therapeutic intervention for perinatal mental health difficulties. Using a narrative synthesis approach, recommendation consistencies and inconsistencies were outlined. RESULTS From the 92 records screened, seven guidelines met the inclusion criteria. Only two guidelines were rated high (> 80%) across all assessed domains, with the other guidelines scoring between poor and excellent across domains. Highest rated domains across all seven guidelines were clarity of presentation (75%) and scope and purpose (70%). Recommendations for structured psychological assessment and intervention were most commonly reported in the guidelines; however, the level of detail and depth of information varied across guidelines. Whilst assessment and intervention recommendations for mother-infant dyad and partners were considered, research into working therapeutically with these client groups in perinatal mental health services is only just emerging. Hence, guideline recommendations for working with the mother-infant dyad and partners were based on consensus of expert opinion. CONCLUSION Perinatal mental health guidelines were consistent in scope but showed considerable variability in quality and depth of recommendations, which could have implications for standards of clinical practice. However, there is still a need to improve the evidence underpinning recommendations in perinatal mental health guidelines to advance the implementation of psychological and/or psychosocial interventions. High quality interventions in the perinatal period could improve outcomes for women and their families.
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Affiliation(s)
- Jayne O'Brien
- The University of Manchester, School of Health Sciences, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Lynsey Gregg
- The University of Manchester, School of Health Sciences, Manchester, M13 9PL, UK
| | - Anja Wittkowski
- The University of Manchester, School of Health Sciences, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK.
- The University of Manchester, Manchester Health Alliance Science Centre, Manchester, M13 9PL, UK.
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Manchester Academic Health Science Centre, Manchester, M13 9NQ, UK.
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Rousseau S, Feldman T, Shlomi Polachek I, Frenkel TI. Persistent symptoms of maternal post-traumatic stress following childbirth across the first months postpartum: Associations with perturbations in maternal behavior and infant avoidance of social gaze toward mother. INFANCY 2023; 28:882-909. [PMID: 37329252 DOI: 10.1111/infa.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 06/18/2023]
Abstract
Recent literature identifies childbirth as a potentially traumatic event, following which mothers may develop symptoms of Post-Traumatic-Stress-Following-Childbirth (PTS-FC). The current study examines whether stable symptoms of PTS-FC during the early postpartum period may impose risk for perturbations in maternal behavior and infant social-engagement with mother, controlling for comorbid postpartum internalizing symptoms. Mother-infant dyads (N = 192) were recruited from the general population, during the third trimester of pregnancy. 49.5% of the mothers were primipara, and 48.4% of the infants were girls. Maternal PTS-FC was assessed at 3-day, 1-month and 4-month postpartum, via self-report and clinician-administered interview. Latent Profile Analysis generated two profiles of symptomology: "Stable-High-PTS-FC" (17.0%), and "Stable-Low-PTS-FC" (83%). Membership in the "Stable-High-PTS-FC" profile associated with perturbed maternal sensitivity, which was in turn significantly associated with infant avoidance of social gaze toward mother (Indirect effect β = -0.15). Results suggest the need for early screening and inform the planning of early preventive interventions.
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Affiliation(s)
- Sofie Rousseau
- School of Education, Ariel University, Ariel, Israel
- Baruch Ivcher School of Psychology, Reichman University (IDC Herzliya), Herzliya, Israel
| | - Tamar Feldman
- Baruch Ivcher School of Psychology, Reichman University (IDC Herzliya), Herzliya, Israel
| | - Inbal Shlomi Polachek
- Be'er Ya'akov Medical Center, Beer Yaakov, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tahl I Frenkel
- Baruch Ivcher School of Psychology, Reichman University (IDC Herzliya), Herzliya, Israel
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11
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Madsen KB, Liu X, Albiñana C, Vilhjálmsson BJ, Agerbo E, Mortensen PB, Hougaard DM, Nordentoft M, Werge T, Mors O, Børglum AD, Munk-Olsen T. Genetic liability to posttraumatic stress disorder and its association with postpartum depression. Psychol Med 2023; 53:5052-5059. [PMID: 35811373 PMCID: PMC10782827 DOI: 10.1017/s0033291722002045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Childbirth may be a traumatic experience and vulnerability to posttraumatic stress disorder (PTSD) may increase the risk of postpartum depression (PPD). We investigated whether genetic vulnerability to PTSD as measured by polygenic score (PGS) increases the risk of PPD and whether a predisposition to PTSD in PPD cases exceeds that of major depressive disorder (MDD) outside the postpartum period. METHODS This case-control study included participants from the iPSYCH2015, a case-cohort of all singletons born in Denmark between 1981 and 2008. Restricting to women born between 1981 and 1997 and excluding women with a first diagnosis other than depression (N = 22 613), 333 were identified with PPD. For each PPD case, 999 representing the background population and 993 with MDD outside the postpartum were matched by calendar year at birth, cohort selection, and age. PTSD PGS was calculated from summary statistics from the Psychiatric Genomics Consortium with LDpred2-auto. Odds ratios (ORs) were estimated using conditional logistic regression adjusted for parental psychiatric history and country of origin, PGS for MDD and age at first birth, and the first 10 principal components. RESULTS The PTSD PGS was significantly associated with PPD (OR 1.42, 95% CI 1.20-1.68 per standard deviation increase in PTSD PGS) compared to healthy female controls. Genetic PTSD vulnerability in PPD cases did not exceed that of matched female depression cases outside the postpartum period (OR 1.10, 95% CI 0.94-1.30 per standard deviation increase). CONCLUSIONS Genetic vulnerability to PTSD increased the risk of PPD but did not differ between PPD cases and women with depression at other times.
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Affiliation(s)
- Kathrine Bang Madsen
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Xiaoqin Liu
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Clara Albiñana
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Bjarni Jóhann Vilhjálmsson
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- CIRRAU – Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Preben Bo Mortensen
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- CIRRAU – Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - David Michael Hougaard
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Merete Nordentoft
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Werge
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Institute of Biological Psychiatry, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
- Lundbeck Foundation Center for GeoGenetics, GLOBE Institute, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
| | - Anders D. Børglum
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Department of Biomedicine and the iSEQ Center, Aarhus University, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, CGPM, Aarhus, Denmark
| | - Trine Munk-Olsen
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Research Unit of Psychiatry, Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
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12
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Shorey S, Downe S, Chua JYX, Byrne SO, Fobelets M, Lalor JG. Effectiveness of Psychological Interventions to Improve the Mental Well-Being of Parents Who Have Experienced Traumatic Childbirth: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:1238-1253. [PMID: 34894877 DOI: 10.1177/15248380211060808] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Considering the adverse impact that traumatic childbirth experiences can have on parental mental well-being, studies that have investigated the potential of providing postnatal psychological support for this group of parents require evaluation. This systematic review aimed to examine the effectiveness of psychological interventions at improving the mental well-being of parents who have experienced traumatic childbirth in terms of anxiety, depression, fear of childbirth, and post-traumatic stress disorder (PTSD) symptoms. Seven electronic databases were searched from their respective inception dates up to January 2021. Only quantitative studies that reported the effects of psychological interventions on anxiety, depression, fear of childbirth, and/or PTSD symptoms in selective (at risk of traumatic childbirth experience) or indicated (self-defined childbirth experience as traumatic for any reason) populations of parents (mothers and/or fathers) were included. Eight studies were included and meta-analyses were conducted using a random-effect model. All studies were conducted on mothers only, and one study had minimal father involvement. Results showed that psychological interventions were more effective in reducing fear of childbirth and improving PTSD symptoms compared to anxiety and depression. Greater improvement in depression was reported at 3-8 weeks' follow-up than at immediate post-intervention. Subgroup analyses showed that technology-based interventions were feasible, and indicated interventions were more effective than selective interventions. Conducting future interventions in more geographical regions, engaging and including fathers more actively, incorporating both personalized professional therapy and informal peer support, striving for flexibility and convenience, as well as addressing topics on self-doubt and coping skills can improve current interventions.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Singapore
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Singapore
| | | | - Maaike Fobelets
- Faculty of Medicine and Pharmacy, Department of Public Health Sciences, Biostatistics and Medical Informatics (BISI) Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus University College Brussels, Brussels, Belgium
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13
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Fish-Williamson A, Hahn-Holbrook J. Nutritional factors and cross-national postpartum depression prevalence: an updated meta-analysis and meta-regression of 412 studies from 46 countries. Front Psychiatry 2023; 14:1193490. [PMID: 37398595 PMCID: PMC10311512 DOI: 10.3389/fpsyt.2023.1193490] [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: 03/24/2023] [Accepted: 05/02/2023] [Indexed: 07/04/2023] Open
Abstract
Background Postpartum depression (PPD) is the most common complication associated with childbirth and can lead to adverse outcomes for both mothers and their children. A previous meta-analysis found that PPD prevalence varies widely across countries. One potential underexplored contributor to this cross-national variation in PPD is diet, which contributes to mental health and varies significantly around the world. Here, we sought to update the global and national estimates of PPD prevalence using systematic review and meta-analysis. Further, we examined whether cross-national variation in PPD prevalence is associated with cross-national variation in diet using meta-regression. Methods To estimate national rates of PPD prevalence, we conducted an updated systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale between 2016-2021 and combined our findings with a previous meta-analysis of articles published between 1985-2015. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To examine dietary predictors, we extracted data on sugar-sweetened beverage, fruit, vegetable, total fiber, yogurt, and seafood consumption from the Global Dietary Database. Random effects meta-regression was used to test whether between-country and within-country variation in dietary factors predicted variation in PPD prevalence, controlling for economic and methodological variables. Results 412 studies of 792,055 women from 46 countries were identified. The global pooled prevalence of PPD was 19.18% (95% confidence interval: 18.02 to 20.34%), ranging from 3% in Singapore to 44% in South Africa. Countries that consumed more sugar-sweetened beverages (SSBs) had higher rates of PPD (Coef. = 0.325, p = 0.044, CI:0.010-0.680); Moreover, in years when higher rates of sugar-sweetened beverages were consumed in a country, there were correspondingly higher rates of PPD in that country (Coef. = 0.129, p = 0.026, CI: 0.016-0.242). Conclusion The global prevalence of PPD is greater than previous calculations, and drastically varies by country. Sugar-sweetened beverage consumption explained some of the national variation in PPD prevalence.
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14
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Craemer KA, Garland CE, Sayah L, Duffecy J, Geller SE, Maki PM. Perinatal mental health in low-income urban and rural patients: The importance of screening for comorbidities. Gen Hosp Psychiatry 2023; 83:130-139. [PMID: 37187032 DOI: 10.1016/j.genhosppsych.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/03/2023] [Accepted: 05/06/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To assess the rates and feasibility of assessing comorbid mental health disorders and referral rates in low-income urban and rural perinatal patients. METHODS In two urban and one rural clinic serving primarily low-income perinatal patients of color, a computerized adaptive diagnostic tool CAT-MH® was implemented to assess major depressive disorder (MDD), general anxiety disorder (GAD), suicidality (SS), substance use disorder (SUD), and post-traumatic stress disorder (PTSD) at the first obstetric visit and/or 8 weeks postpartum. RESULTS Of a total of 717 screens, 10.7% (n = 77 unique patients) were positive for one or more disorders (6.1% one, 2.5% two, 2.1% three or more). MDD was the most common disorder (9.6%) and was most commonly comorbid with GAD (33% of MDD cases), SUD (23%), or PTSD (23%). For patients with a positive screen, referral to treatment was 35.1% overall, with higher rates in urban (51.6%) versus rural (23.9%) clinics (p = 0.03). CONCLUSION Mental health comorbidities are common in low-income urban and rural populations, but referral rates are low. Promoting mental health in these populations requires comprehensive screening and treatment approaches for psychiatric comorbidities and dedication to increase the availability of mental health prevention and treatment options.
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Affiliation(s)
- Katherine A Craemer
- Center for Research on Women and Gender, College of Medicine, University of Illinois Chicago, Chicago, IL, USA.
| | - Caitlin E Garland
- Center for Research on Women and Gender, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Lauren Sayah
- Center for Research on Women and Gender, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Jennifer Duffecy
- Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Stacie E Geller
- Center for Research on Women and Gender, College of Medicine, University of Illinois Chicago, Chicago, IL, USA; Department of Obstetrics and Gynecology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Pauline M Maki
- Center for Research on Women and Gender, College of Medicine, University of Illinois Chicago, Chicago, IL, USA; Department of Obstetrics and Gynecology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA; Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, IL, USA; Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
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15
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Boran P, Dönmez M, Atif N, Nisar A, Barış E, Us MC, Altaş ZM, Hıdıroğlu S, Save D, Rahman A. Adaptation and integration of the thinking healthy programme into pregnancy schools in Istanbul, Turkey. BMC Pregnancy Childbirth 2023; 23:245. [PMID: 37046237 PMCID: PMC10091323 DOI: 10.1186/s12884-023-05572-y] [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: 06/03/2022] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Perinatal mental health is a major public health concern. In Turkey, public hospitals operate pregnancy schools which provides an opportunity to integrate an evidence-based Thinking Healthy Programme (THP) for perinatal depression. The aim of this study is to adapt the THP for universal use in the group setting and to understand its acceptability and feasibility for integration into the existing antenatal care programme for both face-to-face and online delivery. METHODS Following an expert-led adaptation process using the Bernal Framework, field testing was conducted on a group of women and facilitators followed by in-depth interviews (n:8) and group discussions (n = 13). Data were analysed using Thematic Framework Analysis. RESULTS Minor but significant adaptations were made to the individually delivered THP for use in the universal group pregnancy schools. Initial findings indicate that the THP-group version was acceptable to its target population and could be integrated into the antenatal care plan for delivery during face-to-face and online group classes. CONCLUSION THP is transferable to the Turkish cultural and healthcare context. The THP-group version has the potential to add value to Turkey's existing perinatal healthcare programme.
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Affiliation(s)
- Perran Boran
- School of Medicine, Division of Social Pediatrics, Marmara University, Istanbul, Turkey
| | - Melike Dönmez
- School of Medicine, Department of Psychiatry, Marmara University, Istanbul, Turkey
| | - Najia Atif
- Human Development Research Foundation, Islamabad, Pakistan
| | - Anum Nisar
- School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Ezgi Barış
- Institute of Health Sciences, Social Pediatrics Doctorate Program, Marmara University, Istanbul, Turkey
| | - Mahmut Caner Us
- Institute of Health Sciences, Social Pediatrics Doctorate Program, Marmara University, Istanbul, Turkey
| | - Zeynep Meva Altaş
- School of Medicine, Department of Public Health, Marmara University, Istanbul, Turkey
| | - Seyhan Hıdıroğlu
- School of Medicine, Department of Public Health, Marmara University, Istanbul, Turkey
| | - Dilşad Save
- School of Medicine, Department of Public Health, Marmara University, Istanbul, Turkey
| | - Atif Rahman
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool, UK.
- Institute of Population Health, University of Liverpool, Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 3GF, UK.
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16
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Laifer LM, O'Hara MW, DiLillo D, Brock RL. Risk for trauma-related distress following difficult childbirth: Trajectories of traumatic intrusions across 2 years postpartum. Arch Womens Ment Health 2023; 26:191-200. [PMID: 36719513 PMCID: PMC10083078 DOI: 10.1007/s00737-023-01296-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
There is heightened risk for maternal posttraumatic stress disorder (PTSD) during the perinatal period. However, it is unclear whether pregnancy and childbirth uniquely contribute to PTSD symptoms above and beyond elevations in negative affectivity that commonly occur among postpartum women (e.g., irritability, fatigue, depressed mood) and past trauma exposure. The present study explored the associations between childbirth stressors and trauma-related distress (TRD; intrusion and avoidance symptoms) across the 2 years following childbirth in a community sample of women (n = 159). Maternal TRD was assessed at pregnancy and four additional timepoints across 2 years postpartum. At pregnancy, mothers completed surveys measuring exposure to trauma and pregnancy-related anxiety. They also reported on pregnancy and childbirth complications across the first 6 months postpartum. Consistent with predictions, labor/delivery complications uniquely predicted increased maternal intrusions during the first 6 months postpartum above and beyond past trauma exposure. Furthermore, growth mixture models identified a subset of women with intrusion symptoms that persisted up to 2 years postpartum and, on average, exceeded the screening threshold for PTSD. Women who experienced greater labor complications were more likely to exhibit this clinical profile relative to low, stable symptoms. Findings highlight the importance of ongoing screening for TRD across the first 2 years postpartum, particularly among women who experience greater labor/delivery complications.
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Affiliation(s)
- Lauren M Laifer
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE, 68588-0308, USA.
| | - Michael W O'Hara
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - David DiLillo
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE, 68588-0308, USA
| | - Rebecca L Brock
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE, 68588-0308, USA
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17
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Staudt A, Baumann S, Horesh D, Eberhard-Gran M, Horsch A, Garthus-Niegel S. Predictors and comorbidity patterns of maternal birth-related posttraumatic stress symptoms: A Latent Class Analysis. Psychiatry Res 2023; 320:115038. [PMID: 36603381 DOI: 10.1016/j.psychres.2022.115038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/08/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022]
Abstract
Birth-related posttraumatic stress symptoms (PTSS) place a significant burden on mothers and their families. The aim was to (1) identify differential profiles of maternal birth-related PTSS; (2) determine the predictive value of established risk factors; (3) examine comorbidity patterns related to depression and anxiety symptoms. As part of the Norwegian Ahus Birth Cohort, 2,088 (expectant) mothers completed self-report questionnaires from 17 weeks of gestation to 2 years postpartum. The Impact of Event Scale was used to assess PTSS 8 weeks after birth. Latent class analysis revealed four latent classes: a High birth-related PTSS class (4%), a Moderate birth-related PTSS class (16%) particularly characterized by endorsement of intrusion symptoms, a Mild birth-related PTSS class (47%), as well as a No birth-related PTSS class (33%). We found similar (younger age, worse subjective birth experience, higher fear of childbirth) and differential predictors (prior posttraumatic stress disorder, lower education, birth complications). Women classified with High, Moderate, or Mild birth-related PTSS showed higher depression and anxiety symptoms compared to women with No birth-related PTSS. A considerable number of mothers experienced birth-related PTSS, most on a subclinical level, but these women still showed signs of mental distress 2 years postpartum, calling for more universal prevention approaches.
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Affiliation(s)
- Andreas Staudt
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany; Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany.
| | - Sophie Baumann
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany; Department of Methods in Community Medicine, Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel; Department of Psychiatry, NYU Grossman School of Medicine, New York, USA
| | - Malin Eberhard-Gran
- Norwegian Research Centre for Women's Health, Women and Children's Division, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland; Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Susan Garthus-Niegel
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, TU Dresden, Dresden, Germany; Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
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18
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Chen Y, Dai J, Wang Y, Guo L, Huang Q. Postpartum post-traumatic stress disorder symptoms in high-risk pregnancies: Associated resilience and social support. J Psychosom Res 2023; 165:111098. [PMID: 36470754 DOI: 10.1016/j.jpsychores.2022.111098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Ying Chen
- Nanjing Stomatological Hospital, Medicine School of Nanjing University, China.
| | - Jiayang Dai
- Yangzhou University, School of Nursing, School of Public Health, China
| | - Yuanyuan Wang
- Yangzhou University, School of Nursing, School of Public Health, China
| | - Lu Guo
- Yangzhou University, School of Nursing, School of Public Health, China
| | - Qian Huang
- Nanjing Stomatological Hospital, Medicine School of Nanjing University, China
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19
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Val A, Míguez MC. Prevalence of Antenatal Anxiety in European Women: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1098. [PMID: 36673854 PMCID: PMC9858852 DOI: 10.3390/ijerph20021098] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
The presence of anxiety during pregnancy is associated with adverse consequences for both mothers and their babies. The aim of this study was to review the prevalence of anxiety in European pregnant women in order to find out which countries have published the most studies in respect to the presence of anxiety during pregnancy, which countries are the most and least prevalent in terms of anxiety within pregnant women, and which are the most common tools used to assess anxiety during this stage. As such, a literature review was conducted regarding the studies that were published in the last twenty years in the PsycInfo, Medline, and SCOPUS databases. Thirty-eight studies were selected for the purposes of this review. The prevalence of anxiety in pregnancy and generalized anxiety disorder (GAD) varies considerably between studies. The European countries that have carried out the most research on this issue are Spain, Italy, and the United Kingdom. The most widely used assessment instrument is the State Trait Anxiety Inventory (STAI). The lowest prevalence rate of anxiety, using the STAI-E, was found in Poland, 7.7%, and the highest was found in Italy, 36.5%. The prevalence of GAD ranges from 0.3% to 10.8%. This indicates that anxiety in pregnant women is a very relevant mental health problem. It is therefore important to detect and intervene early in order to promote the well-being of both mothers and children.
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Affiliation(s)
| | - M. Carmen Míguez
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain
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20
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Shi W, Hall BJ. Trajectories of Posttraumatic Stress Symptoms Among Young Adults Exposed to a Typhoon: A Three-Wave Longitudinal Study. Int J Public Health 2023; 67:1605380. [PMID: 36686386 PMCID: PMC9845259 DOI: 10.3389/ijph.2022.1605380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
Objective: We used a latent class growth model to identify distinct PTSS trajectories and correlates of these trajectories among young adults who experienced Typhoon Hato, the strongest storm to strike China in the last 50 years. Methods: A longitudinal survey (three-waves) was conducted to explore the mental health status and its correlates among young adults exposed to the typhoon. Data from 362 participants were analyzed via a latent class growth model and multinomial logistic regression. Results: Three distinct classes of PTSS trajectories were identified, including: "resilience" (86.46%), "recovery" (9.12%), and "deterioration" (4.42%). The higher levels of direct typhoon exposure, media use, and posttraumatic growth significantly predicted the higher likelihood of participants being in the "recovery'' class. In addition, more social support significantly predicted the higher possibility of being in the "resilience" class. Finally, more severe depressive and anxiety symptoms significantly predicted the higher likelihood of being in the "deterioration" class. Conclusion: Further research should develop interventions to enhance protective factors (e.g., posttraumatic growth, media use), decrease risk factors (e.g., depressive and anxiety symptoms), and thereby prevent PTSS.
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Affiliation(s)
- Wei Shi
- Institute for Disaster Management and Reconstruction (IDMR), Sichuan University, Chengdu, China
| | - Brian J. Hall
- Center for Global Health Equity, NYU Shanghai, Shanghai, China
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21
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Sufredini F, Catling C, Zugai J, Chang S. The effects of social support on depression and anxiety in the perinatal period: A mixed-methods systematic review. J Affect Disord 2022; 319:119-141. [PMID: 36108877 DOI: 10.1016/j.jad.2022.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The social support offered to women in the perinatal period can buffer against depression and anxiety. The sources and types of support that reduce maternal levels of depression and anxiety are not well understood. AIMS To investigate the effects of structural and functional support on depression and anxiety in women in the perinatal period, and to explore the experiences of women around support during the perinatal period. METHOD A comprehensive search of six electronic databases was undertaken. Relevant studies published from January 2010 to April 2020 were included (PROSPERO reference number: CRD42020194228). Quantitative and qualitative studies were eligible if they reported the effects of, or had themes related to receiving functional or structural support in the perinatal period on women's levels of depression or anxiety. Qualitative data was synthesised using a thematic synthesis method. Quantitative data could not be pooled due to the lack of comparable RCTs or cohort studies and was thus presented in a narrative form. RESULTS Fifty-one articles (41 quantitative and 10 qualitative studies) were included. Analysis of quantitative studies demonstrated that insufficient support from partner, friends and family was associated with greater risk of symptoms of depression and anxiety. Distance-delivered interventions (via internet or telephone) diminished levels of depression and anxiety. Qualitative data revealed three overarching themes: appreciating all forms of support in the perinatal period, recognising appropriate and inappropriate support from health professionals and services, and having barriers to mobilising functional and structural support. LIMITATIONS Grey literature was not explored and search strategies only included English, Spanish and Portuguese language articles. The reviewed studies were heterogeneous and for this reason, quantitative assessments were not feasible. CONCLUSION Support from specific sources such as family members, friends who are also mothers, health professionals, neighbours, supervisors, co-workers and online communities still need to be further investigated. Implications for health professionals involved in the care of women in the perinatal period are discussed.
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Affiliation(s)
| | - Christine Catling
- Centre for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Australia
| | - Joel Zugai
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Midwifery and Health Sciences, University of Notre Dame, Australia
| | - Sungwon Chang
- Improving Care for Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Australia
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22
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Chen J, Lai X, Zhou L, Retnakaran R, Wen SW, Krewski D, Huang L, Li M, Xie RH. Association between exclusive breastfeeding and postpartum post-traumatic stress disorder. Int Breastfeed J 2022; 17:78. [PMID: 36419193 PMCID: PMC9685859 DOI: 10.1186/s13006-022-00519-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Research on the association between breastfeeding and postpartum post-traumatic stress disorder (PTSD) is sparse. This study aimed to examine the association between exclusive breastfeeding up to 42 days after childbirth and postpartum PTSD. METHODS An epidemiologic study was conducted in a tertiary hospital in China between October 2019 and October 2020. Eligible mothers were recruited at 3 days after childbirth and assessed using the Post-Traumatic Stress Disorder Checklist - Civilian version (PCL-C) for PTSD at 42 days postpartum. The independent association between exclusive breastfeeding up to 42 days after childbirth and postpartum PTSD was estimated using log-binomial regression models, after adjusting for potential confounders. RESULTS Ninety-two of 759 (12.1%) mothers developed postpartum PTSD within 42 days after childbirth. Compared with partially breastfeeding mothers, exclusively breastfeeding mothers had lower risks of postpartum PTSD (relative risk [RR] 0.28; 95% confidence interval [CI] 0.13, 0.59), re-experience (RR 0.48; 95% CI 0.30, 0.76), avoidance (RR 0.55; 95% CI 0.32, 0.97), and hyperarousal (RR 0.52; 95% CI 0.34, 0.78). After adjustment for family support, parity, mode of delivery, perceived birth trauma, early contact / suckling, and rooming-in, associations between exclusive breastfeeding and postpartum PTSD remained significant: the overall PTSD adjusted relative risk [aRR] was 0.31; (95% CI 0.15, 0.66), with a re-experience aRR of 0.48; (95% CI 0.30, 0.77) and hyperarousal aRR of 0.56; (95% CI 0.37, 0.85). CONCLUSION Exclusive breastfeeding up to 42 days after childbirth was associated with reduced risk of postpartum PTSD. While the potential for reverse causation cannot be ruled out, strategies to improve rates of exclusive breastfeeding through teaching, counselling, and support may benefit mothers and their infants by reducing the risk of postpartum PTSD.
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Affiliation(s)
- Jingfen Chen
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, Guangzhou, China
| | - Xiaolu Lai
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, Guangzhou, China
| | - Lepeng Zhou
- grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, Guangzhou, China
| | - Ravi Retnakaran
- grid.416166.20000 0004 0473 9881Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario Canada ,grid.250674.20000 0004 0626 6184Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Division of Endocrinology, University of Toronto, Toronto, Ontario Canada
| | - Shi Wu Wen
- grid.412687.e0000 0000 9606 5108Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada ,grid.28046.380000 0001 2182 2255Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario Canada ,grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada
| | - Daniel Krewski
- grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada ,grid.28046.380000 0001 2182 2255McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario Canada ,Risk Science International, Ottawa, Ontario Canada
| | - Liping Huang
- grid.284723.80000 0000 8877 7471Department of Obstetrics and Gynecology, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Meng Li
- grid.284723.80000 0000 8877 7471The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China ,grid.284723.80000 0000 8877 7471Department of Obstetrics, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
| | - Ri-hua Xie
- grid.284723.80000 0000 8877 7471Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, China ,grid.284723.80000 0000 8877 7471School of Nursing, Southern Medical University, Guangzhou, China ,grid.28046.380000 0001 2182 2255The Telfer School of Management, University of Ottawa, Ottawa, Ontario Canada
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23
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Mateus V, Cruz S, Costa R, Mesquita A, Christoforou A, Wilson CA, Vousoura E, Dikmen-Yildiz P, Bina R, Dominguez-Salas S, Contreras-García Y, Motrico E, Osório A. Rates of depressive and anxiety symptoms in the perinatal period during the COVID-19 pandemic: Comparisons between countries and with pre-pandemic data. J Affect Disord 2022; 316:245-253. [PMID: 35964769 PMCID: PMC9365708 DOI: 10.1016/j.jad.2022.08.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The COVID-19 pandemic was a significant threat to perinatal mental health. This study examined differences in clinically significant depression, anxiety, and co-morbid symptoms among pregnant and postpartum women across several countries and compared prevalence of perinatal depression and anxiety before and during the pandemic in each participating country. METHODS Participants were 3326 pregnant and 3939 postpartum women (up to six months postpartum) living in Brazil, Chile, Cyprus, Greece, Israel, Portugal, Spain, Turkey, and the United Kingdom. An online survey was completed between June 7th and October 31st 2020, and included the Edinburgh Postnatal Depression Scale (EPDS) and the Generalized Anxiety Disorder Screener (GAD-7). The pre-pandemic studies were identified through literature review. RESULTS Prevalence of clinically significant depression (EPDS≥13), anxiety (GAD-7 ≥ 10), and co-morbid (EPDS≥13 and GAD-7 ≥ 10) symptoms was 26.7 %, 20 % and 15.2 %, in pregnant women, and 32.7 %, 26.6 % and 20.3 %, in postpartum women, respectively. Significant between-country differences were found in all mental health indicators in both perinatal periods. Higher levels of symptoms were observed during (versus before) the pandemic, especially among postpartum women. LIMITATIONS Participants were mostly highly educated and cohabiting with a partner. The online nature of the survey may have limited the participation of women from vulnerable socio-economically backgrounds. CONCLUSIONS Our findings expand previous literature on the negative impact of the COVID-19 pandemic on perinatal mental health, by highlighting that this may be influenced by country of residence. Mental health care policies and interventions should consider the unique needs of perinatal women in different parts of the world.
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Affiliation(s)
- Vera Mateus
- Developmental Disorders Program and Mackenzie Center for Research in Childhood and Adolescence, Center for Biological and Health Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Sara Cruz
- Instituto de Psicologia e de Ciências de Educação [Institute of Psychology and Education], Lusíada University of Porto, Porto, Portugal; Centro de Investigação em Psicologia para o Desenvolvimento (CIPD) [The Psychology for Positive Development Research Center], Lusíada University of Porto, Porto, Portugal
| | - Raquel Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, 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
| | - Ana Mesquita
- School of Psychology, University of Minho, Portugal
| | - Andri Christoforou
- Department of Social and Behavioral Sciences, European University Cyprus, Cyprus
| | - Claire A Wilson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, UK
| | - Eleni Vousoura
- Department of Psychology, National and Kapodistrian University of Athens, Greece
| | | | - Rena Bina
- School of Social Work, Bar Ilan University, Israel
| | | | - Yolanda Contreras-García
- Departamento de Obstetricia y Puericultura, Facultad de Medicina, Universidad de Concepción, Chile
| | - Emma Motrico
- Psychology Department, Universidad Loyola Andalucia, Sevilla, Spain
| | - Ana Osório
- Developmental Disorders Program and Mackenzie Center for Research in Childhood and Adolescence, Center for Biological and Health Sciences, Mackenzie Presbyterian University, São Paulo, Brazil.
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24
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Malaju MT, Alene GD. Longitudinal patterns of the relation between anxiety, depression and posttraumatic stress disorder among postpartum women with and without maternal morbidities in Northwest Ethiopia: a cross-lagged autoregressive structural equation modelling. Arch Public Health 2022; 80:225. [PMID: 36309711 PMCID: PMC9617360 DOI: 10.1186/s13690-022-00978-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The postpartum period is a time where mothers can undergo significant changes that increase vulnerability for depression, anxiety and posttraumatic stress disorder symptoms. However, the direct and indirect factors of depression, anxiety and posttraumatic stress disorder symptoms and their direction of relationships following childbirth is not well investigated in Ethiopia. The aim of this study was to determine the direct and indirect factors of depression, anxiety and posttraumatic stress disorder symptoms and their direction of relationships following childbirth. METHODS A total of 775 women consented to participate at the first, second and third follow-up of the study (6th, 12th and 18th week of postpartum period) during October, 2020 - March, 2021. Women were recruited after childbirth and before discharge using the World Health Organization maternal morbidity working group criteria to identify exposed and non-exposed groups. A cross-lagged autoregressive path analysis and linear structural equation modelling were carried out using Stata version 16 software. RESULTS Prevalence rates of anxiety were 18.5%, 15.5% and 8.5% at the 6th, 12th and 18th week of postpartum respectively. The prevalence rates for depression were also found to be 15.5%, 12.9% and 8.6% respectively during the same follow up period and for posttraumatic stress disorder it was found to be 9.7%, 6.8% and 3.5% at the 6th, 12th and 18th week of postpartum respectively. Moreover, anxiety and depression were found to be a causal risk factors for posttraumatic stress disorder in the postpartum period. Direct maternal morbidity, fear of childbirth, higher gravidity, perceived traumatic childbirth and indirect maternal morbidity were found to have a direct and indirect positive association with depression, anxiety and posttraumatic stress disorder. In contrast, higher parity, higher family size and higher social support have a direct and indirect negative association. CONCLUSION Postnatal mental health screening, early diagnosis and treatment of maternal morbidities, developing encouraging strategies for social support and providing adequate information about birth procedures and response to mothers' needs during childbirth are essential to improve maternal mental health in the postpartum period.
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Affiliation(s)
- Marelign Tilahun Malaju
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Getu Degu Alene
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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25
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Nagle U, Naughton S, Ayers S, Cooley S, Duffy RM, Dikmen-Yildiz P. A survey of perceived traumatic birth experiences in an Irish maternity sample – prevalence, risk factors and follow up. Midwifery 2022; 113:103419. [DOI: 10.1016/j.midw.2022.103419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
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26
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Nie X, Cheng L, Huang F, Zhang T, Yao Y, Tan J, Ke Y. Construct validity and psychometric properties of the Chinese version of the City Birth Trauma Scale. J Obstet Gynaecol Res 2022; 48:2946-2955. [DOI: 10.1111/jog.15391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 06/20/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Li Cheng
- Hubei University of Medicine Shi Yan China
| | - Fei Huang
- Hubei University of Medicine Shi Yan China
| | | | - Yin‐Di Yao
- Hubei University of Medicine Shi Yan China
| | - Jing Tan
- Hubei University of Medicine Shi Yan China
| | - Yu‐Ye Ke
- Hubei University of Medicine Shi Yan China
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27
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Malaju MT, Alene GD, Bisetegn TA. Longitudinal path analysis for the directional association of depression, anxiety and posttraumatic stress disorder with their comorbidities and associated factors among postpartum women in Northwest Ethiopia: A cross-lagged autoregressive modelling study. PLoS One 2022; 17:e0273176. [PMID: 35969630 PMCID: PMC9377604 DOI: 10.1371/journal.pone.0273176] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Vulnerability for depression, anxiety and posttraumatic stress disorder symptoms due to perceived traumatic birth increase during the postpartum period. Traumatic birth has been defined as an event occurring during labour and birth that may be a serious threat to the life and safety of the mother and/or child. However, the comorbidity and multimorbidity of depression, anxiety and PTSD with their direct and indirect predictors is not well investigated in the postpartum period. In addition, the longitudinal directional association of depression, anxiety and PTSD with their comorbidities is not studied in Ethiopia. OBJECTIVE The aim of this study was to assess prevalence of postnatal comorbid and multimorbid anxiety, depression and PTSD. It also aimed to determine the directional association of postnatal anxiety, depression and PTSD with the comorbidity and multimorbidity of these mental health problems over time and to explore the factors that are directly or indirectly associated with comorbidity and multimorbidity of anxiety, depression and PTSD. METHODS A total of 775 women were included at the first, second and third follow-up of the study (6th, 12th and 18th week of postpartum period) during October, 2020 -March, 2021. A cross-lagged autoregressive path analysis was carried out using Stata 16.0 software in order to determine the autoregressive and cross-lagged effects of depression, anxiety and PTSD with their comorbidities. In addition, a linear structural equation modelling was also carried out to determine the direct and indirect effects of independent variables on the comorbidities of depression, anxiety and PTSD. RESULTS Comorbidity of anxiety with depression was the most common (14.5%, 12.1% and 8.1%) at the 6th, 12th and 18th week of postnatal period respectively. With regard to the direction of association, comorbidity of PTSD (due to perceived traumatic birth) with depression, PTSD with anxiety, depression with anxiety and triple comorbidity predicted depression and anxiety in subsequent waves of measurement. Direct and indirect maternal morbidity, fear of childbirth and perceived traumatic childbirth were found to have a direct and indirect positive association with comorbidities of depression, anxiety and PTSD. In contrast, higher parity, higher family size and higher social support had a direct and indirect negative association with these mental health disorders. CONCLUSION Postnatal mental health screening, early diagnosis and treatment of maternal morbidities, developing encouraging strategies for social support and providing adequate information about birth procedures and response to mothers' needs during childbirth are essential to avert comorbidity of anxiety, depression and PTSD in the postpartum period.
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Affiliation(s)
- Marelign Tilahun Malaju
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getu Degu Alene
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Telake Azale Bisetegn
- Department of Health Education and Behavioral Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sandoz V, Lacroix A, Stuijfzand S, Bickle Graz M, Horsch A. Maternal Mental Health Symptom Profiles and Infant Sleep: A Cross-Sectional Survey. Diagnostics (Basel) 2022; 12:1625. [PMID: 35885530 PMCID: PMC9319039 DOI: 10.3390/diagnostics12071625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022] Open
Abstract
The distinct influence of different, but comorbid, maternal mental health (MMH) difficulties (postpartum depression, anxiety, childbirth-related posttraumatic stress disorder) on infant sleep is unknown, although associations between MMH and infant sleep were reported. This cross-sectional survey aimed: (1) to examine associations between MMH symptoms and infant sleep; (2) to extract data-driven maternal MMH symptom profiles from MMH symptoms; and (3) to investigate the distinct influence of these MMH symptom profiles on infant sleep when including mediators and moderators. Mothers of 3-12-month-old infants (n = 410) completed standardized questionnaires on infant sleep, maternal perception of infant negative emotionality, and MMH symptoms. Data was analyzed using: (1) simple linear regressions; (2) factor analysis; and (3) structural equation modelling. MMH symptoms were all negatively associated with nocturnal sleep duration and only postpartum depression and anxiety symptoms were associated with night waking. Three MMH symptom profiles were extracted: depressive, anxious, and birth trauma profiles. Maternal perception of infant negative emotionality mediated the associations between the depressive or anxious profiles and infant sleep but only for particular infant ages or maternal education levels. The birth trauma profile was not associated with infant sleep. The relationships between MMH and infant sleep may involve distinct mechanisms contingent on maternal symptomatology.
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Affiliation(s)
- Vania Sandoz
- Institute of Higher Education and Research in Healthcare, University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (A.L.); (S.S.)
- Child Abuse and Neglect Team, Department Woman-Mother-Child, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Alain Lacroix
- Institute of Higher Education and Research in Healthcare, University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (A.L.); (S.S.)
| | - Suzannah Stuijfzand
- Institute of Higher Education and Research in Healthcare, University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (A.L.); (S.S.)
| | - Myriam Bickle Graz
- Neonatology Unit, Department Woman-Mother-Child, Lausanne University Hospital, 1011 Lausanne, Switzerland;
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, 1010 Lausanne, Switzerland; (V.S.); (A.L.); (S.S.)
- Neonatology Unit, Department Woman-Mother-Child, Lausanne University Hospital, 1011 Lausanne, Switzerland;
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29
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Nielsen-Scott M, Fellmeth G, Opondo C, Alderdice F. Prevalence of perinatal anxiety in low- and middle-income countries: A systematic review and meta-analysis. J Affect Disord 2022; 306:71-79. [PMID: 35306121 DOI: 10.1016/j.jad.2022.03.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/19/2022] [Accepted: 03/10/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Perinatal anxiety is associated with adverse outcomes for women and their infants. Women in low- and middle-income countries (LMIC) may be at higher risk of perinatal anxiety. We aimed to systematically review and synthesise the evidence on prevalence of perinatal anxiety in LMIC. METHOD We searched MEDLINE, Embase, PscyhINFO, Global Health and Web of Science to identify studies assessing prevalence of perinatal anxiety in LMIC. Studies published since January 2016 were included. Screening and data extraction was conducted independently by two reviewers. Pooled prevalence estimates were calculated using random-effect meta-analyses and sources of heterogeneity explored through subgroup analyses and meta-regression. RESULTS We screened 9494 titles and abstracts, reviewed 700 full-texts and included 54 studies in the systematic review and meta-analysis. The pooled prevalence of self-reported anxiety symptoms was 29.2% (95%CI 24.5-34.2; I2 98.7%; 36 studies; n = 28,755) antenatally and 24.4% (95%CI 16.2-33.7; I2 98.5%; 15 studies; n = 6370) postnatally. The prevalence of clinically-diagnosed anxiety disorder was 8.1% (95%CI 4.4-12.8; I2 88.1% 5 studies; n = 1659) antenatally and 16.0% (95% CI 13.5-18.9; n = 113) postnatally. LIMITATIONS Our search was limited to studies published since January 2016 in order to update a previous review on this topic. CONCLUSION Perinatal anxiety represents a significant burden in LMIC, with one in four women experiencing symptoms during pregnancy or postpartum. Research remains lacking in a significant proportion of LMIC, particularly in the lowest income countries. Further research should guide application of screening tools in clinical settings to identify women with anxiety disorders in order to provide appropriate treatment.
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Affiliation(s)
- Maria Nielsen-Scott
- School of Medicine and Biomedical Sciences, University of Oxford, Oxford, UK
| | - Gracia Fellmeth
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Charles Opondo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Mother's Loneliness: Involuntary Separation of Pregnant Women in Maternity Care Settings and Its Effects on the Experience of Mothers during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095081. [PMID: 35564476 PMCID: PMC9099559 DOI: 10.3390/ijerph19095081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/06/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
The aim of the study was to investigate the challenges of involuntary separation experienced by women during pregnancy and childbirth in the time of the COVID-19 pandemic. The study was conducted by the means of a self-administered questionnaire. One thousand and eleven women (1011) from Poland took part in the study, with an average age of approximately 30 years. The study was approved by the Research Ethics Committee of Warmia and Mazury University in Olsztyn, Poland. The results show that the majority of the surveyed women experienced involuntary separation from their partners during pregnancy and childbirth: 66.27% had no choice but to give birth alone and 84.37% had not been able to attend medical appointments with their partners. Solitary encounters with healthcare were associated with the feeling of fear (36.4%), anger (41%), a sense of injustice (52.2%), acute sadness (36.6%) and a sense of loss (42.6%), with all the reported levels higher in younger women. Over 74% of respondents were afraid of childbirth without a partner present. Almost 70% felt depressed because of a lonely delivery experience. Nearly a quarter of the mothers surveyed declared that if they could go back in time, they would not have made the decision to become pregnant during the pandemic. Based on our study, we found that adjustments to prenatal and neonatal care arrangements under COVID-19-related regimens are needed. Our proposal is to implement at least three fundamental actions: (1) risk calculations for pandemic-related cautionary measures should take into account the benefits of the accompanied medical appointments and births, which should be restored and maintained if plausible; (2) medical personnel should be pre-trained to recognise and respond to the needs of patients as a part of crisis preparedness. If the situation does not allow the patient to stay with her family during important moments of maternity care, other forms of contact, including new technologies, should be used; (3) psychological consultation should be available to all patients and their partners. These solutions should be included in the care plan for pregnant women, taking into account a risk-benefit assessment.
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31
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Malaju MT, Alene GD, Bisetegn TA. Longitudinal mediation analysis of the factors associated with trajectories of posttraumatic stress disorder symptoms among postpartum women in Northwest Ethiopia: Application of the Karlson-Holm-Breen (KHB) method. PLoS One 2022; 17:e0266399. [PMID: 35404954 PMCID: PMC9000968 DOI: 10.1371/journal.pone.0266399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/18/2022] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION In recent years, literatures identified childbirth as a potentially traumatic experience resulting in posttraumatic stress disorder (PTSD), with 19.7 to 45.5% of women perceiving their childbirth as traumatic. A substantial variation in PTSD symptoms has been also indicated among women who experience a traumatic childbirth. However, there has been no research that has systematically investigated these patterns and their underlying determinants in postpartum women in Ethiopia. OBJECTIVE The aim of this study was to investigate the trajectories of PTSD symptoms and mediating relationships of variables associated with it among postpartum women in Northwest Ethiopia. METHODS A total of 775 women were recruited after childbirth and were followed at the 6th, 12th and 18th week of postpartum period during October, 2020 -March, 2021. A group-based trajectory modeling and mediation analysis using KHB method were carried out using Stata version 16 software in order to determine the trajectories of PTSD symptoms and mediation percentage of each mediator on the trajectories of PTSD symptoms. RESULTS Four distinct trajectories of postpartum posttraumatic stress disorder symptoms were identified. Perceived traumatic childbirth, fear of childbirth, depression, anxiety, psychological violence, higher WHODAS 2.0 total score, multigravidity, stressful life events of health risk, relational problems and income instability were found to be predictors of PTSD with recovery and chronic PTSD trajectory group membership. Depression and anxiety not only were strongly related to trajectories of PTSD symptoms directly but also mediated much of the effect of the other factors on trajectories of PTSD symptoms. In contrast, multiparity and higher mental quality of life scores were protective of belonging to the PTSD with recovery and chronic PTSD trajectory group membership. CONCLUSION Women with symptoms of depression, anxiety, fear of childbirth and perceived traumatic childbirth were at increased risk of belonging to recovered and chronic PTSD trajectories. Postnatal screening and treatment of depression and anxiety may contribute to decrease PTSD symptoms of women in the postpartum period. Providing adequate information about birth procedures and response to mothers' needs during childbirth and training of health care providers to be mindful of factors that contribute to negative appraisals of childbirth are essential to reduce fear of childbirth and traumatic childbirth so as to prevent PTSD symptoms in the postpartum period.
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Affiliation(s)
- Marelign Tilahun Malaju
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Getu Degu Alene
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Telake Azale Bisetegn
- School of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Waqas A, Zafar SW, Meraj H, Tariq M, Naveed S, Fatima B, Chowdhary N, Dua T, Rahman A. Prevention of common mental disorders among women in the perinatal period: a critical mixed-methods review and meta-analysis. Glob Ment Health (Camb) 2022; 9:157-172. [PMID: 36618726 PMCID: PMC9806961 DOI: 10.1017/gmh.2022.17] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 01/11/2023] Open
Abstract
Perinatal depression and anxiety account for a high burden of perinatal morbidity and poor psychosocial functioning. There is a growing interest among mental health professionals, to devise interventions to prevent this condition. This review synthesizes evidence for the effectiveness of psychological and psychosocial interventions aimed at the prevention of perinatal depression and anxiety. We also explore qualitative evidence to understand the acceptability and feasibility of these interventions. Using a mixed-methods approach, data from a total of 21 studies were collated to inform the evidence for preventive interventions for perinatal depression and anxiety. Based on their theoretical orientations, these interventions were described by authors as cognitive-behavioral (n = 7); psychoeducational (n = 6); mindfulness (n = 2); and interpersonal psychotherapy (n = 2). These also included psychosocial approaches such as social support (n = 1) and multicomponent interventions (n = 3). For depressive symptoms, these interventions yielded moderate to strong effect sizes in favor of the intervention group [standardized mean difference (SMD) = -0.59; 95% confidence interval (CI) -0.95 to -0.23]. For anxiety symptoms, a strong effect size was estimated in favor of the intervention group (SMD = -1.43, 95% CI -2.22 to -0.65). Preventive interventions significantly reduce the severity of perinatal depressive and anxiety symptoms. These interventions are also acceptable and feasible in many settings.
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Affiliation(s)
- Ahmed Waqas
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Hafsa Meraj
- Human Development Research Foundation, Islamabad, Pakistan
| | | | | | - Batool Fatima
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, UK
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Furtado M, Frey BN, Green SM. Validation of the intolerance of uncertainty scale as a screening tool for perinatal anxiety. BMC Pregnancy Childbirth 2021; 21:829. [PMID: 34903196 PMCID: PMC8670292 DOI: 10.1186/s12884-021-04296-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background To date, there is a significant lack of research validating clinical tools for early and accurate detection of anxiety disorders in perinatal populations. Intolerance of uncertainty was recently identified as a significant risk factor for postpartum anxiety symptoms and is a key trait of non-perinatal anxiety disorders. The present study aimed to validate the Intolerance of Uncertainty Scale (IUS) in a perinatal population and evaluate its use as a screening tool for anxiety disorders. Methods Psychiatric diagnoses were assessed in a sample of perinatal women (n = 198), in addition to completing a self-report battery of questionnaires. Psychometric properties including internal consistency and convergent and discriminant validity were assessed. Determination of an optimal clinical cut-off score was measured through a ROC analysis in which the area under the curve, sensitivity, specificity, as well as positive and negative predictive values were calculated. Results The IUS demonstrated excellent internal consistency (α = 0.95) and an optimal clinical cut-off score of 64 or greater was established, yielding a sensitivity of 89%. The IUS also demonstrated very good positive (79%) and negative (80%) predictive values. Conclusions These findings suggest that the IUS represents a clinically useful screening tool to be used as an aid for the early and accurate detection of perinatal anxiety.
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Affiliation(s)
- Melissa Furtado
- Department of Psychology, Neuroscience and Behaviour, McMaster University, 1280 Main Street West, Ontario, Hamilton, L8S 4L8, Canada. .,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.
| | - Benicio N Frey
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Administration B3, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada
| | - Sheryl M Green
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Administration B3, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada
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Köneş MÖ, Yıldız H. The level of grief in women with pregnancy loss: a prospective evaluation of the first three months of perinatal loss. J Psychosom Obstet Gynaecol 2021; 42:346-355. [PMID: 32370579 DOI: 10.1080/0167482x.2020.1759543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To prospectively investigate perinatal grief in women with pregnancy loss. METHODS A total of 215 women (mean (SD) age: 30.7 (5.9) years) who experienced pregnancy loss were included. Data on sociodemographic, marital and obstetric characteristics and Perinatal Grief Scale (PGS) (first 48 h, 1 week, 1 month and 3 months after the loss) were recorded. RESULTS Active grief scores were lower (p ranged < .05 to <.01), while difficulty coping (p < .05 for each) and despair (p < .05 for each) scores were higher in the 3rd month as compared with prior assessments. All PGS scores at the 48 h and 3rd month assessments were significantly higher in assisted and planned pregnancies (p < .01 for each). Maternal age was positively correlated with 48 h active grief (r = 0.19, p < .001), despair (r = 0.13, p < .05) and total PGS (r = 0.13, p < .05) scores. Parity and the number of children were negatively correlated (r ranged from -0.35 to -0.20, p < .01 for each) with all PGS scores. CONCLUSION Our findings revealed decrease in active grief levels, whereas gradual increase in difficulty coping and despair in women with pregnancy loss within the first 3 months of losing a child. Our finding indicate association of older maternal age, primiparity, assisted and planned pregnancies with regular antenatal follow up with higher total PGS scores as well as active grief, difficulty coping and despair scores in women regardless of the time of assessment within 3 months after the pregnancy loss.
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Affiliation(s)
- Miray Özgür Köneş
- Department of Obstetrics and Gynecology Nursing, Istanbul Faculty of Medicine Hospital, Istanbul University, Istanbul, Turkey
| | - Hatice Yıldız
- Department of Obstetrics and Gynecology Nursing, Division of Nursing, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
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Wenzel ES, Gibbons RD, O’Hara MW, Duffecy J, Maki PM. Depression and anxiety symptoms across pregnancy and the postpartum in low-income Black and Latina women. Arch Womens Ment Health 2021; 24:979-986. [PMID: 33970310 PMCID: PMC8667769 DOI: 10.1007/s00737-021-01139-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
Underserved women of color experience high rates of perinatal affective disorders, but most research to date on the natural history of these disorders has been conducted on White women. The present study investigated longitudinal changes in anxiety and depression in a sample of perinatal non-Hispanic Black and Latina women. Categorical (yes/no) measures of positive anxiety and depression screens, as well as total symptom scores, were measured longitudinally across the perinatal period in 178 women (115 non-Hispanic Black, 63 Latina) using the CAT-MH™, a computerized adaptive test. Time (up to 4 visits) and race/ethnicity effects were assessed in linear mixed effects models. Rates of positive anxiety screenings were 13.6%, 3.2%, 8.5%, and 0% in Latina women and 2.6%, 4.2%, 6.1%, and 5.8% in non-Hispanic Black women in the 1st, 2nd, and 3rd trimesters, and postpartum, respectively. Rates of positive anxiety screenings overall were highest in the first trimester (OR = 0.20; 95% CI 0.04-0.98), and there was a significant time-by-race/ethnicity interaction for positive anxiety screens (OR = 8.88; 95% CI 1.42-55.51), as positive screens were most frequent in the first trimester and sharply declined for Latina women, while rates were relatively consistent across the perinatal period in non-Hispanic Black women. Rates of positive depression screens did not change over time, but there was a trend (OR = 1.93; 95% CI 0.93-4.03) for a time-by-race/ethnicity interaction in a direction similar to that seen for anxiety. The odds of positive anxiety screens vary by race/ethnicity and trimester, suggesting that anxiety screening and anxiety interventions may be most resourcefully used in the first trimester for Latina women in particular.
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Affiliation(s)
- Elizabeth S. Wenzel
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert D. Gibbons
- Center for Health Statistics and Departments of Medicine and Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Michael W. O’Hara
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Pauline M. Maki
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA,Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA,Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA
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36
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Brown A, Nielsen JDJ, Russo K, Ayers S, Webb R. The Journey towards resilience following a traumatic birth: A grounded theory. Midwifery 2021; 104:103204. [PMID: 34839226 DOI: 10.1016/j.midw.2021.103204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 10/01/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022]
Abstract
Statistics have shown that up to 30% of women experience birth as traumatising. However, most women do not go on to develop post-traumatic stress disorder (PTSD), and instead appear to be resilient. Research is still sparse in the field of traumatic birth and resilience, and it is not known how women develop resilience after a traumatic birth. OBJECTIVES The aim of this study was to understand the process of fostering resilience after a traumatic birth. METHOD Semi-structured interviews were conducted with eight female participants aged 30 to 50 years who experienced a traumatic birth. A constructivist grounded theory was used to analyse interviews. RESULTS Two main themes were identified which were developed into an emergent model: 1) the feeling of powerlessness during a traumatic birth; and 2) the journey towards resilience. The powerlessness of a traumatic birth was related to a perceived lack of voice and abandonment by healthcare professionals. The model revealed that women's journey towards resilience was aided by both internal and external resources that included healing self-care and ownership of the role of mother; and drawing upon faith, spirituality and supportive relationships. DISCUSSION The findings suggest resilience is a process whereby women draw upon internal and external resources or both at different points in their journey. The implications of the findings include training healthcare professionals in communication to avoid trauma during labour; and prompting women to identify and utilise both internal and external resources to help them to overcome any trauma.
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Affiliation(s)
- Abigail Brown
- CMHT Hertfordshire NHS Trust and Community Perinatal Team Hertfordshire NHS.
| | - Jessica D Jones Nielsen
- Department of Psychology, City, University of London, Northampton Square, London, EC1V 0HB, United Kingdom
| | - Kate Russo
- Clinical Psychologist, IPA Consultant Psychology & Coaching, Townsville, Australia
| | - Susan Ayers
- Centre for Maternal and Child Health Research, City, University of London, Northampton Square, London, EC1V 0HB, United Kingdom
| | - Rebecca Webb
- Centre for Maternal and Child Health Research, City, University of London, Northampton Square, London, EC1V 0HB, United Kingdom
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Liu Y, Zhang L, Guo N, Jiang H. Postpartum depression and postpartum post-traumatic stress disorder: prevalence and associated factors. BMC Psychiatry 2021; 21:487. [PMID: 34610797 PMCID: PMC8491367 DOI: 10.1186/s12888-021-03432-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 08/18/2021] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Despite the increased global interest from researchers in postpartum depression (PPD) and postpartum post-traumatic stress disorder (PP-PTSD), studies of PPD in China have shown a wide range of variability. Indeed, the prevalence and risk factors for PP-PTSD have received little attention in China. AIM To determine the prevalence of PPD and PP-PTSD in China, and to examine the relationships between a range of sociodemographic, pregnancy-related, and newborn-related variables, and PPD and PP-PTSD. METHODS A cross-sectional study involving 1136 women who returned to the obstetrics clinic for routine postpartum examination were enrolled. The sociodemographic, pregnancy-related, and newborn-related characteristics were collected. Social support, and PPD and PP-PTSD symptoms were measured by the Perceived Social Support Scale (PSSS), the Edinburgh Postnatal Depression Scale (EPDS), and the Perinatal Post-traumatic Stress Questionnaire (PPQ). RESULTS The prevalence rates of PPD and PP-PTSD symptoms were 23.5 and 6.1%, respectively. A multivariate model showed that the presence of PP-PTSD was the strongest risk factor for PPD symptoms and vice versa. Other risk factors for PPD included low sleep quality, low social support and newborn's incubator admission. In terms of PP-PTSD symptoms, risk factors included the presence of PPD symptoms, non-Han ethnicity, and low social support, while having one child was a protective factor. CONCLUSIONS This study addressed some gaps in the literature and provided a better understanding of PPD and PP-PTSD in China, which may contribute to early detection and intervention. Attention should be paid to women who are most susceptible to PPD and/or PP-PTSD, including those with low social support, low sleep quality, newborn's incubator admission, non-Han ethnicity, and women with siblings.
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Affiliation(s)
- Ying Liu
- Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204 China
| | - Lan Zhang
- Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204 China
| | - Nafei Guo
- Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204 China
| | - Hui Jiang
- Nursing Department, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No.2699, West Gaoke Road, Pudong New Area, Shanghai, 201204 China
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Stress and Psychopathology Reduction in Pregnant Women through Online Cognitive Behavioural Therapy during COVID-19: A Feasibility Study. Behav Sci (Basel) 2021; 11:bs11070100. [PMID: 34356717 PMCID: PMC8301144 DOI: 10.3390/bs11070100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The global pandemic has affected the psychological health of the population, including pregnant women. Due to the difficulty of offering conventional therapies to reduce stress in this population, studies are needed to show the effect of online therapies. Therefore, the objective was to test the effect of online cognitive behavioural therapy in pregnant women during the pandemic on the main variables of stress and psychopathology. Methods: The sample consisted of 16 pregnant women who participated in a weekly cognitive behavioural intervention for 8 weeks. Prenatal concerns, general stress, stress vulnerability, resilience and psychopathology were assessed. Results: The results show a reduction in prenatal concerns, perceived stress, stress vulnerability and psychopathology, as well as an increase in resilience. Conclusions: Online cognitive behavioural intervention may be effective in pregnant women, so it is important to conduct a randomised controlled trial to certify these findings.
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Memon RI, Safdar B, Hafeez H, Abbas EF, Waqas A, Azeem MW, Naveed S. The Association Between Peripartum Depression and Childhood Resilience: A Systematic Review. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210614-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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40
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Abramovitz LM, Lutgendorf MA, Bukowinski AT, Gumbs GR, Conlin AMS, Hall C. Posttraumatic Stress Disorder in a Cohort of Pregnant Active Duty U.S. Military Servicewomen. J Trauma Stress 2021; 34:586-595. [PMID: 33544939 DOI: 10.1002/jts.22656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 01/04/2023]
Abstract
The present study aimed to describe the demographic and occupational characteristics, comorbidities, and psychotropic medication receipt associated with posttraumatic stress disorder (PTSD) diagnosis during pregnancy among a sample of active duty U.S. military servicewomen. Data from the U.S. Department of Defense Birth and Infant Health Research program were used to identify pregnancies in active duty servicewomen from 2007 through 2014. Demographic and occupational data were linked with electronic medical and pharmacy records to capture mental health diagnoses and medication receipt dates. Cases of PTSD were identified by the presence of ICD-9-CM Diagnostic Code 309.81 on maternal records from 1 year before the date of the last menstrual period through the end of pregnancy. Of 134,244 identified pregnancies among active duty servicewomen, 2,240 (1.7%) met the case criteria for PTSD. Women with a PTSD diagnosis compared to those without a PTSD diagnosis were more likely to be White non-Hispanic (51.3% vs. 47.4%), unmarried (33.3% vs. 28.2%), in the Army (49.6% vs. 35.8%) or Marine Corps (10.9% vs. 8.0%), in a service and supply occupation (18.2% vs. 13.6%), and to have a junior enlisted rank (56.3% vs. 50.1%) and have been previously deployed (51.2% vs. 39.6%), RRs = 1.15-1.75. Among PTSD cases, the most common mental health comorbidities were depressive disorder (60.9%), adjustment disorder (43.4%), and anxiety disorder (39.3%). During pregnancy, 44.2% of PTSD cases and 7.2% of noncases received psychotropic medications. Demographic and occupational characteristics, comorbidities, and psychotropic medication use differed substantially among PTSD cases and noncases in this large records-based study.
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Affiliation(s)
- Lisa M Abramovitz
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Monica A Lutgendorf
- Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, California, USA
| | - Anna T Bukowinski
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Gia R Gumbs
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Ava Marie S Conlin
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Clinton Hall
- Leidos, Inc., San Diego, California, USA.,Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
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41
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Lopes F, Nakamura MU, Nomura RMY. Women's satisfaction with childbirth in a public hospital in Brazil. Birth 2021; 48:251-256. [PMID: 33543497 DOI: 10.1111/birt.12534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate women's satisfaction with vaginal birth in a public hospital in São Paulo, Brazil. METHODS A total of 372 low-risk postpartum women were interviewed. Maternal satisfaction was measured by the Mackey Childbirth Satisfaction Rating Scale (MCSRS), validated to Brazilian Portuguese. The scale is divided into six subscales: self-evaluation, partner, baby, nursing, physicians, and overall satisfaction. Childbirth care data were related to maternal mobility, shower bath, birth ball exercises, manual massage, and the health care providers assisting delivery. RESULTS The MCSRS total score was significantly higher in women living with their partners than those not living with a partner (median 145.5 vs 133.0; P = 0.019), in women with a companion during childbirth than those with no labor support (146.0 vs 136.5; P = 0.047), and in women who early breastfed within the first hour compared with those who did not (146.0 vs 137.0; P = 0.001). Multiple regression identified 'living with partner' (coefficient 6.205; P = 0.043) and 'breastfeeding within the first hour' (coefficient 7.856; P = 0.005) as independent variables that determine the total score of MCSRS. CONCLUSIONS Our findings indicate that living with one's partner and early initiation of breastfeeding are key factors enhancing satisfaction with vaginal birth in women who received care at a public Brazilian hospital.
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Affiliation(s)
- Fernanda Lopes
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
| | - Mary Uchiyama Nakamura
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
| | - Roseli Mieko Yamamoto Nomura
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, São Paulo, Brazil
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Yuan G, Shi W, Lowe S, Chang K, Jackson T, Hall BJ. Associations between posttraumatic stress symptoms, perceived social support and psychological distress among disaster-exposed Chinese young adults: A three-wave longitudinal mediation model. J Psychiatr Res 2021; 137:491-497. [PMID: 33798977 DOI: 10.1016/j.jpsychires.2021.03.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 01/06/2023]
Abstract
Research has documented a strong association between perceived social support, posttraumatic stress symptoms (PTSS), and psychological distress (PD) among people exposed to natural disasters. However, the direction of associations between these factors remains unclear. This study examined possible mediational relationships among perceived social support, PTSS, and PD. A three-wave longitudinal design (6 months intervals) was employed in a sample of 341 Chinese university students (Mage = 21.24, SD = 2.72; 75.7% female) aged 18 to 34 who were directly exposed to a typhoon that occurred in Macao, China, during August 2017. Results indicated that perceived social support at T2 mediated the linkage between PTSS at T1 and PD at T3, and that PTSS at T2 significantly mediated the relationship between PD at T1 and perceived social support at T3. This three-wave longitudinal study highlights the key role of perceived social support on the aggravating effect of acute PTSS on long-term psychological problems, and demonstrates that adverse psychological health outcomes negatively affect the perception of supportive social resources in the context of a natural disaster.
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Affiliation(s)
- Guangzhe Yuan
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Wei Shi
- Institute for Disaster Management and Reconstruction, Sichuan University, People's Republic of China
| | - Sarah Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, USA
| | - Kay Chang
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Todd Jackson
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao (SAR), People's Republic of China
| | - Brian J Hall
- New York University (Shanghai), Shanghai, People's Republic of China.
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Fujita A, Hamada Y, Matsuura T. Mothers' Experiences With Pregnancy and Childbirth Following Pediatric Living Liver Transplant Donation: A Qualitative Descriptive Study. Transplant Proc 2020; 53:630-635. [PMID: 33357958 DOI: 10.1016/j.transproceed.2020.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Half of pediatric living liver transplantation donors are mothers, including women of reproductive age. Reports on pregnancy and childbirth after living donor liver transplantation are limited to medical aspects, and mothers' experiences remain unclear. We describe the experiences of women who became pregnant and gave birth after living donor liver transplantation. METHODS We used a qualitative descriptive approach. Eleven women who became pregnant and delivered following pediatric living liver transplant donation participated in face-to-face, in-depth interviews. Data collected via semi-structured interviews were assessed using an inductive qualitative analysis. The study was conducted in accordance with the Declaration of Helsinki. RESULTS Women's experiences with pregnancy and childbirth following pediatric living liver transplant donation were categorized as follows: explanation and consultation on pregnancy and childbirth after liver donation; physical and mental burden after liver donation; concern about the effects of donor surgery on pregnancy and childbirth; consideration for own body; concern about the physical condition of my child, who is the recipient; and the presence of health professionals with which to easily consult. CONCLUSION After donation, mothers are physically burdened and experiences anxiety about the physical condition of the recipient as well as about pregnancy and childbirth. Therefore, continuous psychosocial support is necessary.
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Affiliation(s)
- Ayaka Fujita
- Division of Nursing Science Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Yuko Hamada
- Division of Nursing Science Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiharu Matsuura
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Bayrı Bingöl F, Bal MD, Dişsiz M, Sormageç MT, Yildiz PD. Validity and reliability of the Turkish version of the City Birth Trauma Scale (CityBiTS). J OBSTET GYNAECOL 2020; 41:1023-1031. [PMID: 33263267 DOI: 10.1080/01443615.2020.1821354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The City Birth Trauma Scale (CityBiTS) was developed to be consistent with the current Diagnostic and Statistical Manual of Mental Disorders-DSM-5. It has been used as a complementary instrument that measures the psychological trauma related to childbirth. The aim of this study was to investigate the validity and reliability of the Turkish version of the CityBiTS. This research is a methodological study. This study was conducted with 315 women who had 6-month-old infants from August to October 2018. The CityBiTS is a 29-item instrument that was developed according to DSM-5 criteria to assess childbirth-related Post-Traumatic Stress Disorder. Test-retest measurements were performed at two-week intervals to evaluate the invariance of the scale over time. Cronbach's alpha coefficient of reliability was used to analyse internal consistency of scale. Cronbach's alpha coefficients were .76 for re-experiencing symptoms, .57 for avoidance symptoms, .77 for negative cognitions and mood, .83 for hyperarousal and .82 for dissociative symptoms. In conclusion, The Turkish version of the CityBiTS, as an instrument developed to be consistent with DSM-5 criteria in assessing childbirth-related trauma symptoms, is a valid and reliable tool.Impact statementWhat is already known on this subject? One of the possible barriers for this is the lack of validated questionnaires that measure the postpartum PTSD.What do the results of this study add? The aim of this study was to investigate the validity and reliability of the Turkish version of the CityBiTS. The City Birth Trauma Scale has good psychometric properties and the two symptom clusters identified are consistent with previous research on symptoms of postpartum PTSD.What are the implications of these findings for clinical practice and/or further research? The City Birth Trauma Scale provides with a measure of birth-related PTSD foruse in research and clinical practice.
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Affiliation(s)
- Fadime Bayrı Bingöl
- Midwifery Department, Marmara University, Health Sciences Faculty, Istanbul, Turkey
| | - Meltem Demirgöz Bal
- Midwifery Department, Marmara University, Health Sciences Faculty, Istanbul, Turkey
| | - Melike Dişsiz
- Hamidiye Faculty of Nursing, University of Health Science, Uskudar, Istanbul, Turkey
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45
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Catala P, Suso-Ribera C, Marin D, Peñacoba C. Predicting postpartum post-traumatic stress and depressive symptoms in low-risk women from distal and proximal factors: a biopsychosocial prospective study using structural equation modeling. Arch Gynecol Obstet 2020; 303:1415-1423. [PMID: 33159548 DOI: 10.1007/s00404-020-05857-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Posttraumatic stress (PTSD) and depression (PPD) are common mental disorders in the postpartum that constitute a threat both to the mother and the baby. It is unclear whether both disorders share similar antecedents, which is important to plan efficient interventions. The goal of this study was to examine the contribution of set of biopsychosocial predictors on both PTSD and PPD. METHODS The study design was prospective. The study was conducted at Hospital Universitario de Fuenlabrada, a public university hospital located in the south of Madrid (Spain). The sample was composed of 116 pregnant women with low pregnancy risk. STROBE reporting guidelines were followed. RESULTS The multivariate results show that psychopathology severity assessed during the first trimester (ß = 0.50, p < .001) and the Apgar score 5 min after delivery (ß = - 0.19, p = .030) were the two variables to significantly contribute to postpartum depressive symptoms. Conversely, only satisfaction with home care after delivery was independently associated with postpartum posttraumatic stress (ß = - 0.26, p = .016). The proposed model explained 21.8% of the variance of postpartum depressive symptoms (p = .041) and 27.1% of the variance of posttraumatic stress symptoms (p = .014). CONCLUSION Special attention should be given to shared and unique predictive factors of PDD and PTSD to develop effective prevention programs in perinatal care.
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Affiliation(s)
- Patricia Catala
- Department of Psychology, Rey Juan Carlos University, Avda. de Atenas s/n, Madrid, 28922, Alcorcón, Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón, Spain
| | - Dolores Marin
- Department of Nursing and Stomatology. Rey Juan Carlos University, Avda. Atenas s/n, Alcorcón, Spain.,Obstetrics Department, Hospital Universitario de Fuenlabrada, Madrid, Fuenlabrada, Spain
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, Avda. de Atenas s/n, Madrid, 28922, Alcorcón, Spain.
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Health care practitioners' views of the support women, partners, and the couple relationship require for birth trauma: current practice and potential improvements. Prim Health Care Res Dev 2020; 21:e40. [PMID: 33004100 PMCID: PMC7576522 DOI: 10.1017/s1463423620000407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIM To examine health care practitioners' views of the support women, partners, and the couple relationship require when affected by birth trauma, barriers to gaining such support, and potential improvements. BACKGROUND Ongoing distress following psychologically traumatic childbirth, also known as birth trauma, can affect women, partners, and the couple relationship. Birth trauma can lead to post traumatic stress symptoms (PTSS) or disorder (PTSD). Whilst there is a clear system of care for a PTSD diagnosis, support for the more prevalent experience of birth trauma is not well-defined. METHOD An online survey of health care practitioners' views of the support parents require for birth trauma, barriers to accessing support, and potential improvements. Practitioners were recruited in 2018 and the sample for the results presented in the article ranged from 95 to 110. RESULTS Practitioners reported differing needs of support for women, partners, and the couple as a unit. There was correlation between practitioners reporting having the skills and knowledge to support couples and feeling confident in giving support. The support most commonly offered by practitioners to reduce the impact on the couple relationship was listening to the couple. However practitioners perceived the most effective support was referral to a debriefing service. Practitioners observed several barriers to both providing support and parents accessing support, and improvements to birth trauma support were suggested. CONCLUSIONS Practitioners indicate that some women, partners, and the couple as a unit require support with birth trauma and that barriers exist to accessing effective support. The support that is currently provided often conflicts with practitioners' perception of what is most effective. Practitioners indicate a need to improve the identification of parents who need support with birth trauma, and more suitable services to support them.
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Delicate A, Ayers S, McMullen S. Health-care practitioners' assessment and observations of birth trauma in mothers and partners. J Reprod Infant Psychol 2020; 40:34-46. [PMID: 32614606 DOI: 10.1080/02646838.2020.1788210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evidence shows that traumatic childbirth can cause ongoing distress, often referred to as birth trauma. This can have an impact on parents and the couple relationship, and consequently identifying and supporting parents with birth trauma is important to practice. AIM To investigate the experiences of health-care practitioners from the United Kingdom (UK) in assessment for birth trauma, perceived occurrence of birth trauma and observed impact on parents and the couple relationship. METHODS An online survey of UK health-care practitioners working with parents in the first postnatal year. RESULTS A sample of 202 practitioners reported identifying birth trauma in 34.4% of mothers and 25.0% of partners. Assessment for birth trauma was only conducted for 50.3% of mothers and 25.9% of partners. The most observed symptoms were re-experiencing among mothers (87.1%) and avoidance among partners (50.9%). Birth trauma was perceived as impacting on the couple relationship for 29.8% of mothers and 26.9% of partners. Written responses provided more detailed observations of the impact of birth trauma. CONCLUSION Understanding how birth trauma may present differently in mothers and partners could support effective assessment. Once birth trauma is identified, parents require personalised support to help them cope with the impact.
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Affiliation(s)
- Amy Delicate
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
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González-Mesa E, Kabukcuoglu K, Blasco M, Körükcü O, Ibrahim N, González-Cazorla A, Cazorla O. Comorbid anxiety and depression (CAD) at early stages of the pregnancy. A multicultural cross-sectional study. J Affect Disord 2020; 270:85-89. [PMID: 32275225 DOI: 10.1016/j.jad.2020.03.086] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/23/2020] [Accepted: 03/25/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION When anxiety and depression are comorbid (CAD), symptoms are more severe and the response to treatments is worse. Given the links between mood disorders and poor perinatal outcomes, CAD and its correlates deserve special clinical attention during pregnancy. The main objective of this study was to learn about the prevalence of comorbid anxiety and depression (CAD) in early stages of the pregnancy analyzing the relationship between CAD and cultural and sociodemographic factors. METHODS We have studied a multicultural sample of 514 Turkish and Spanish pregnant women (264 in Málaga, 102 in Istambul and 148 in Antalya) recruited at the moment of their first pregnancy medical check-up between 10 and 12 weeks of pregnancy. These women completed a questionnaire that included the Turkish or Spanish validated versions of the Edinburg postnatal depression scale (EDS), the state and trait anxiety scale (STAI) and a series of questions related to health status, general mood, and sociodemographic variables. RESULTS We found a CAD prevalence rate of 26.9% and a significant higher prevalence rate among Turkish women (47.6%) when compared to Spanish participants (9.5%) (p<0.001). The multivariate analysis showed that the lack of someone who provided emotional support was the variable that best predicted CAD symptoms. CONCLUSION The CAD prevalence rate was high and significant differences were found depending on the geographic and cultural context.
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Affiliation(s)
| | | | - Marta Blasco
- Hospital Regional Universitario de Málaga, Spain
| | - Oznur Körükcü
- Akdeniz University Nursing Faculty Campus, 07058 Antalya, Turkey
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Chabbert M, Panagiotou D, Wendland J. Predictive factors of women's subjective perception of childbirth experience: a systematic review of the literature. J Reprod Infant Psychol 2020; 39:43-66. [PMID: 32475156 DOI: 10.1080/02646838.2020.1748582] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Up to 33% of women report a negative or traumatic childbirth experience. Given this high prevalence and its consistent association with adverse postpartum and child outcomes, it is essential to identify predictive factors and to improve the management of the childbirth experience. Objective: This systematic review explores and identifies risk and protective factors for women's subjective childbirth experience and birth satisfaction by reviewing original research. Methods: A systematic search was performed for childbirth experience literature on three online databases. Reviewed papers focused on women's subjective childbirth experience and its predictive factors. The articles were assessed with the Mixed Methods Appraisal Tool (MMAT). Results: Risk and protective factors are notably different depending on the study design, the country, or the method employed. The main risk factors are obstetric, such as emergency caesarean and highly perceived labour pain, and women's dissatisfaction with social support. The main protective factors are: obstetric, including highly perceived control during labour or satisfaction regarding partner's support. However, overall results are inconclusive for methodological or conceptual reasons. Conclusions: Several risk factors can be identified through pregnancy or childbirth. This underlines the importance of the quality of maternal interpersonal and professional relationships, especially with first-line perinatal health-care professionals, such as midwives.
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Affiliation(s)
- Margaux Chabbert
- Laboratory of Psychopathology and Health Processes, Université De Paris , Paris, France
| | - Danaé Panagiotou
- Laboratory of Psychopathology and Health Processes, Université De Paris , Paris, France.,Laboratory of Psychology, University of Bourgogne Franche Comté , Besançon, France
| | - Jaqueline Wendland
- Laboratory of Psychopathology and Health Processes, Université De Paris , Paris, France
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Kaya Şenol D, Aydın Özkan S, Aslan E. Adaptation of the Prenatal Comfort Scale into Turkish: A Validity and Reliability Study. Florence Nightingale Hemsire Derg 2020; 29:221-228. [PMID: 34263241 PMCID: PMC8245015 DOI: 10.5152/fnjn.2021.20051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/30/2020] [Indexed: 11/24/2022] Open
Abstract
AIM This study aims to test the validity and the reliability of the Turkish version of the Prenatal Comfort Scale. METHOD The sample of this methodological study included 260 pregnant women presenting to a prenatal screening outpatient clinic. The Prenatal Comfort Scale included 15 items and 5 subscales. Internal consistency analysis, item-total score correlations, and confirmatory factor analysis with Lisrel (8.51) were used to test the reliability of the scale. RESULTS The internal consistency Cronbach’s alpha value was .86 for the Prenatal Comfort Scale and .78, .79, .82, .69, and .60 for the subscales. The item-total score correlation coefficients ranged from .32 to .66 (r = .32–.66). A factor analysis was made to evaluate consistency between the Turkish version of the scale and the original scale. The second item loaded on interacting with fetal movements in the original scale was found to load on recognizing changes during pregnancy in the Turkish version of the scale. CONCLUSION The Turkish version of the Prenatal Comfort Scale was found to have sufficient compatibility. It is also a valid and reliable scale.
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Affiliation(s)
- Derya Kaya Şenol
- Department of Midwifery, Faculty of Health Sciences, Osmaniye Korkut Ata University, Osmaniye, Turkey
| | - Semiha Aydın Özkan
- Departmant of Midwifery, Adıyaman University, School of Health, Adıyaman, Turkey
| | - Ergül Aslan
- Department of Women Health and Disease Nursing, İstanbul University-Cerrahpaşa, Florence Nightingale Faculty of Nursing, İstanbul, Turkey
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