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Jones MC, Byun JY, Billings R, Shorten A, Kempf MC, Vance DE, Puga F. Tools for Screening and Measuring Anxiety Among Women Living with HIV of Reproductive Age: A Scoping Review. AIDS Behav 2023:10.1007/s10461-023-03990-9. [PMID: 36757556 DOI: 10.1007/s10461-023-03990-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/10/2023]
Abstract
Emerging evidence suggests that women living with HIV (WLWH) may experience higher rates of anxiety than men living with HIV and women living without HIV. To date, relatively little knowledge exists on valid anxiety screening and diagnostic tools and how they are used among WLWH, specifically WLWH of reproductive age. Thus, the purpose of this scoping review was to describe what is known in the published literature about anxiety among WLWH and the tools used to measure and screen for anxiety in clinical and research contexts. The Arksey and O'Malley methodological framework was used to guide a scoping review of published articles in PsycINFO, Scopus, Sociological Abstracts, and PubMed databases. Twenty-one measures of anxiety were used across the 52 articles identified in the search. Most measures used were self-report. Inconsistencies in standardized screening tools and cutoff scores were observed across studies. Further, measures to assess anxiety varied among studies focused on WLWH. Based on the results from this review, there is a need for consistent, valid measures of anxiety to advance research and clinical practice to support the well-being of WLWH.
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Affiliation(s)
- Meghan C Jones
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA.
| | - Jun Y Byun
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
| | - Rebecca Billings
- UAB Libraries, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Allison Shorten
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
| | - Frank Puga
- School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, 35294-1210, Birmingham, AL, USA
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2
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Lombardi BN, Jensen TM, Parisi AB, Jenkins M, Bledsoe SE. The Relationship Between a Lifetime History of Sexual Victimization and Perinatal Depression: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:139-155. [PMID: 34132148 PMCID: PMC9660263 DOI: 10.1177/15248380211021611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The association between a lifetime history of sexual victimization and the well-being of women during the perinatal period has received increasing attention. However, research investigating this relationship has yet to be systematically reviewed or quantitatively synthesized. AIM This systematic review and meta-analysis aims to calculate the pooled effect size estimate of the statistical association between a lifetime history of sexual victimization and perinatal depression (PND). METHOD Four bibliographic databases were systematically searched, and reference harvesting was conducted to identify peer-reviewed articles that empirically examined associations between a lifetime history of sexual victimization and PND. A random effects model was used to ascertain an overall pooled effect size estimate in the form of an odds ratio and corresponding 95% confidence intervals (CIs). Subgroup analyses were also conducted to assess whether particular study features and sample characteristic (e.g., race and ethnicity) influenced the magnitude of effect size estimates. RESULTS This review included 36 studies, with 45 effect size estimates available for meta-analysis. Women with a lifetime history of sexual victimization had 51% greater odds of experiencing PND relative to women with no history of sexual victimization (OR = 1.51, 95% CI [1.35, 1.67]). Effect size estimates varied considerably according to the PND instrument used in each study and the racial/ethnic composition of each sample. CONCLUSION Findings provide compelling evidence for an association between a lifetime history of sexual victimization and PND. Future research should focus on screening practices and interventions that identify and support survivors of sexual victimization perinatally.
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Affiliation(s)
- Brooke N. Lombardi
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Todd M. Jensen
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Anna B. Parisi
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Melissa Jenkins
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Sarah E. Bledsoe
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
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3
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Moseholm E, Aho I, Mellgren Å, Pedersen G, Katzenstein TL, Johansen IS, Bach D, Storgaard M, Weis N. Psychosocial health in pregnancy and postpartum among women living with - and without HIV and non-pregnant women living with HIV living in the Nordic countries - Results from a longitudinal survey study. BMC Pregnancy Childbirth 2022; 22:20. [PMID: 34996383 PMCID: PMC8740861 DOI: 10.1186/s12884-021-04357-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The success of antiretroviral therapy has normalized pregnancy among women living with HIV (WWH) with a very low risk of perinatal transmission of HIV. Despite these advances, WWH still face complex medical and psychosocial issues during pregnancy and postpartum. The aim of this study was to assess differences in psychosocial health outcomes between pregnant WWH, non-pregnant WWH, and pregnant women without HIV, and further identify factors associated with probable depression in the third trimester and postpartum. METHODS In a longitudinal survey study, participants were included from sites in Denmark, Finland, and Sweden during 2019-2020. Data was collected in the 3rd trimester, 3 and 6 months postpartum using standardized questionnaires assessing depression, perceived stress, loneliness, and social support. Mixed regression models were used to assess changes over time within and between groups. Logistic regression models were used to identify factors associated with depression in pregnancy and postpartum. RESULTS A total of 47 pregnant WWH, 75 non-pregnant WWH, and 147 pregnant women without HIV were included. The prevalence of depression was high among both pregnant and non-pregnant WWH. There was no significant difference between pregnant and non-pregnant WWH in depression scores, perceived stress scores, or social support scores at any time point. Compared to pregnant women without HIV, pregnant WWH reported worse outcomes on all psychosocial scales. Social support and loneliness were associated with an increased odds of depressive symptoms in the adjusted analysis. CONCLUSIONS A high burden of adverse psychosocial outcomes was observed in both pregnant and non-pregnant women living with HIV compared to pregnant women without HIV. Loneliness and inadequate social support were associated with increased odds of depression in pregnancy and should be a focus in future support interventions.
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Affiliation(s)
- Ellen Moseholm
- Department of Infectious Diseases, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Hvidovre, Denmark. .,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Inka Aho
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Åsa Mellgren
- Department of Infectious Diseases, Region Vestra Gotland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gitte Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Diana Bach
- Department of Gynecology and Obstetrics, Copenhagen University Hospital, Hvidovre, Hvidovre, Denmark
| | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Kettegård Alle 30, 2650, Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Waldron EM, Burnett-Zeigler I, Wee V, Ng YW, Koenig LJ, Pederson AB, Tomaszewski E, Miller ES. Mental Health in Women Living With HIV: The Unique and Unmet Needs. J Int Assoc Provid AIDS Care 2021; 20:2325958220985665. [PMID: 33472517 PMCID: PMC7829520 DOI: 10.1177/2325958220985665] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Women living with HIV (WLWH) experience depression, anxiety, and posttraumatic
stress symptoms at higher rates than their male counterparts and more often than
HIV-unaffected women. These mental health issues affect not only the well-being
and quality of life of WLWH, but have implications for HIV management and
transmission prevention. Despite these ramifications, WLWH are under-treated for
mental health concerns and they are underrepresented in the mental health
treatment literature. In this review, we illustrate the unique mental health
issues faced by WLWH such as a high prevalence of physical and sexual abuse
histories, caregiving stress, and elevated internalized stigma as well as myriad
barriers to care. We examine the feasibility and outcomes of mental health
interventions that have been tested in WLWH including cognitive behavioral
therapy, mindfulness-based interventions, and supportive counseling. Future
research is required to address individual and systemic barriers to mental
health care for WLWH.
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Affiliation(s)
- Elizabeth M Waldron
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Inger Burnett-Zeigler
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Victoria Wee
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Yiukee Warren Ng
- Department of Psychiatry, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Linda J Koenig
- Division of HIV/AIDS Prevention, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aderonke Bamgbose Pederson
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
| | - Evelyn Tomaszewski
- Department of Social Work, College of Health and Human Services, 49340George Mason University, Fairfax, VA, USA
| | - Emily S Miller
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Feinberg School of Medicine, 12244Northwestern University, Chicago, IL, USA
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Harrington BJ, Klyn LL, Ruegsegger LM, Thom A, Jumbe AN, Maliwichi M, Stockton MA, Akiba CF, Go V, Pence BW, Maselko J, Gaynes BN, Miller WC, Hosseinipour MC. Locally contextualizing understandings of depression, the EPDS, and PHQ-9 among a sample of postpartum women living with HIV in Malawi. J Affect Disord 2021; 281:958-966. [PMID: 33272687 PMCID: PMC7855608 DOI: 10.1016/j.jad.2020.10.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/24/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9) are widely used depression screening tools, yet perceptions and understandings of their questions and of depression are not well defined in cross-cultural research. METHODS 30 postpartum women living with HIV in Malawi were recruited from a cohort study and participated in in-depth cognitive interviews. Transcripts were evaluated following an inductive approach to identify common themes. RESULTS Participants most frequently described looking sad or different than usual, self-isolation, 'thinking too much,' and anger as key symptoms of being depressed. HIV-associated stigma was commonly identified as a cause of depression. The EPDS and PHQ-9 were generally well understood but did not capture all the important symptoms of depression that women described. Participants sometimes requested clarification or rephrasing of certain EPDS and PHQ-9 questions when asked to explain the questions' meanings in their own words, and requested rephrasing more often for EPDS questions than PHQ-9 questions. Few women believed either tool was sufficient to detect depression. LIMITATIONS Our results may not be generalizable, but are locally contextualized. Women suffering with depression may have been more or less likely to agree to the qualitative interview depending on their comfort level discussing any current depressive symptoms. CONCLUSIONS Researchers and practitioners who use the EPDS and PHQ-9 should be aware of the tools' limitations in their context and population. New instruments may need to be developed or adaptations to existing tools made to improve accuracy of depression screening and diagnosis in different cultural contexts.
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Affiliation(s)
- Bryna J Harrington
- University of North Carolina at Chapel Hill; The Johns Hopkins University School of Medicine Dept. of Gynecology and Obstetrics, USA.
| | | | | | | | | | | | - Melissa A Stockton
- University of North Carolina at Chapel Hill; Columbia University Vagelos College of Physicians and Surgeons Dept. of Psychiatry, USA
| | | | - Vivian Go
- University of North Carolina at Chapel Hill, USA
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Midwifery and Nursing Strategies to protect against COVID-19 During the Third Trimester of Pregnancy. Midwifery 2020; 92:102876. [PMID: 33220602 PMCID: PMC7834539 DOI: 10.1016/j.midw.2020.102876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 09/29/2020] [Accepted: 10/23/2020] [Indexed: 01/08/2023]
Abstract
Objective The rapid pace of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic (COVID-19) presents significant challenges to midwives and nurses. This study aimed to explore midwifery and nursing interventions to limit the transmission of COVID-19 among women in their third trimester of pregnancy, to reduce the incidence of nosocomial infection and promote safety of care for women and their infants. Method We completed a retrospective review of medical records from 35 women in their third trimester of pregnancy with SARS-CoV-2, admitted to one hospital in Wuhan, China in January and February 2020. We investigated the clinical characteristics of the COVID-19 infection in pregnancy, and the individualized midwifery and nursing care offered, including environmental protection, prevention of nosocomial infection, maternal observations, monitoring of signs and symptoms of COVID-19, and psychological care. Result Thirty-one women had a caesarean section, and four had vaginal births. Retrospective analysis of midwifery and nursing strategies implemented to care for these women showed no maternal complications or nosocomial infections. Conclusions and implications for practice The care strategies we implemented could prevent complications and nosocomial infection in the third trimester of pregnancy, thus ensuring the safety of women and their infants. Further research needs to determine treatment priorities for women infected with COVID-19 during pregnancy and the postnatal period.
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Aurpibul L, Tongprasert F, Wichasilp U, Tangmunkongvorakul A. Depressive Symptoms Associated with Low Quality of Life Among Pregnant and Postpartum Women Living with HIV in Chiang Mai, Thailand. Int J MCH AIDS 2020; 9:421-429. [PMID: 33163291 PMCID: PMC7604762 DOI: 10.21106/ijma.375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND OR OBJECTIVES Women living with HIV (WLHIV) are at increased risk of depression. In pregnancy, depression could affect health and pregnancy outcomes, as well as child rearing. We assessed depressive symptoms and quality of life of WLHIV during the perinatal period. METHODS This cross-sectional study was conducted at 15 hospitals in Chiang Mai, Thailand. The Patient Health Questionnaire-9 and the World Health Organization quality of life questionnaire (WHOQOL-BREF_THAI) were used to screen for depressive symptoms and to assess quality of life (QOL), respectively. Statistical analysis was performed by the SPSS. Descriptive statistics were reported. Factors associated with depressive symptoms were assessed by univariate and multivariate analyses. Linear regression analysis was performed to determine association between depressive symptom scores and QOL. Regression coefficient (b) and 95% confidence intervals (CI) were reported. P-values < 0.05 were considered statistically significant. RESULTS One hundred WLHIV were enrolled and the mean age was 29.2 ±7.5 years. The overall prevalence of depressive symptoms was 30 (30%), 95% CI 21-39; specifically, 34 (34%) in pregnant and 27 (27%) in postpartum women. Overall, depressive symptoms were mild in 22 (22%), moderate in 7 (7%), and moderately severe in one (1%). Multivariate logistic regression analysis revealed that verbal abuse by partner (b=4.751 (95% CI=2.306-9.790), p< 0.001) and lifetime alcohol use (b=3.403 (95% CI=1.427-8.115), p=0.006) were associated with depressive symptoms. The overall perception of own health and quality of life of WLHIV in all domains were lower than that of HIV-negative women. WLHIV with depressive symptoms had a significantly lower QOL than those without. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS In this study, the prevalence of depressive symptoms in women living with HIV was similar to that in HIV-negative women. WLHIV with depressive symptoms had a significantly lower QOL than those without. Mental health screening in antenatal and postpartum clinic is warranted.
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Affiliation(s)
- Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, 110 Intavaroros Road,Sri Phum Subdistrict, Muang Chiang Mai District, Chiang Mai 50200, Thailand
| | - Fuanglada Tongprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, 110 Intavaroros Road, Sri Phum Subdistrict, Muang Chiang Mai District, Chiang Mai 50200, Thailand
| | - Uraiwan Wichasilp
- Nakornping Hospital, 159 Chotana Road, Don Kaeo Subdistrict, Mae Rim District, Chiang Mai 50180, Thailand
| | - Arunrat Tangmunkongvorakul
- Research Institute for Health Sciences, Chiang Mai University, 110 Intavaroros Road,Sri Phum Subdistrict, Muang Chiang Mai District, Chiang Mai 50200, Thailand
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Zhu QY, Huang DS, Lv JD, Guan P, Bai XH. Prevalence of perinatal depression among HIV-positive women: a systematic review and meta-analysis. BMC Psychiatry 2019; 19:330. [PMID: 31666033 PMCID: PMC6822469 DOI: 10.1186/s12888-019-2321-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 10/14/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Increasing attention has been paid to differences in the prevalence of perinatal depression by HIV status, although inconsistent results have been reported. The aim of this systematic review and meta-analysis was to assess the relationship between perinatal depression and HIV infection. A comprehensive meta-analysis of comparative studies comparing the prevalence of antenatal or postnatal depression between HIV-infected women and HIV-negative controls was conducted. METHODS Studies were identified through PubMed/Medline, Scopus, Web of Science, Cochrane Library, Embase and PsycINFO, and the reading of complementary references in August 2019. Subgroup analyses were performed for anticipated explanation of heterogeneity using methodological quality and pre-defined study characteristics, including study design, geographical location and depression screening tools for depression. The overall odds ratio (OR) and mean prevalence of each group were calculated. RESULTS Twenty-three studies (from 21 publications), thirteen regarding antenatal depression and ten regarding postnatal depression were included, comprising 3165 subjects with HIV infection and 6518 controls. The mean prevalence of antenatal depressive symptoms in thirteen included studies was 36% (95% CI: 27, 45%) in the HIV-positive group and 26% (95% CI: 20, 32%) in the control group. The mean prevalence of postnatal depressive symptoms in ten included studies was 21% (95% CI: 14, 27%) in the HIV-positive group and 16% (95% CI: 10, 22%) in the control group. Women living with HIV have higher odds of antenatal (OR: 1.42; 95% CI: 1.12, 1.80) and postnatal depressive symptoms (OR: 1.58; 95% CI: 1.08, 2.32) compared with controls. Publication bias and moderate heterogeneity existed in the overall meta-analysis, and heterogeneity was partly explained by the subgroup analyses. CONCLUSIONS Women with HIV infection exhibit a significantly higher OR of antenatal and postnatal depressive symptoms compared with controls. For the health of both mother and child, clinicians should be aware of the significance of depression screening before and after delivery in this particular population and take effective measures to address depression among these women.
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Affiliation(s)
- Qi-Yu Zhu
- 0000 0000 9678 1884grid.412449.eDepartment of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122 China
| | - De-Sheng Huang
- 0000 0000 9678 1884grid.412449.eDepartment of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122 China ,0000 0000 9678 1884grid.412449.eDepartment of Mathematics, School of Fundamental Sciences, China Medical University, Shenyang, China
| | - Jian-Da Lv
- 0000 0000 9678 1884grid.412449.eDepartment of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122 China
| | - Peng Guan
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, 110122, China.
| | - Xing-Hua Bai
- grid.412636.4Department of Radiation Oncology, The First Affiliated Hospital of China Medical University, Shenyang, China
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Abstract
The purpose of this review was to understand research about treatment adherence among mothers in the US who are living with HIV. Treatment adherence included Antiretroviral Therapy and attending medical care appointments. A scoping review was conducted, and five peer-reviewed databases were searched with predetermined search terms for the period of 2006-2016. Thirty-five articles were identified for the review, including (n = 17) quantitative studies, (n = 6) qualitative studies, (n = 4) reviews and (n = 8) conceptual/theoretical articles. The most frequently identified theme among the articles was prevention of mother-to-child transmission of HIV. Authors disagreed about whether parenting children was a burden or a source of strength for the affected women. Implications identified for practice included a more longitudinal approach to care for mothers, rather than focusing narrowly on prevention of transmission to infants.
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HARRINGTON BJ, PENCE BW, MALIWICHI M, JUMBE AN, GONDWE NA, WALLIE SD, GAYNES BN, MASELKO J, MILLER WC, HOSSEINIPOUR MC. Probable antenatal depression at antiretroviral initiation and postpartum viral suppression and engagement in care. AIDS 2018; 32:2827-2833. [PMID: 30234603 PMCID: PMC6528829 DOI: 10.1097/qad.0000000000002025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To estimate the association of probable antenatal depression with postpartum HIV care engagement among pregnant women in Malawi. DESIGN We conducted a prospective cohort study of 299 women who were initiating antiretroviral therapy (ART) through Option B+ at a government antenatal clinic in Malawi. METHODS Probable antenatal depression was assessed on the day of ART initiation with the validated Chichewa version of the Edinburgh Postnatal Depression Scale (EPDS). We estimated crude and adjusted risk differences (RD, aRD) of visit attendance and prevalence differences (PD, aPD) of viral suppression through 12 months post-ART initiation comparing women with versus without probable antenatal depression. RESULTS One in 10 women had probable antenatal depression. Most women were engaged in care through 12 months post-ART initiation: 85% attended all scheduled ART visits, and 81% were in care and virally suppressed. Women with and without probable antenatal depression had a comparable probability of attending all scheduled visits (RD: -0.02; 95% CI -0.16 to 0.12; aRD: -0.04; 95% CI -0.18 to 0.10), and of viral suppression (PD: -0.02; 95% CI -0.17 to 0.13; aPD: -0.01; 95% CI -0.17 to 0.15) in crude and adjusted analyses. CONCLUSION Probable antenatal depression was not associated with engagement in HIV care through 12 months post-ART initiation. In a population with high HIV care engagement, antenatal depression may not impair HIV-related outcomes.
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11
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Prevalence and incidence of probable perinatal depression among women enrolled in Option B+ antenatal HIV care in Malawi. J Affect Disord 2018; 239:115-122. [PMID: 29990658 PMCID: PMC6089649 DOI: 10.1016/j.jad.2018.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/09/2018] [Accepted: 06/01/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Perinatal depression is a common condition of pregnancy and the postpartum period. Depression negatively affects engagement in HIV care, but systematic screening for perinatal depression is not done in most sub-Saharan African countries. Estimating the burden and timing of perinatal depression can help inform medical programs with the current scale-up of HIV care for pregnant women. METHODS Women (n = 299) initiating antiretroviral therapy for HIV were recruited from a government antenatal clinic in Malawi in 2015-2016 into a cohort study. Probable perinatal depression was assessed at enrollment and at 6 weeks and 3, 6, and 12 months postpartum with the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9). We estimated point prevalence and incidence of depression as well as concordance between EPDS and PHQ-9 scores. RESULTS One in ten women screened positive for probable antenatal depression, whereas 1-6% screened positive postpartum. Sensitivity analyses to account for loss to follow-up suggested that postpartum depression prevalence could have ranged from 1-11%. At postpartum time points, 0-3% of participants screened positive for incident probable depression. EPDS and PHQ-9 scores were concordant for 96% of assessments during antenatal and postpartum visits. LIMITATIONS Lack of diagnostic psychiatric evaluation precludes actual diagnosis of major depression, and social desirability bias may have contributed to low postpartum scores. CONCLUSIONS Probable depression was more common during the antenatal period than postpartum among our participants. Given the association between depression and negative HIV outcomes, screening for depression during pregnancy should be integrated into antenatal HIV care.
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Harrington BJ, Pence BW, John M, Melhado CG, Phulusa J, Mthiko B, Gaynes BN, Maselko J, Miller WC, Hosseinipour MC. Prevalence and factors associated with antenatal depressive symptoms among women enrolled in Option B+ antenatal HIV care in Malawi: a cross-sectional analysis. J Ment Health 2018; 28:198-205. [PMID: 30270683 DOI: 10.1080/09638237.2018.1487542] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Option B+ has increased the number of pregnant women initiating antiretroviral therapy for HIV, yet retention in HIV care is sub-optimal. Retention may be affected by antenatal depression. However, few data exist on antenatal depression in this population. AIM Describe the prevalence and factors associated with antenatal depression among Malawian women enrolled in Option B+. METHOD At their first antenatal visit, women with HIV provided demographic and psychosocial information, including depression as measured with the locally validated Edinburgh Postnatal Depression Scale (EPDS). Prevalence ratios (PR) for factors associated with probable depression (EPDS ≥6) were estimated with log binomial regression. RESULTS 9.5% (95% CI: 7.5-11.9%) of women screened positive for current depression, and 46% self-reported a history of depression or anxiety. Women were more likely to screen positive for current depression if they reported a history of depression (adjusted PR: 2.42; 95% CI: 1.48-3.95) or had ever experienced intimate partner violence (1.77; 1.11-2.81). Having an unintended current pregnancy (1.78; 0.99-3.21), being unmarried (1.66; 0.97-2.84), or employed (1.56; 1.00-2.44) had potential associations with probable depression. CONCLUSIONS Probable antenatal depression affected a notable proportion of women living with HIV, comparable to other global regions. Screening for antenatal depression in HIV care should be considered.
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Affiliation(s)
- Bryna J Harrington
- a Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Brian W Pence
- a Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Mathias John
- b Project Malawi, University of North Carolina , Lilongwe , Malawi , and
| | - Caroline G Melhado
- b Project Malawi, University of North Carolina , Lilongwe , Malawi , and
| | - Jacob Phulusa
- b Project Malawi, University of North Carolina , Lilongwe , Malawi , and
| | - Bryan Mthiko
- b Project Malawi, University of North Carolina , Lilongwe , Malawi , and
| | - Bradley N Gaynes
- a Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Joanna Maselko
- a Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - William C Miller
- c College of Public Health , The Ohio State University , Columbus , OH , USA
| | - Mina C Hosseinipour
- a Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,b Project Malawi, University of North Carolina , Lilongwe , Malawi , and
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Angrand RC, Sperling R, Roccobono K, Osborne LM, Jao J. Depression in perinatally HIV-infected pregnant women compared to non-perinatally HIV-infected and HIV-uninfected pregnant women. AIDS Care 2018; 30:1168-1172. [PMID: 29776314 DOI: 10.1080/09540121.2018.1476659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
"Depression (as noted in chart by a physician)" was compared between HIV infected pregnant women and controls. Perinatally HIV-infected (PHIV), non-perinatally HIV-infected (NPHIV), and HIV-uninfected (HIV-U) pregnant women were all compared using a logistic regression model. Overall, HIV-infected women had higher rates of depression than HIV-U, with PHIV women demonstrating a clinically and statistically significant increased risk compared to HIV-U women [adjusted OR: 15.9, 95% CI = 1.8-143.8]. Future studies in larger populations are warranted to confirm these findings and further elucidate mental health outcomes of PHIV and NPHIV pregnant women.
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Affiliation(s)
- Ruth C Angrand
- a Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Rhoda Sperling
- a Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | | | - Lauren M Osborne
- c The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Jennifer Jao
- a Icahn School of Medicine at Mount Sinai , New York , NY , USA
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Falah-Hassani K, Shiri R, Dennis CL. The prevalence of antenatal and postnatal co-morbid anxiety and depression: a meta-analysis. Psychol Med 2017; 47:2041-2053. [PMID: 28414017 DOI: 10.1017/s0033291717000617] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To date, the precise prevalence of co-morbidity of anxiety and depression in the perinatal period is not well known. We aimed to estimate the prevalence of co-morbid anxiety and depression in the antenatal and postnatal periods. Systematic searches of multiple electronic databases were conducted for studies published between January 1950 and January 2016. We included 66 (24 published and 42 unpublished) studies incorporating 162 120 women from 30 countries. Prevalence of self-reported antenatal anxiety symptoms and mild to severe depressive symptoms was 9.5% [95% confidence interval (CI) 7.8-11.2, 17 studies, n = 25 592] and of co-morbid anxiety symptoms and moderate/severe depressive symptoms was 6.3% (95% CI 4.8-7.7, 17 studies, n = 27 270). Prevalence of a clinical diagnosis of any antenatal anxiety disorder and depression was 9.3% (95% CI 4.0-14.7, 10 studies, n = 3918) and of co-morbid generalized anxiety disorder and depression was 1.7% (95% CI 0.2-3.1, three studies, n = 3085). Postnatally between 1 and 24 weeks postpartum, the prevalence of co-morbid anxiety symptoms and mild to severe depressive symptoms was 8.2% (95% CI 6.5-9.9, 15 studies, n = 14 731), while co-morbid anxiety symptoms and moderate/severe depressive symptoms was 5.7% (95% CI 4.3-7.1, 13 studies, n = 20 849). The prevalence of a clinical diagnosis of co-morbid anxiety and depression was 4.2% (95% CI 1.9-6.6, eight studies, n = 3251). Prevalence rates did not differ with regard to year of publication, country income, selection bias and attrition bias. The results suggest that co-morbid perinatal anxiety and depression are prevalent and warrant clinical attention given the potential negative child developmental consequences if left untreated. Further research is warranted to develop evidence-based interventions for prevention, identification and treatment of this co-morbidity.
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Affiliation(s)
| | - R Shiri
- Finnish Institute of Occupational Health,Helsinki,Finland
| | - C-L Dennis
- University of Toronto,Toronto, ON,Canada
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Abstract
OBJECTIVES To explore and understand the experiences and priorities of pregnant women living with fears and worries related to fetal/infant and maternal health, the birthing process and ability to parent the infant (ie, pregnancy-related anxiety (PRA)) in Mwanza, Tanzania. DESIGN Descriptive phenomenological approach. SETTING Two clinics in the Ilemela and Nyamagana districts of Mwanza. PARTICIPANTS Pregnant and postpartum women who obtained high scores on a PRA scale during pregnancy in a larger quantitative study were contacted to participate in an interview (10 women, aged 18-34 years; 3 HIV positive). MEASURES Semi-structured interviews were undertaken, with guiding questions related to the women's experience during pregnancy. The Colaizzi method was used with transcripts that had been translated and back translated from Swahili to English and then hand-coded by the interviewer, with independent review by another researcher to verify the analysis. RESULTS PRA, as experienced by women in Mwanza, was a state of worry and concern, often causing physical symptoms, and disrupting personal sense of peace. While some themes in the women's experiences reflected the domains examined in the PRA scale used to identify potential participants, others such as lack of knowledge, partner relationship, interactions with the healthcare system, spirituality and fear of HIV/AIDS were otherwise missing. Their prominence in the participants' stories broadens our understanding of PRA. CONCLUSIONS The realities and viewpoints of women in low-income and middle-income countries (LMIC) experiencing PRA are still relatively unknown. The findings from this study provided much-needed insight into the perspectives and priorities of women in Mwanza who have experienced PRA and further support the need to explore this phenomenon in other LMIC. The additional domains identified reinforce the need for a PRA tool that accurately and adequately capture the complexities of PRA for women in this region.
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Affiliation(s)
| | - Shahirose Sadrudin Premji
- Faculty of Nursing, University of Calgary, Calgary, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Elias Charles Nyanza
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- School of Public Health, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | - David Este
- Faculty of Social Work, University of Calgary, Calgary, Canada
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Tuthill EL, Pellowski JA, Young SL, Butler LM. Perinatal Depression Among HIV-Infected Women in KwaZulu-Natal South Africa: Prenatal Depression Predicts Lower Rates of Exclusive Breastfeeding. AIDS Behav 2017; 21:1691-1698. [PMID: 27752868 DOI: 10.1007/s10461-016-1557-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Exclusive breastfeeding (EBF) provides infants with optimal nutrition, and together with appropriate antiretroviral therapy has also been shown to decrease mother-to-child transmission of HIV from 45 to less than 1 %. However, rates of EBF are particularly low in South Africa, where rates of HIV are some of the highest in the world. Although perinatal depression has been identified as a potential barrier to EBF, little is known about its impact on EBF among HIV-infected women. A cohort study was conducted as part of a pilot randomized controlled trial (RCT) examining the effect of an Information, Motivation and Behavioral skills-based intervention promoting EBF among South African women living with HIV in their third trimester (28-42 weeks) of pregnancy. At baseline and follow-up, participants were interviewed on depression symptoms (PHQ-9), and breastfeeding intentions and behavior. Multivariate logistic regressions were conducted to determine predictors of EBF at 6-weeks postpartum. A total of 68 women were enrolled and 58 women completed both baseline and follow-up assessments. Most (80.9 %) of the sample reported at least some symptoms of depression prenatally. Rates of depression were lower postpartum (47.1 %). In multivariate models, higher prenatal depression scores significantly predicted lower likelihood of EBF at 6-weeks postpartum after adjusting for demographics, condition, and intentions (AOR = 0.68, p < 0.05). Postpartum depression was not a significant predictor of EBF rates (AOR = 0.99, p = 0.96). These findings demonstrate the negative impact of prenatal depression on breastfeeding behavior. Future interventions focused on depression are warranted to identify those at risk for sub-optimal EBF. Improving maternal psychosocial well-being could be a new frontier to improving infant and young child feeding and reducing pre/postnatal transmission.
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Affiliation(s)
- Emily L Tuthill
- UCSF School of Nursing, University of California San Francisco, 2 Koret Way, Box 0608, San Francisco, CA, 94143-0608, USA.
| | - Jennifer A Pellowski
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sera L Young
- Department of Anthropology, Institute for Policy Research Northwestern University, Evanston, IL, USA
| | - Lisa M Butler
- Department of Pediatrics, Harvard Medical School, Boston, USA
- Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, USA
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Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry 2017; 210:315-323. [PMID: 28302701 DOI: 10.1192/bjp.bp.116.187179] [Citation(s) in RCA: 728] [Impact Index Per Article: 104.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/03/2016] [Accepted: 11/13/2016] [Indexed: 01/21/2023]
Abstract
BackgroundMaternal anxiety negatively influences child outcomes. Reliable estimates have not been established because of varying published prevalence rates.AimsTo establish summary estimates for the prevalence of maternal anxiety in the antenatal and postnatal periods.MethodWe searched multiple databases including MEDLINE, Embase, and PsycINFO to identify studies published up to January 2016 with data on the prevalence of antenatal or postnatal anxiety. Data were extracted from published reports and any missing information was requested from investigators. Estimates were pooled using random-effects meta-analyses.ResultsWe reviewed 23 468 abstracts, retrieved 783 articles and included 102 studies incorporating 221 974 women from 34 countries. The prevalence for self-reported anxiety symptoms was 18.2% (95% CI 13.6-22.8) in the first trimester, 19.1% (95% CI 15.9-22.4) in the second trimester and 24.6% (95% CI 21.2-28.0) in the third trimester. The overall prevalence for a clinical diagnosis of any anxiety disorder was 15.2% (95% CI 9.0-21.4) and 4.1% (95% CI 1.9-6.2) for a generalised anxiety disorder. Postnatally, the prevalence for anxiety symptoms overall at 1-24 weeks was 15.0% (95% CI 13.7-16.4). The prevalence for any anxiety disorder over the same period was 9.9% (95% CI 6.1-13.8), and 5.7% (95% CI 2.3-9.2) for a generalised anxiety disorder. Rates were higher in low- to middle-income countries.ConclusionsResults suggest perinatal anxiety is highly prevalent and merits clinical attention. Research is warranted to develop evidence-based interventions.
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Affiliation(s)
- Cindy-Lee Dennis
- Cindy-Lee Dennis, PhD, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada; Kobra Falah-Hassani, PhD, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Rahman Shiri, MD, PhD, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Kobra Falah-Hassani
- Cindy-Lee Dennis, PhD, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada; Kobra Falah-Hassani, PhD, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Rahman Shiri, MD, PhD, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Rahman Shiri
- Cindy-Lee Dennis, PhD, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada; Kobra Falah-Hassani, PhD, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Rahman Shiri, MD, PhD, Finnish Institute of Occupational Health, Helsinki, Finland
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FitzHarris LF, Hollis ND, Nesheim SR, Greenspan JL, Dunbar EK. Pregnancy and linkage to care among women diagnosed with HIV infection in 61 CDC-funded health departments in the United States, 2013. AIDS Care 2017; 29:858-865. [PMID: 28132520 DOI: 10.1080/09540121.2017.1282107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Timely linkage to HIV care (LTC) following an HIV diagnosis is especially important for pregnant women with HIV to prevent perinatal transmission and improve maternal health. However, limited data are available on LTC among U.S. pregnant women. Our analysis aimed to identify HIV diagnoses among childbearing age (CBA) women (15-44 years old) by pregnancy status and to compare LTC of HIV-infected pregnant women to HIV-infected non-pregnant women. We analyzed 2013 CDC-funded HIV testing data from 61 health departments and 151 directly funded community-based organizations among CBA women. LTC includes linkage at any time after an HIV diagnosis and within 90 days after HIV diagnosis. Pearson's chi-square was used to compare LTC of pregnant and non-pregnant women. Data were analyzed using SAS v9.3. Among the 1,379,860 HIV testing events among CBA women in 2013, 0.3% (n = 3690) were HIV-positive. Among all HIV-positive diagnoses with an available pregnancy status (n = 1987), 7%, (n = 138) were pregnant. Among women with pregnancy status data, LTC any time after an HIV-positive diagnosis was 73.2% for pregnant women and 60.7% for non-pregnant women. LTC within 90 days was 71.7% for pregnant women and 56.2% for non-pregnant women. Pregnancy was associated with LTC any time (p < 0.01) and within 90 days of diagnosis (p < 0.01). Compared with non-pregnant women, a higher proportion of pregnant women with HIV were linked to care overall, and linked within 90 days. Pregnancy appears to facilitate better LTC, but improvements are needed for women overall and pregnant women specifically.
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Affiliation(s)
- Lauren F FitzHarris
- a Centers for Disease Control and Prevention , Division of HIV/AIDS Prevention , Atlanta , USA.,b ICF International , Atlanta , USA
| | - Natasha D Hollis
- a Centers for Disease Control and Prevention , Division of HIV/AIDS Prevention , Atlanta , USA
| | - Steven R Nesheim
- a Centers for Disease Control and Prevention , Division of HIV/AIDS Prevention , Atlanta , USA
| | - Julia L Greenspan
- a Centers for Disease Control and Prevention , Division of HIV/AIDS Prevention , Atlanta , USA.,c Rollins School of Public Health , Emory University , Atlanta , USA
| | - Erica K Dunbar
- a Centers for Disease Control and Prevention , Division of HIV/AIDS Prevention , Atlanta , USA
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Antiretroviral Resistance and Pregnancy Characteristics of Women with Perinatal and Nonperinatal HIV Infection. Infect Dis Obstet Gynecol 2016; 2016:4897501. [PMID: 27413359 PMCID: PMC4930810 DOI: 10.1155/2016/4897501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/12/2016] [Accepted: 05/22/2016] [Indexed: 11/23/2022] Open
Abstract
Objective. To compare HIV drug resistance in pregnant women with perinatal HIV (PHIV) and those with nonperinatal HIV (NPHIV) infection. Methods. We conducted a multisite cohort study of PHIV and NPHIV women from 2000 to 2014. Sample size was calculated to identify a fourfold increase in antiretroviral (ARV) drug resistance in PHIV women. Continuous variables were compared using Student's t-test and Wilcoxon rank-sum tests. Categorical variables were compared using χ2 and Fisher's exact tests. Univariate analysis was used to determine factors associated with antiretroviral drug resistance. Results. Forty-one PHIV and 41 NPHIV participants were included. Women with PHIV were more likely to have drug resistance than those with NPHIV ((55% versus 17%, p = 0.03), OR 6.0 (95% CI 1.0–34.8), p = 0.05), including multiclass resistance (15% versus 0, p = 0.03), and they were more likely to receive nonstandard ARVs during pregnancy (27% versus 5%, p = 0.01). PHIV and NPHIV women had similar rates of preterm birth (11% versus 28%, p = 0.08) and cesarean delivery (47% versus 46%, p = 0.9). Two infants born to a single NPHIV woman acquired HIV infection. Conclusions. PHIV women have a high frequency of HIV drug resistance mutations, leading to nonstandard ARVs use during pregnancy. Despite nonstandard ARV use during pregnancy, PHIV women did not experience increased rates of adverse pregnancy outcomes.
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