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Walker D, Knight D, Reysen R, Norris K. Pregnancy loss and suicidal behavior: Investigating the mediating role of depressive mood. J Affect Disord 2024; 361:605-611. [PMID: 38925303 DOI: 10.1016/j.jad.2024.06.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 06/19/2024] [Accepted: 06/22/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Pregnancy loss is arguably a traumatic and stressful life event that potentially impacts the emotional and behavioral health of those who experience it, especially adolescents. Research assessing this relationship has primarily focused on adult women populations. METHODS Using data from National Longitudinal Study of Adolescent to Adult Health, a cross-sectional research design was employed to investigate whether pregnancy loss outcomes are associated with depressive mood and suicidal behavior (i.e., suicidal thoughts and suicide attempt) among adolescent girls (N = 6, 913). We also investigated the mediating effect of depressive mood. Initially, an all-encompassing pregnancy loss variable was used, which included abortions and miscarriages. Acknowledging the differences between these pregnancy loss outcomes, we created separate measures for each. RESULTS Using the all-encompassing pregnancy loss variable, findings from logistic regression analyses showed that pregnancy loss is positively and significantly associated with depressive mood and suicidal behaviors. Depressive mood mediated the relationship between pregnancy loss and suicidal behaviors. Miscarriage was positively and significantly associated with suicidal thoughts as well as attempting suicide. Depressive mood mediated the relationship between miscarriage and suicidal thoughts, while only partially mediating the relationship between miscarriage and suicide attempt. No significant effects were observed for abortion on outcomes of interest. LIMITATIONS Cross-sectional analyses were performed limiting our ability to make casual inferences. CONCLUSIONS Pregnancy loss is associated with depressive mood and suicidal behavior, especially among adolescent girls who experience a miscarriage. Adolescent pregnancy and pregnancy loss should remain a focus of scholars and health professionals.
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Affiliation(s)
- D'Andre Walker
- Department of Criminal Justice and Legal Studies, University of Mississippi, United States of America.
| | - Deja Knight
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States of America
| | - Rebekah Reysen
- Counselor Education Department, Sacred Heart University, United States of America
| | - Katherine Norris
- Department of Criminal Justice and Legal Studies, University of Mississippi, United States of America
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Alfayumi-Zeadna S, Ghalion HA, O'Rourke N, Azbarga Z, Daoud N. Direct and indirect predictors of postpartum depression symptoms among indigenous Bedouin mothers in Israel. Res Nurs Health 2024; 47:114-124. [PMID: 38073270 DOI: 10.1002/nur.22361] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/27/2023] [Accepted: 11/24/2023] [Indexed: 03/25/2024]
Abstract
Postpartum depression (PPD) is a common and complex phenomenon with negative outcomes for children, women and their families. This study set out to identify both direct and indirect predictors of PPD symptoms among indigenous Bedouin mothers in Israel. The study included 305 women, 18 to 45 years of age, who were interviewed while pregnant and again, 2 to 4 months postpartum. Interviews were conducted in Arabic and included the Edinburgh Postnatal Depression Scale, administered at both points of measurement. Using path analyses, we identified four significant, direct predictors of PPD symptoms. The strongest was depressive symptoms when pregnant, followed by low relative income, low hemoglobin, and number of prior miscarriages. The latter was significantly associated with consanguinity, meaning that women married to a first cousin experienced more miscarriages which, in turn, increased PPD risk. Low relative income was the only variable that had both a direct and indirect effect upon PPD symptoms (via symptoms of depression when pregnant and hemoglobin). Education and polygamy also emerged as indirect predictors of PPD via depressive symptoms reported during pregnancy. Results suggest a high rate of PPD in this perinatal sample of indigenous women. Our findings underscore the need for tailored interventions to reduce PPD, especially for low-income Bedouin women, faced with many barriers and insufficient access to healthcare services.
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Affiliation(s)
- Samira Alfayumi-Zeadna
- Nursing Department, School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
| | - Huda Abu Ghalion
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion, University of the Negev, Be'er Sheva, Israel
- Clalit Health Services, Be'er Sheva, Israel
| | - Norm O'Rourke
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion, University of the Negev, Be'er Sheva, Israel
- Department of Psychology, Faculty of Humanities and Social Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | | | - Nihaya Daoud
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion, University of the Negev, Be'er Sheva, Israel
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Froeliger A, Deneux-Tharaux C, Loussert L, Bouchghoul H, Madar H, Sentilhes L. Prevalence and risk factors for postpartum depression 2 months after a vaginal delivery: a prospective multicenter study. Am J Obstet Gynecol 2024; 230:S1128-S1137.6. [PMID: 38193879 DOI: 10.1016/j.ajog.2023.08.026] [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: 07/03/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Very little is known about the prevalence and risk factors of postpartum depression among women with vaginal births without major pregnancy complications. OBJECTIVE This study aimed to assess the prevalence of postpartum depression and identify its characteristics 2 months after singleton vaginal delivery at or near term. STUDY DESIGN This was an ancillary cohort study of the TRanexamic Acid for Preventing Postpartum Hemorrhage After Vaginal Delivery randomized controlled trial, which was conducted in 15 French hospitals in 2015-2016 and enrolled women with singleton vaginal deliveries after 35 weeks of gestation. After randomization, the characteristics of labor, delivery, and the immediate postpartum experience, including the experience of childbirth, were prospectively collected. Medical records provided women's other characteristics, particularly any psychiatric history. Of note, 2 months after childbirth, provisional postpartum depression diagnosis was defined as a score of ≥13 on the Edinburgh Postnatal Depression Scale, a validated self-administered questionnaire. The corrected prevalence of postpartum depression was calculated with the inverse probability weighting method to take nonrespondents into account. Associations between potential risk factors and postpartum depression were analyzed by multivariate logistic regression. Moreover, an Edinburgh Postnatal Depression Scale cutoff value of ≥11 was selected to perform a sensitivity analysis. RESULTS The questionnaire was returned by 2811 of 3891 women (72.2% response rate). The prevalence rates of the provisional diagnosis were 9.9% (95% confidence interval, 8.6%-11.3%) defined by an Edinburgh Postnatal Depression Scale score of ≥13 and 15.5% (95% confidence interval, 14.0%-17.1%) with a cutoff value of ≥11. The characteristics associated with higher risks of postpartum depression in multivariate analysis were mostly related to prepregnancy characteristics, specifically age of <25 years (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-2.9) and advanced age (adjusted odds ratio, 1.8; 95% confidence interval, 1.2-2.6), migration from North Africa (adjusted odds ratio, 2.9; 95% confidence interval, 1.9-4.4), previous abortion (adjusted odds ratio, 1.4; 95% confidence interval, 1.0-2.0), and psychiatric history (adjusted odds ratio, 2.9; 95% confidence interval, 1.8-4.8). Some characteristics of labor and delivery, such as induced labor (adjusted odds ratio, 1.5; 95% confidence interval, 1.1-2.0) and operative vaginal delivery (adjusted odds ratio, 1.4; 95% confidence interval, 1.0-2.0), seemed to be associated with postpartum depression. In addition, bad memories of childbirth in the immediate postpartum were strongly associated with postpartum depression symptoms at 2 months after giving birth (adjusted odds ratio, 2.4; 95% confidence interval, 1.3-4.2). CONCLUSION Approximately 10% of women with vaginal deliveries have postpartum depression symptoms, assessed by a score of ≥13 on the depression scale that was used at 2 months. Prepregnancy vulnerability factors; obstetrical characteristics, such as induced labor and operative vaginal delivery; and bad memories of childbirth 2 days after delivery were the main factors associated with this provisional diagnosis. A screening approach that targets risk factors may help to identify women at risk of postpartum depression who could benefit from early intervention.
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Affiliation(s)
- Alizée Froeliger
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France; Perinatal Obstetrical and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics, National Institute of Health and Medical Research, Université Paris Cité, Paris, France
| | - Catherine Deneux-Tharaux
- Perinatal Obstetrical and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics, National Institute of Health and Medical Research, Université Paris Cité, Paris, France
| | - Lola Loussert
- Perinatal Obstetrical and Pediatric Epidemiology Research Team, Center for Research on Epidemiology and Statistics, National Institute of Health and Medical Research, Université Paris Cité, Paris, France; Department of Obstetrics and Gynecology, Toulouse University Hospital, Toulouse, France
| | - Hanane Bouchghoul
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Hugo Madar
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.
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Vlachou F, Iakovou D, Daru J, Khan R, Pepas L, Quenby S, Iliodromiti S. Fetal loss and long-term maternal morbidity and mortality: A systematic review and meta-analysis. PLoS Med 2024; 21:e1004342. [PMID: 38335157 PMCID: PMC10857720 DOI: 10.1371/journal.pmed.1004342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 01/03/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Evidence suggests common pathways between pregnancy losses and subsequent long-term maternal morbidity, rendering pregnancy complications an early chronic disease marker. There is a plethora of studies exploring associations between miscarriage and stillbirth with long-term adverse maternal health; however, these data are inconclusive. METHODS AND FINDINGS We systematically searched MEDLINE, EMBASE, AMED, BNI, CINAHL, and the Cochrane Library with relevant keywords and MeSH terms from inception to June 2023 (no language restrictions). We included studies exploring associations between stillbirth or miscarriage and incidence of cardiovascular, malignancy, mental health, other morbidities, and all-cause mortality in women without previous pregnancy loss. Studies reporting short-term morbidity (within a year of loss), case reports, letters, and animal studies were excluded. Study selection and data extraction were performed by 2 independent reviewers. Risk of bias was assessed using the Newcastle Ottawa Scale (NOS) and publication bias with funnel plots. Subgroup analysis explored the effect of recurrent losses on adverse outcomes. Statistical analysis was performed using an inverse variance random effects model and results are reported as risk ratios (RRs) with 95% confidence intervals (CIs) and prediction intervals (PIs) by combining the most adjusted RR, odds ratios (ORs) and hazard ratios (HRs) under the rare outcome assumption. We included 56 observational studies, including 45 in meta-analysis. There were 1,119,815 women who experienced pregnancy loss of whom 951,258 had a miscarriage and 168,557 stillbirth, compared with 11,965,574 women without previous loss. Women with a history of stillbirth had a greater risk of ischaemic heart disease (IHD) RR 1.56, 95% CI [1.30, 1.88]; p < 0.001, 95% PI [0.49 to 5.15]), cerebrovascular (RR 1.71, 95% CI [1.44, 2.03], p < 0.001, 95% PI [1.92, 2.42]), and any circulatory/cardiovascular disease (RR 1.86, 95% CI [1.01, 3.45], p = 0.05, 95% PI [0.74, 4.10]) compared with women without pregnancy loss. There was no evidence of increased risk of cardiovascular disease (IHD: RR 1.11, 95% CI [0.98, 1.27], 95% PI [0.46, 2.76] or cerebrovascular: RR 1.01, 95% CI [0.85, 1.21]) in women experiencing a miscarriage. Only women with a previous stillbirth were more likely to develop type 2 diabetes mellitus (T2DM) (RR: 1.16, 95% CI [1.07 to 2.26]; p < 0.001, 95% PI [1.05, 1.35]). Women with a stillbirth history had an increased risk of developing renal morbidities (RR 1.97, 95% CI [1.51, 2.57], p < 0.001, 95% [1.06, 4.72]) compared with controls. Women with a history of stillbirth had lower risk of breast cancer (RR: 0.80, 95% CI [0.67, 0.96], p-0.02, 95% PI [0.72, 0.93]). There was no evidence of altered risk of other malignancies in women experiencing pregnancy loss compared to controls. There was no evidence of long-term mental illness risk in women with previous pregnancy losses (stillbirth: RR 1.90, 95% CI [0.93, 3.88], 95% PI [0.34, 9.51], miscarriage: RR 1.78, 95% CI [0.88, 3.63], 95% PI [1.13, 4.16]). The main limitations include the potential for confounding due to use of aggregated data with variable degrees of adjustment. CONCLUSIONS Our results suggest that women with a history of stillbirth have a greater risk of future cardiovascular disease, T2DM, and renal morbidities. Women experiencing miscarriages, single or multiple, do not seem to have an altered risk.
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Affiliation(s)
- Florentia Vlachou
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Whitechapel, London, United Kingdom
| | - Despoina Iakovou
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Whitechapel, London, United Kingdom
| | - Jahnavi Daru
- Women’s Health Research Unit, Institute for Population Health, Queen Mary University of London, London, United Kingdom
| | - Rehan Khan
- Royal London Hospital, Department of Obstetrics & Gynaecology, Barts Health NHS Trust, London, United Kingdom
| | - Litha Pepas
- Barts Centre of Reproductive Medicine, Barts NHS Trust, London, United Kingdom
| | - Siobhan Quenby
- Division of Reproductive Health, Centre for Early Life, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Stamatina Iliodromiti
- Women’s Health Research Unit, Institute for Population Health, Queen Mary University of London, London, United Kingdom
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5
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Reardon DC. Postpartum psychiatric episodes study missed effects of prior pregnancy losses. Acta Psychiatr Scand 2023. [PMID: 38148270 DOI: 10.1111/acps.13652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 12/28/2023]
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Zeng X, Yan X, Yang Y, Peng Z, Wei S, Chen J, Wu F, Chen J, Zhao M, Luo C. A correlation analysis on the postpartum anxiety disorder and influencing factors in puerperae with gestational diabetes mellitus. Front Endocrinol (Lausanne) 2023; 14:1202884. [PMID: 38089633 PMCID: PMC10711276 DOI: 10.3389/fendo.2023.1202884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/07/2023] [Indexed: 12/18/2023] Open
Abstract
Objective The aim of this study is to discuss the postpartum anxiety disorder and influencing factors in puerperae with gestational diabetes mellitus (GDM) to provide a clinical basis for better early identification and intervention of adverse mood. Methods Convenient sampling method was adopted to investigate 205 pregnant women as the observation group and 201 normal healthy pregnant women in the same period as the control group. The self-rating anxiety scale (SAS) was used to investigate and observe the respondents, evaluate the postpartum anxiety status of patients with GDM, and analyze the related influencing factors. Statistical analysis of the data was performed using SAS 3.0 software. A proposed P < 0.05 was considered as statistically significant. Results Patients with GDM had a higher risk than normal maternal anxiety, related to years of education, triglycerides, 1-h postprandial blood glucose, and a history of induced abortion. Conclusion GDM can lead to the occurrence of postpartum anxiety, and the poor psychological state is not conducive to the maternal and infant health. Early identification and early intervention can reduce the harm caused by anxiety and promote the progress of maternal and infant health and clinical research.
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Affiliation(s)
- Xun Zeng
- Out-Patient Department, The First Affiliated Hospital, Sun Yat sen University, Guangzhou, China
| | - Xiaofen Yan
- Deparment of Private Medical Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Yang
- Department of Internal Medicine, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan, China
| | - Zhangqing Peng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shiyao Wei
- Department of Oral Implantology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Jinxia Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fengchun Wu
- Department of Psychiatry, the Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Psychiatry, Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Jiebing Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming Zhao
- Out-Patient Department of Nansha Division, The First Affiliated Hospital, SunYat-sen University, Guangzhou, China
| | - Chunqi Luo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Ozdil M. Postpartum Depression Among Mothers of Infants Hospitalized in the Neonatal Intensive Care Unit During the COVID-19 Pandemic. Cureus 2023; 15:e44380. [PMID: 37779733 PMCID: PMC10540708 DOI: 10.7759/cureus.44380] [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: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background Neonatal intensive care unit (NICU) hospitalization of newborn babies has been shown to have a negative impact on the mental health of postpartum women. The mental health of new mothers may be further burdened by the effects of the coronavirus disease 2019 (COVID-19) pandemic on social, economic, and psychological dimensions. This study aimed to evaluate postpartum depression and related factors in mothers of infants hospitalized in NICU during two distinct COVID-19 pandemic periods and examine any additional effects of the pandemic on the mental health of postpartum women. Methodology The Edinburgh Postpartum Depression Scale (EPDS) was applied to 250 NICU mothers during the COVID-19 pandemic. The first 125 women's children were hospitalized during a period of high number of cases and deaths when restrictions were in place for NICU parental visits (November 2021 to February 2022, the early group). The remaining 125 women completed the scale when there was a lower number of cases and restrictions had been eased (March to June 2022, the late group). Results In the early group, the EPDS scores were statistically higher (7.53.9 vs. 5.63.4; p < 0.001), smoking and NICU stay duration were significantly higher (p = 0.01), whereas the duration of marriage was significantly lower (p = 0.01). Women in the late group with EPDS scores ≥13 were statistically less educated (p = 0.01). EPDS scores ≥13 were significantly associated with depression during pregnancy and with a history of abortion/stillbirth/neonatal death (odds ratio (OR) = 5.240, 95% confidence interval (CI) 1.114 to 27.967, p = 0.03 and OR = 1.641, 95% CI = 1.009 to 2.669, p = 0.04, respectively). Conclusions NICU admission is a significant maternal risk factor for postpartum depression due to the disruption of maternal-infant bonding, and this risk may be exacerbated during times of global public health crises such as the COVID-19 pandemic. Depression during pregnancy and the presence of a perinatal loss may also contribute to worse postpartum mental outcomes in NICU mothers.
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Affiliation(s)
- Mine Ozdil
- Department of Pediatrics, Division of Neonatology, University of Health Sciences, Balıkesir Atatürk City Hospital, Balıkesir, TUR
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Tato Fernandes F, de Almeida AB, Fernandes M, Correia R, Magalhães R, Buchner G, Braga J, Freitas P. Perinatal depression and mental health uptake referral rate in an obstetric service. Sci Rep 2023; 13:10987. [PMID: 37419918 PMCID: PMC10328992 DOI: 10.1038/s41598-023-33832-6] [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: 02/04/2022] [Accepted: 04/19/2023] [Indexed: 07/09/2023] Open
Abstract
Perinatal depression is an important indicator of mothers' mental health. Studies have been carried out to identify and characterize women at risk of such affective disorder. The aim of this study is to assess mothers' adherence to our perinatal depression screening and eventual follow-up by a multidisciplinary team, including mental health and obstetrics professionals. Ultimately, a risk profile for the uptake rate of referral was described to psychological support. Pregnant women from a maternity of a tertiary center with on-site assessment and treatment (n = 2163) were included in this study. The identification of women at risk for depression was based on a two-question screening and the EPDS scale. Demographic and obstetric data were obtained from medical records. The number of screening evaluations, the uptake referral rate and the compliance to treatment were analyzed. Logistic regression was used to predict a risk profile for adherence. Among 2163 enrolled in the protocol, 10.2% screened positive for depression. Of these, 51.8% accepted referral for mental health assistance. 74.9% were compliant to Psychology appointments and 74.1% to Psychiatry appointments. Women who had a previous history of depression were more likely to accept referral for mental health support. With this study, we were able to understand the behaviour of this population towards the screening protocol we offer. Women with a previous history of depression are more likely to accept mental health assistance.
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Affiliation(s)
| | - Ana Beatriz de Almeida
- Gynaecology and Obstetrics Department, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mónica Fernandes
- Clinical Psychology, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rosa Correia
- Clinical Psychology, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rui Magalhães
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Graça Buchner
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Gynaecology and Obstetrics Department, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jorge Braga
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Gynaecology and Obstetrics Department, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Paula Freitas
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Psychiatric Department, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
- CINTESIS, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Koly KN, Saba J, Billah MA, McGirr A, Sarker T, Haque M, Mustary E, Hanifi SMMA, Begum F. Depressive symptoms and anxiety among women with a history of abortion living in urban slums of Bangladesh. BMC Psychol 2023; 11:197. [PMID: 37403178 DOI: 10.1186/s40359-023-01224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 06/16/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Globally, major emphasis has been placed on understanding the physiological consequences of losing a pregnancy. However, its mental health impact on socially disadvantaged women remains unexplored. To further inform the field the present study investigated the prevalence and factors associated with the development of depressive symptoms and anxiety among women with a history of spontaneous abortion living in the urban slums of Dhaka, Bangladesh. METHODS Information was obtained from 240 women who experienced a spontaneous abortion from July 2020 to December 2021. It was obtained through the urban health and demographic surveillance system (UHDSS) survey. Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) were used to measure mental health symptoms. Bivariate and multivariate linear regression analyses were performed to assess the associated factors with the mental health outcomes. RESULTS Of the 240 women, majority (77.50%) of the women experienced mild to severe depressive symptoms and more than half (58.75%) of the respondants experienced mild to severe anxiety, within one and half years of experiencing spontaneous abortion. A higher level of education and being employed were protective factors for anxiety and depressive symptoms, respectively. However, women with higher sexual and reproductive health rights (SRHR) knowledge had significantly increased anxiety and depressive symptoms. In contrast, receiving post-abortion care (PAC) was associated with decreased anxiety and depressive symptoms. CONCLUSION The findings indicate that ensuring access to affordable PAC services and integrating mental health services into the standard PAC service package is crucial. This study also emphasizes the importance of providing education for women living in urban slums and encouraging them to participate in economic activities.
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Affiliation(s)
- Kamrun Nahar Koly
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh.
| | - Jobaida Saba
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
| | - Md Arif Billah
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
| | - Alba McGirr
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
| | - Tithi Sarker
- Reproductive Health Services Training and Education Program (RHSTEP), Mirpur, 1216, Dhaka, Bangladesh
| | - Mahbubul Haque
- Reproductive Health Services Training and Education Program (RHSTEP), Mirpur, 1216, Dhaka, Bangladesh
| | - Elvina Mustary
- Reproductive Health Services Training and Education Program (RHSTEP), Mirpur, 1216, Dhaka, Bangladesh
| | - S M Manzoor Ahmed Hanifi
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
| | - Farzana Begum
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, 1212, Mohakhali, Bangladesh
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Shapiro MO, Kroll-Desrosiers A, Mattocks KM. Understanding the Mental Health Impact of Previous Pregnancy Loss Among Currently Pregnant Veterans. Womens Health Issues 2023; 33:422-427. [PMID: 37100719 DOI: 10.1016/j.whi.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 03/01/2023] [Accepted: 03/24/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Pregnancy loss, including miscarriage and stillbirth, is common and associated with an increased risk for prenatal and postnatal depression, as well as posttraumatic stress disorder (PTSD). Racial disparities have been observed in pregnancy loss, with Black women having higher rates of pregnancy loss and postnatal depression. However, no research to date has examined the mental health and demographic correlates of pregnancy loss within a veteran population. METHOD The current study examined associations between pregnancy loss and mental health and demographic correlates among 1,324 pregnant veterans, of which 368 had a history of at least one stillbirth and/or miscarriage. RESULTS Veterans with a history of pregnancy loss, compared with those without, were more likely to have a diagnosis of anxiety (52.7% vs. 46.4%, p = .04), depression (62.5% vs. 50.8%, p = .0001), or PTSD (46.5% vs. 37.6%, p = .003); were more likely to report receiving mental health care during pregnancy (23.1% vs. 16.8%, p = .01); and were more likely to have experienced military sexual trauma (harassment: 56.5% vs. 49.9%, p = .04; rape: 38.9% vs. 29.3%, p = .0004). Results also indicated that Black veterans were more likely to report a history of pregnancy loss (32.1% vs. 25.3%, p = .01). Further, Black veterans were more likely to experience clinically meaningful prenatal depression symptoms (adjusted odds ratio: 1.90; 95% confidence interval: 1.42-2.54) after accounting for past loss and age in logistic regression models. DISCUSSION Taken together, findings from the present investigation corroborate previous research highlighting the deleterious impact of pregnancy loss and extend prior work by examining these associations among a diverse sample of pregnant veterans.
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Affiliation(s)
- Mary O Shapiro
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana; South Central Mental Illness Research, Education and Clinical Center; Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana.
| | - Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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11
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King BC, Eastin SM, Ho SY, Shapiro P, Sheen JJ, Fitelson EM. Inpatient obstetric consultation-liaison services: Meeting unmet needs in perinatal mental health. Gen Hosp Psychiatry 2023; 83:179-184. [PMID: 37267727 DOI: 10.1016/j.genhosppsych.2023.04.014] [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: 01/15/2023] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 06/04/2023]
Abstract
Obstetric patients are at increased risk for psychological distress and the development or exacerbation of mental illness, particularly in the setting of pregnancy or delivery complications. Inpatient antepartum, labor and delivery, and postpartum hospitalization is an important opportunity for psychiatric support and intervention. The aims of this paper are to review the unmet mental health needs in obstetric inpatient care, examine the current state of obstetric consultation-liaison (OB CL) psychiatry services, present one existing model of such a service at the authors' institution, provide broad recommendations for the structure and implementation of this service, and detail areas of future research within the area of OB CL psychiatry. We argue that the inpatient obstetric setting is a critical space for mental health evaluation, education and intervention, and that dedicated OB CL psychiatry services are a potentially valuable tool in addressing the perinatal mental health crisis.
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Affiliation(s)
- Bridget C King
- Department of Psychiatry, New York-Presbyterian Hospital Columbia University Irving Medical Center, New York, NY, USA.
| | - Shiloh M Eastin
- Department of Psychiatry, New York-Presbyterian Hospital Columbia University Irving Medical Center, New York, NY, USA
| | - Sheau-Yan Ho
- Department of Psychiatry, New York-Presbyterian Hospital Columbia University Irving Medical Center, New York, NY, USA
| | - Peter Shapiro
- Department of Psychiatry, New York-Presbyterian Hospital Columbia University Irving Medical Center, New York, NY, USA
| | - Jean-Ju Sheen
- Department of Obstetrics and Gynecology, NewYork-Presbyterian Sloane Hospital for Women, New York, NY, USA
| | - Elizabeth M Fitelson
- Department of Psychiatry, New York-Presbyterian Hospital Columbia University Irving Medical Center, New York, NY, USA
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12
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Głaz S. Religious Experience as a Predictor of the Meaning in Life and Life Satisfaction in the Lives of Polish Women after a Stillbirth. JOURNAL OF RELIGION AND HEALTH 2023; 62:839-858. [PMID: 36418755 PMCID: PMC10042945 DOI: 10.1007/s10943-022-01698-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
Many researchers have demonstrated the relationship of religiosity with dimensions of mental health such as searching for meaning in life, the presence of meaning in life, and life satisfaction. Hence, this study attempts to link such aspects of religiosity with the experience of the presence and/or absence of God with the search for and presence of meaning in life and satisfaction with life among a group of Polish women who have experienced a stillbirth in the past five years. The study included 64 women who lost a baby through stillbirth after the 22nd week of gestation. All the women were born into Christian families and declared themselves to be Christians and actively practicing their faith. Women's ages ranged from 29 to 47 years. The research results showed that the experience of God's presence and absence have a positive and significant relationship with the search for meaning in life and the presence of meaning in life, as well as with the satisfaction with life in the lives of women after stillbirth. The strongest relationship was between the presence of meaning in life and life satisfaction (r = .72; p < .01), God's presence and life satisfaction (r = .66; p < .01), as well as the presence of meaning in life and the search for meaning in life (r = .57; p < .01). The structural equation model showed that the experience of God's presence and God's absence have a significant, direct impact on the search for meaning in life and the presence of meaning in life, and the satisfaction with life. These also have an indirect impact on the satisfaction with life in the lives of women who have lost a child to stillbirth.
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Affiliation(s)
- Stanisław Głaz
- Jesuit University Ignatianum in Krakow, Ul. Kopernika 26, 31-501, Kraków, Poland.
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13
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Buskmiller C, Grauerholz KR, Bute J, Brann M, Fredenburg M, Refuerzo JS. Validation of a Brief Measure for Complicated Grief Specific to Reproductive Loss. Cureus 2023; 15:e37884. [PMID: 37214013 PMCID: PMC10199718 DOI: 10.7759/cureus.37884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/23/2023] Open
Abstract
Objective Complicated grief reactions follow some pregnancy outcomes, like miscarriage, stillbirth, neonatal death, infant death, selective reduction, or termination of pregnancy. Stigma can delay treatment and worsen outcomes. Screening tools such as the Edinburgh Postnatal Depression Scale detect complicated grief poorly, and specific tools for prolonged or complicated grief after a reproductive loss are cumbersome. In this study, a five-item questionnaire to detect complicated grief after reproductive loss of any type was designed and preliminary validated. Methods A questionnaire patterned after the extensively validated Brief Grief Questionnaire (BGQ) was created by a group of physicians and lay advocates to employ non-traumatic but specific language related to grief after miscarriage, stillbirth, neonatal death, infant death, selective reduction, or termination of pregnancy. One hundred and forty women at a large academic center were recruited in person and via social media to validate the questionnaire with well-studied instruments for anxiety (7-item Panic Disorder Severity Scale, PDSS), trauma (22-item Impact of Events Scale), and reproductive grief and depressive symptoms (33-item Perinatal Grief Scale [PGS]). Results The response rate was 74.9%. Of the 140 participants, 18 (12.8%) experienced their loss during high-risk pregnancies, and 65 (46.4%) were recruited via social media. Seventy-one (51%) respondents had a score > 4, a positive screen for the BGQ. On average, women experienced their loss 2 years prior to participation (IQR 1-5 years). Cronbach's alpha was 0.77 (95% CI: 0.69-0.83). The goodness of fit indices of the model met Fornell and Larker criteria (RMSEA = 0.167, CFI = 0.89, SRMR = 0.06). The AVE was 0.42 and the CR 0.78. Conclusions This investigator-created screening tool is internally consistent and meets preliminary criteria for discriminant validity. This tool can be refined prior to testing for sensitivity and specificity in screening for complicated grief after a reproductive loss.
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Affiliation(s)
- Cara Buskmiller
- Obstetrics and Gynecology, Baylor College of Medicine, Houston, USA
| | | | - Jennifer Bute
- Communication, Indiana University-Purdue University Indianapolis (IUPUI), Indianpolis, USA
| | - Maria Brann
- Communication Studies, Indiana University Purdue University Indianapolis, Indianapolis, USA
| | | | - Jerrie S Refuerzo
- Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston McGovern Medical School, Houston, USA
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14
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Serum oxytocin and corticotropin-releasing hormone levels in the third trimester of pregnancy for predicting postpartum depression in Thai women. Asian J Psychiatr 2023; 80:103392. [PMID: 36516698 DOI: 10.1016/j.ajp.2022.103392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE This prospective observational study aimed to determine whether serum oxytocin (OT) or corticotrophin-releasing hormone (CRH) levels in the third trimester of pregnancy (or late pregnancy) could prospectively predict postpartum depression (PPD) at six weeks after childbirth. METHODS We measured late pregnancy OT and CRH levels in Thai women, assessed depression using the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9), and collected mothers, labor, and newborn data. At six weeks postpartum, an EPDS score ≥ 11 or PHQ-9 score ≥ 10 was defined as the presence of PPD. Multivariable binary logistic regression analysis was performed to determine the predictors of PPD. RESULTS Of 200 participants, 136 (68.0%) were reassessed at six weeks postpartum, and 19 of them (14.0%) had PPD. Of the 19 participants with PPD, 9 met the EPDS criterion only, 3 met the PHQ-9 criterion only, and 7 met both criteria. OT levels were not significantly different between those with and without PPD (p = 0.35). CRH levels (aOR = 1.011, 95% CI = 1.001-1.023, p = 0.041), DASS-21 stress (aOR = 1.259, 95% CI = 1.132-1.400, p < 0.001), and APGAR at 1 min (aOR = 0.425, 95% CI = 0.240-0.752, p = 0.003) were significant predictors of PPD. CONCLUSIONS Only high CRH but not OT levels in late pregnancy may predict 6-week PPD. However, combining these CRH levels, late pregnancy stress, and newborn well-being immediately after birth seems to increase the accuracy of PPD prediction.
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Lazarides C, Moog NK, Verner G, Voelkle MC, Henrich W, Heim CM, Braun T, Wadhwa PD, Buss C, Entringer S. The association between history of prenatal loss and maternal psychological state in a subsequent pregnancy: an ecological momentary assessment (EMA) study. Psychol Med 2023; 53:855-865. [PMID: 34127159 PMCID: PMC9975992 DOI: 10.1017/s0033291721002221] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Prenatal loss which occurs in approximately 20% of pregnancies represents a well-established risk factor for anxiety and affective disorders. In the current study, we examined whether a history of prenatal loss is associated with a subsequent pregnancy with maternal psychological state using ecological momentary assessment (EMA)-based measures of pregnancy-specific distress and mood in everyday life. METHOD This study was conducted in a cohort of N = 155 healthy pregnant women, of which N = 40 had a history of prenatal loss. An EMA protocol was used in early and late pregnancy to collect repeated measures of maternal stress and mood, on average eight times per day over a consecutive 4-day period. The association between a history of prenatal loss and psychological state was estimated using linear mixed models. RESULTS Compared to women who had not experienced a prior prenatal loss, women with a history of prenatal loss reported higher levels of pregnancy-specific distress in early as well as late pregnancy and also were more nervous and tired. Furthermore, in the comparison group pregnancy-specific distress decreased and mood improved from early to late pregnancy, whereas these changes across pregnancy were not evident in women in the prenatal loss group. CONCLUSION Our findings suggest that prenatal loss in a prior pregnancy is associated with a subsequent pregnancy with significantly higher stress and impaired mood levels in everyday life across gestation. These findings have important implications for designing EMA-based ambulatory, personalized interventions to reduce stress during pregnancy in this high-risk group.
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Affiliation(s)
- Claudia Lazarides
- Institute of Medical Psychology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nora K. Moog
- Institute of Medical Psychology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Glenn Verner
- Institute of Medical Psychology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Manuel C. Voelkle
- Faculty of Life Science, Department of Psychology, Psychological Research Methods, Humboldt-University of Berlin, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christine M. Heim
- Institute of Medical Psychology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thorsten Braun
- Department of Obstetrics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pathik D. Wadhwa
- Development, Health and Disease Research Program, University of California, Irvine, CA, USA
| | - Claudia Buss
- Institute of Medical Psychology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Development, Health and Disease Research Program, University of California, Irvine, CA, USA
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Sonja Entringer
- Institute of Medical Psychology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Development, Health and Disease Research Program, University of California, Irvine, CA, USA
- Department of Pediatrics, University of California, Irvine, CA, USA
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Cuenca D. Pregnancy loss: Consequences for mental health. Front Glob Womens Health 2023; 3:1032212. [PMID: 36817872 PMCID: PMC9937061 DOI: 10.3389/fgwh.2022.1032212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/20/2022] [Indexed: 01/24/2023] Open
Abstract
Pregnancy loss, in all its forms (miscarriage, abortion, and fetal death), is one of the most common adverse pregnancy outcomes, but the psychological impact of such loss is often underestimated. The individual response to this outcome may vary between women-and could be influenced by age, race, culture, or religious beliefs-but most experience anxiety, stress, and symptoms of depression. Because pregnancy loss is not uncommon, health providers are used to dealing with this diagnosis, however the correct management of the process of diagnosis, information-gathering, and treatment can greatly ameliorate the adverse mental consequences for these women. The aim of this review is to examine the different types of pregnancy loss, and consider how each can influence the mental health of the women affected and their partners-in both the short- and long-term; to review the risk factors with the aim of identifying the women who may be at risk of consequential mental health problems; and to provide some advice for health providers to help these women better cope with pregnancy loss. Finally, we provide some points for health providers to follow in order to aid the management of a pregnancy loss, particularly for spontaneous, induced, or recurrent miscarriage, or stillbirth.
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17
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Bozkurt MA, Cesur B. The effect of the Ebe Evimde application on the self-efficacy and anxiety levels of mothers: Randomized controlled trial. Digit Health 2023; 9:20552076231169840. [PMID: 37124329 PMCID: PMC10134124 DOI: 10.1177/20552076231169840] [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: 12/23/2022] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
Objective Family health can be improved by making home visits with mobile applications. This study was carried out to evaluate the effect of a mobile application and web-based software called Ebe Evimde (My Home Midwife), which was designed by the researchers for use in the postpartum period, on mothers' self-efficacy and anxiety levels. Methods Home visits to 60 mothers in the intervention group, who are over 18 years of age, who have given birth at term, who have no complications in mother and baby, and who are in the second to fifth postpartum days, were made with the online home visits mobile support application Midwifery Home software and their self-efficacy and anxiety levels were evaluated. Mothers were divided into two groups as intervention (60) and control group (60) using a random number table. Results While there was a significant difference between the pretest and posttest self-efficacy levels of the intervention group, there was no difference between the pretest and posttest self-efficacy levels of the control group. When the groups obtained from the Postpartum Specific Anxiety Scale were examined, it was seen that there was a negative and very strong significant relationship between the pretest and posttest scores of the mothers in the intervention group, while when the relationship between the pretest and posttest scores of the mothers in the control group was examined; no significant relationship was observed. Conclusion The practice of Ebe Evimde (My Home Midwife) had a positive effect on mothers' self-efficacy and postpartum anxiety levels.
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Affiliation(s)
- Merve Ayşe Bozkurt
- Merve Ayşe Bozkurt, Department of Midwifery, Faculty of Health Sciences, Cumhuriyet University, 58000 Sivas, Turkiye.
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Studnicki J, Longbons T, Reardon DC, Fisher JW, Harrison DJ, Skop I, Cirucci CA, Craver C, Tsulukidze M, Ras Z. The Enduring Association of a First Pregnancy Abortion with Subsequent Pregnancy Outcomes: A Longitudinal Cohort Study. Health Serv Res Manag Epidemiol 2022; 9:23333928221130942. [PMID: 36246345 PMCID: PMC9554127 DOI: 10.1177/23333928221130942] [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] [Indexed: 11/17/2022] Open
Abstract
Introduction Multiple abortions are consistently associated with adverse health consequences. Prior abortion is a known risk factor for another abortion. Objective To determine the persistence of the association of a first-pregnancy abortion with the likelihood of subsequent pregnancy outcomes. Methods Data was extracted for a study population of 5453 continuously eligible Medicaid beneficiaries in states which funded and reported elective abortions 1999-2015. Women age 16 in 1999 were organized into three cohorts based upon the first pregnancy outcome: abortion, birth, natural loss. Results Women in the abortion cohort are more likely than those in the birth cohort to experience another abortion rather than a birth or natural loss, and less likely to experience a live birth rather than an abortion or natural loss, for every subsequent pregnancy. The tendency toward abortion (OR 2.99, CL 2.02-4.43) and away from birth (OR 0.49, CL 0.39-0.63) peaks at the sixth pregnancy, but persists throughout the reproductive period ages 16-32. The pattern is reversed, but similarly consistent, for women in the birth cohort. They remain likelier to have another birth rather than an abortion or natural loss in subsequent pregnancies. Compared to the birth cohort, the abortion cohort had 1.35 times as many pregnancies: 4.31 times the abortions, 1.53 times the natural losses, but only 0.52 times the births. They were 4.3 and 5.0 times as likely to have 2-plus and 3-plus abortions, but only 0.47 times and 0.31 times as likely to have 2-plus and 3-plus births. Of the abortion cohort, 37.1% had no births. By contrast, 73.6% of the birth cohort had no abortions. Conclusion The first-pregnancy abortion maintains a strong and persistent association with the likelihood of another abortion in subsequent pregnancies, enabling a cascade of adverse events associated with multiple abortions.
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Affiliation(s)
- James Studnicki
- Charlotte Lozier Institute, Arlington, VA, USA,James Studnicki, Charlotte Lozier Institute, 2800 Shirlington Rd., Ste. 1200, Arlington, VA, 22206, USA.
| | | | | | | | - Donna J. Harrison
- American Association of Pro-Life Obstetricians and Gynecologists, Eau Claire, MI, USA
| | - Ingrid Skop
- Charlotte Lozier Institute, Arlington, VA, USA
| | | | | | - Maka Tsulukidze
- Department of Health Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Zbigniew Ras
- Computer Science Department, University of North Carolina at Charlotte, Charlotte, NC, USA
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Chichester M, Tepner L, Côté-Arsenault D. Nursing Care of Childbearing Families After Previous Perinatal Loss. Nurs Womens Health 2022; 26:379-388. [PMID: 36065093 DOI: 10.1016/j.nwh.2022.07.011] [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: 05/17/2021] [Revised: 06/12/2022] [Accepted: 07/24/2022] [Indexed: 06/15/2023]
Abstract
Nurses who care for childbearing families facilitate the family's adaptation to the arrival of a newborn through assessment of physical, emotional, and psychological needs. After experiencing a perinatal loss, such as miscarriage, stillbirth, or neonatal death, a woman's perception of pregnancy and of her sense of control in becoming a mother can include fear and anxiety, and she may have significantly different needs than a pregnant woman who has not experienced perinatal loss. In this article, we provide evidence-based information and recommendations for maternal-child nurses caring for childbearing families who are preparing to welcome a new baby (sometimes called a "rainbow baby") after a previous perinatal loss.
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Shelke A, Chakole S. A Review on Risk Factors of Postpartum Depression in India and Its Management. Cureus 2022; 14:e29150. [PMID: 36258936 PMCID: PMC9573019 DOI: 10.7759/cureus.29150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
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The Relationship between Social Support and Postnatal Anxiety and Depression: Results from the Listening to Mothers in California Survey. Womens Health Issues 2022; 32:251-260. [PMID: 35246352 DOI: 10.1016/j.whi.2022.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Perinatal mood and anxiety disorders (PMADs) impact multiple domains of maternal and child well-being. Estimates of postpartum depressive symptoms range from 6.5% to 12.9% and from 8.6% to 9.9% for postpartum anxiety. We sought to identify the role social support could play in mitigating PMADs. METHODS The data are drawn from the Listening to Mothers in California survey; results are representative of women who gave birth in 2016 in a California hospital. The Patient Health Questionnaire-4 was used to assess total symptoms of PMADs and anxiety and depressive symptoms individually. Two questions adapted from the Medical Outcomes Study Social Support Survey were used to assess emotional, practical, and functional (combined) social support. After exclusions for missing data related to PMADs or social support, we analyzed data from 2,372 women. RESULTS At the time of survey administration (mean 5.7 months after birth), 7.0% of respondents reported elevated PMAD symptoms and 45.9% reported that they always received functional social support. In multivariable analysis, controlling for demographic and pregnancy-related factors and prenatal anxiety and depressive symptoms, women who reported consistent support had a prevalence of elevated PMAD symptoms one-half that of those who did not (adjusted odds ratio, 0.50; 95% confidence interval, 0.34-0.74). CONCLUSIONS This study suggests that consistent social support serves as a robust protective factor against postpartum symptoms of PMADs. Because many predictors of PMADs are not modifiable, social support stands out as an important target for programmatic intervention, particularly in light of increased isolation related to the COVID-19 pandemic.
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Alcocer FED, Bignotto KB, Barbosa GDS. Abordagem psicossocial às perdas gestacionais na Atenção Primária à Saúde. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)2927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: Perdas gestacionais são eventos comuns na vida reprodutiva. Tendo em vista a dificuldade individual e profissional de lidar com o sofrimento mental que ocasionam, indaga-se sobre a escolha da técnica, a periodicidade e o modo de execução das abordagens que melhor se adequariam ao enfrentamento dessa situação. Sendo assim, esta revisão clínica tem como objetivo avaliar a literatura recente acerca do tema e buscar as melhores evidências científicas em relação à abordagem psicossocial a essas perdas. Métodos: Foram utilizadas palavras-chave determinadas pelo Medical Subject Headings (MeSH) para selecionar títulos de estudos nas bases de dados: PubMed, ACCESSSS, British Medical Journal (BMJ), DYNAMED, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Os critérios de inclusão foram: ano de publicação entre 2010 e 2020; tipo de estudo (metanálise, revisão sistemática, ensaio clínico randomizado, ensaio clínico não randomizado, coorte ou caso controle); não abordar abortamento induzido; estar em inglês, português ou espanhol; ser passível de ser encontrado na íntegra. Resultados: Foram encontrados 28 artigos, que tiveram seus resumos avaliados; 14 foram excluídos e 14 lidos na íntegra. No fim, nove estudos foram incluídos nesta revisão. Foi possível observar que sintomas psicológicos são frequentemente apresentados após perdas gestacionais, que há diversas maneiras de acessar esses dados e que não há consenso sobre qual a melhor intervenção a ser feita. Além disso, em homens e casais homossexuais, há maior chance de invisibilidade do sofrimento e menor abordagem de luto por profissionais de saúde. Conclusão: Na falta de consenso sobre quais intervenções apresentam melhores resultados, recomenda-se o rastreamento de sofrimento mental e o compartilhamento da decisão com as partes envolvidas.
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Promotion and Prevention of Perinatal Mood and Anxiety Disorders: Doulas’ Roles and Challenges. J Perinat Educ 2022; 31:82-93. [PMID: 35386494 PMCID: PMC8970132 DOI: 10.1891/jpe-2021-00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Doulas are uniquely positioned to support women during birth and the postpartum period and can serve as a great asset to identify symptoms of perinatal mood and anxiety disorders (PMADs) and refer women to treatment. The goal of this study is to increase knowledge of doulas’ training on PMADs and their work with women who experienced symptoms. Results from a survey of 156 doulas and interviews with 27 doulas indicate that they felt ill-prepared to identify PMAD symptoms. They struggled in referring patients to the appropriate services and finding professional support related to supporting clients with PMADs. The study concludes that there is a need to develop a standardized model for postpartum doula care that explicitly addresses PMADs.
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Tasnim S, Auny FM, Hassan Y, Yesmin R, Ara I, Mohiuddin MS, Kaggwa MM, Gozal D, Mamun MA. Antenatal depression among women with gestational diabetes mellitus: a pilot study. Reprod Health 2022; 19:71. [PMID: 35305655 PMCID: PMC8934461 DOI: 10.1186/s12978-022-01374-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gestational diabetes mellitus (GDM) is quite prevalent in low- and middle-income countries, and has been proposed to increase the risk of depression. There is only a prior study assessing antenatal depression among the subjects with GDM in the Bangladesh, which leads this study to be investigated.
Objective
To determine the prevalence of depressive symptoms and potential associations among pregnant women diagnosed with GDM.
Methods
A cross-sectional study was carried out among 105 pregnant women diagnosed with GDM over the period of January to December 2017 in 4- hospitals located in two different cities (Dhaka and Barisal). A semi-structured questionnaire was developed consisting of items related to socio-demographics, reproductive health history, diabetes, anthropometrics, and depression.
Results
Mild to severe antenatal depression was present in 36.2% of the subjects (i.e., 14.3%, 19% and 2.9% for mild, moderate and severe depression, respectively). None of the socio-demographic factors were associated with depression, but the history of reproductive health-related issues (i.e., abortion, neonatal death) and uncontrolled glycemic status were associated with the increased risk of depressive disorders.
Conclusions
GDM is associated with a high prevalence of depressive symptoms, which is enhanced by poor diabetes control. Thus, in women presenting with GDM, screening for depression should be pursued and treated as needed.
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Advancing research on perinatal depression trajectories: Evidence from a longitudinal study of low-income women. J Affect Disord 2022; 301:44-51. [PMID: 34995707 DOI: 10.1016/j.jad.2022.01.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/02/2021] [Accepted: 01/02/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The current study aimed to describe and predict perinatal depression trajectories in a sample of low-income women from the first trimester of pregnancy to six months postpartum. METHODS The study sample consisted of 899 women in Wisconsin who received home visiting services. Eligible participants were screened for depressive symptoms by home visitors using the Edinburgh Postnatal Depression Scale at least three times across four time periods from the first trimester of pregnancy to six months postpartum. Growth Mixture Modeling was applied to identify distinct trajectory classes, and multinomial logistic regressions were performed to analyze predictors of class membership. RESULTS Mean depressive symptom scores in this racially/ethnically diverse sample of low-income women decreased significantly over time from a high of 8.1 at time1 to a low of 6.8 at time4. Four classes were identified, including a low-stable group (78.2% of sample), a high-stable group (10.6%) along with decreasing (7.1%) and increasing (4.1%) trajectories. Women with a history of abuse and mental health difficulties were more likely to be classified in the high-stable and decreasing depression groups than the low-stable group. Low social support was linked to an increasing trajectory that resulted in high levels of postpartum depression. CONCLUSIONS AND IMPLICATIONS Although most women exhibited stable and positive trajectories, more than one out of five presented with either persistently or intermittently high depression scores. Taken together, the findings underscore the importance of depression screening throughout the perinatal period and identifying factors that may be used to target resources to at-risk populations.
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Roseingrave R, Murphy M, O'Donoghue K. Pregnancy after stillbirth: maternal and neonatal outcomes and health service utilization. Am J Obstet Gynecol MFM 2021; 4:100486. [PMID: 34547534 DOI: 10.1016/j.ajogmf.2021.100486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/18/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stillbirth occurs in every 3.5 of 1000 pregnancies in Ireland and is a devastating event for a family. Women who have a pregnancy after stillbirth require increased antenatal support. OBJECTIVE This study aimed to determine maternal and fetal outcomes and to quantify health service utilization in pregnancy after stillbirth. STUDY DESIGN A retrospective cohort study of all pregnancies after stillbirth was conducted from 2011 to 2017 in a large tertiary referral university maternity teaching hospital with approximately 8000 births annually. RESULTS There were 222 stillbirths from 2011 to 2017. Two-thirds of women (145 of 222 [64.3%]) had a pregnancy after stillbirth. Almost one-fifth of these women (28 of 145 [19.3%]) had a miscarriage, but 16 of 28 women (57.1%) had a subsequent live birth, giving an overall live birth rate of 90.3% (131/145). The average interval from index loss to booking in the next pregnancy was 13 months, with almost half of the women (72 of 145 [49.7%]) booking within 1 year. The average number of antenatal appointments was twice than expected (10; range, 2-27), and the average number of ultrasound scans was 5 times higher than expected (5; range, 0-29). Rates of induction of labor (63 of 131 [48.1%]) and cesarean delivery (53 of 131 [40.5%]) were significantly higher than national rates for multiparous women. Almost two-thirds of women (40 of 63 [63.5%]) cited previous history of stillbirth as the indication for induction. There was a significantly higher rate of preterm delivery (30 of 131 [22.9%]). Moreover, 1 in 4 babies (35 of 137 [25.5%]) required admission to the neonatal intensive care unit, more than twice the number expected (median gestation, 37 0/7 weeks; range, 25 4/7 to 39 2/7 weeks). CONCLUSION Pregnancy after stillbirth was associated with increased surveillance and intervention. The women in this study had higher rates of cesarean delivery, induction of labor, and preterm delivery than the general multiparous population. Decision-making for intervention was often based on previous history of stillbirth. Clinicians should be cognizant of additional supports required for this population and focus on evidence-based interventions that improve maternal well-being and perinatal outcomes in pregnancy after stillbirth.
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Affiliation(s)
- Ruth Roseingrave
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland (Ms Roseingrave and Dr O'Donoghue); School of Nursing and Midwifery, University College Cork, Cork, Ireland (Dr Murphy); Pregnancy Loss Research Group, The Irish Centre for Maternal and Child Health Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland (Dr O'Donoghue).
| | - Margaret Murphy
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland (Ms Roseingrave and Dr O'Donoghue); School of Nursing and Midwifery, University College Cork, Cork, Ireland (Dr Murphy); Pregnancy Loss Research Group, The Irish Centre for Maternal and Child Health Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland (Dr O'Donoghue)
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Cork, Ireland (Ms Roseingrave and Dr O'Donoghue); School of Nursing and Midwifery, University College Cork, Cork, Ireland (Dr Murphy); Pregnancy Loss Research Group, The Irish Centre for Maternal and Child Health Research (INFANT), Cork University Maternity Hospital, University College Cork, Cork, Ireland (Dr O'Donoghue)
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Teenage Mothers in Yaoundé, Cameroon-Risk Factors and Prevalence of Perinatal Depression Symptoms. J Clin Med 2021; 10:jcm10184164. [PMID: 34575274 PMCID: PMC8470336 DOI: 10.3390/jcm10184164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Perinatal depression is defined as a non-psychotic depressive episode occurring during pregnancy or during the first year following childbirth. This depressive disorder is highly prevalent among teenage women but there is a lack of data in low- and middle-income countries. The objective of this study was to provide baseline data on the sociodemographic characteristics of pregnant teenagers or teenage mothers in an urban zone in Yaoundé, Cameroon. Risk factors were assessed, and prevalence of depressive disorders was determined. METHODS Women aged 20 years old or less in the perinatal period were invited to participate in the study. A total of 1344 women participated in the four-stage data collection process involving a questionnaire including questions on sociodemographic background, an assessment of their risk of perinatal depression using the EPDS questionnaire (Edinburgh Postnatal Depression Scale), a clinical interview based on the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders), and a final section focusing on risk factors of perinatal depression. RESULTS The EPDS score was obtained for 1307 women. The prevalence of depressive disorder symptoms among teenage or young pregnant women is estimated to be 70.0%. This risk is significantly increased by different factors including unintended or unplanned pregnancy (aOR: 1.33, 1.14-1.56 CI95%), being separated or single (aOR: 1.34, 1.12-1.60 CI95%), experiencing depression and anxiety before childbirth (aOR: 1.50, 1.02-2.27 CI95%), abortion experience (aOR: 2.60, 1.03-7.14 CI95%) and domestic violence (aOR: 1.76, 1.12-2.83 CI95%). CONCLUSION The results of this study reveal a high prevalence of depressive disorder symptoms within the study population. These findings highlight the need to develop maternal care programs to support both mothers and their infants.
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Clark OE, Fortney CA, Dunnells ZDO, Gerhardt CA, Baughcum AE. Parent Perceptions of Infant Symptoms and Suffering and Associations With Distress Among Bereaved Parents in the NICU. J Pain Symptom Manage 2021; 62:e20-e27. [PMID: 33631329 DOI: 10.1016/j.jpainsymman.2021.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
CONTEXT Healthcare providers and parents face many challenges caring for infants at the end of life (EOL). Symptom assessment and management in critically ill infants can be especially difficult. However, the impact of the infant's EOL experience on bereaved parents is largely unknown. OBJECTIVE Explore associations between parental perceptions of infant symptoms and suffering at EOL in the neonatal intensive care unit (NICU) and parent adjustment following the death. METHODS Retrospective, cross-sectional pilot study involving parents of infants who died within the previous five years in a large, Midwestern, level IV NICU. Parents were recruited through mailed invitations, and 40 mothers and 27 fathers participated from 40 families. Parents retrospectively reported on infant symptom burden and suffering during the last week of life and the Impact of Events Scale-Revised (IES-R), and Prolonged Grief-13 (PG-13). Hierarchical regressions examined demographic/medical factors and parent perceptions at EOL in relation to post-traumatic stress symptoms (PTSS) and prolonged grief (PG). RESULTS Clinical levels of PTSS (Mothers = 18%; Fathers = 11%) and PG (Mothers and Fathers = 3%) were low. Maternal perception of higher symptom burden was associated with greater PTSS, R2 = 0.46, P= 0.001, and PG, R2 = 0.47, P < 0.01. Paternal perception of greater infant suffering was associated with greater PTSS, R2 = 0.48, P= 0.001, and PG, R2 = .38, P < 0.01. CONCLUSION Perceptions of symptoms and suffering were associated differently with mother and father adjustment after bereavement. While not necessarily causal, better symptom management at EOL could minimize distress for both infants and their parents.
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Affiliation(s)
- Olivia E Clark
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Christine A Fortney
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA; College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Zackery D O Dunnells
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA; Division of Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA; Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Amy E Baughcum
- College of Nursing, The Ohio State University, Columbus, Ohio, USA; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.
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Abstract
Importance Psychological reactions to perinatal loss, although often self-limited, may lead to significant psychological morbidities. Obstetrician-gynecologists and other maternal health providers play a key role in recognizing the range of psychological responses to perinatal loss and providing education, support, and treatment options to their patients. Objective This review aims to define psychological reactions associated with perinatal loss, examine psychotherapy and psychopharmacologic treatments for psychiatric morbidities, discuss interpregnancy interval following perinatal loss, and highlight brief, psychological interventions that can be implemented by maternal health providers. Evidence Acquisition Search terms "perinatal loss psychology," "reproductive loss grief," "perinatal psychopharmacology," "psychopharmacology grief," and "interpregnancy interval" were utilized to search PubMed, Google Scholar, and PsycINFO. Results Grief is an expected, normal response to perinatal loss. Psychological morbidities, including major depressive disorder, generalized anxiety disorder, and posttraumatic stress disorder, are also associated with perinatal loss. Risk factors for these conditions include history of a psychiatric illness, childlessness, unknown cause of perinatal loss, limited social support, and marital/relationship discord. Careful interviewing and brief screening measures can help identify patients who may suffer from depressive or anxiety disorders following reproductive loss. Patients with perinatal loss can benefit from psychological and possibly pharmacologic treatments. Recommended interpregnancy interval after perinatal loss should be customized by gestational age and cause of loss. Conclusions and Relevance Patients with perinatal loss emotionally benefit from their reproductive health care providers acknowledging the psychological aspects of reproductive loss, inquiring about their emotional needs, and providing information regarding grief and mental health referrals.
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An R, Chen X, Wu Y, Liu J, Deng C, Liu Y, Guo H. A survey of postpartum depression and health care needs among Chinese postpartum women during the pandemic of COVID-19. Arch Psychiatr Nurs 2021; 35:172-177. [PMID: 33781396 PMCID: PMC7886635 DOI: 10.1016/j.apnu.2021.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic seriously endangers the public's mental health, especially to pregnant and postpartum women. But little is known about postpartum depression and health care needs among Chinese postpartum women. AIM To investigate the status and risk factors of postpartum depression and health care needs among Chinese postpartum women during the COVID-19 pandemic. METHODS In this cross-sectional study, 209 Chinese postpartum women were recruited from May to July 2020 by convenience sampling and assessed online with self-designed Maternal General Information Questionnaire, Edinburgh Postpartum Depression Scale (EPDS) and Chinese Version of the Perceived Stress Scale (CPSS). Descriptive statistics, chi-square test, independent samples t-test, one-way ANOVA, Pearson correlation and multiple linear regression were used for data analysis. RESULTS With the EPDS cut-off value of 10, the incidence of postpartum depressive symptoms was 56.9%. Age, history of abortion and perceived stress were the influencing factors of postpartum depression (adjusted R2 = 0.432, F = 23.611, p < .001). The top three health care needs were infant rearing guidance (78.0%), maternal and infant protection guidance (60.3%) and dietary guidance (45.0%). The proportion of psychological rehabilitation guidance needs in the depressed group was significantly higher than that in the non-depressed group (34.5% vs. 20.0%, p < .05). CONCLUSIONS Maternal postpartum depression in China was at a high level during the COVID-19 pandemic. Women aged 25-34, with a history of abortion and high stress levels were at higher risk for postpartum depression. Timely psychological counselling, intervention and COVID-19-related health education are in great need for postpartum women.
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Affiliation(s)
- Ran An
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Xiaoli Chen
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Yuanyuan Wu
- Department of Nursing, Suizhou Hospital , Hubei University of Medicine, Suizhou, Hubei, China
| | - Juan Liu
- Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Che Deng
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Yanqun Liu
- School of Health Sciences, Wuhan University, Wuhan, Hubei, China.
| | - Hongxia Guo
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Reardon DC, Craver C. Effects of Pregnancy Loss on Subsequent Postpartum Mental Health: A Prospective Longitudinal Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042179. [PMID: 33672236 PMCID: PMC7926811 DOI: 10.3390/ijerph18042179] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/12/2021] [Accepted: 02/17/2021] [Indexed: 01/28/2023]
Abstract
Pregnancy loss, natural or induced, is linked to higher rates of mental health problems, but little is known about its effects during the postpartum period. This study identifies the percentages of women receiving at least one postpartum psychiatric treatment (PPT), defined as any psychiatric treatment (ICD-9 290-316) within six months of their first live birth, relative to their history of pregnancy loss, history of prior mental health treatments, age, and race. The population consists of young women eligible for Medicaid in states that covered all reproductive services between 1999-2012. Of 1,939,078 Medicaid beneficiaries with a first live birth, 207,654 (10.7%) experienced at least one PPT, and 216,828 (11.2%) had at least one prior pregnancy loss. A history of prior mental health treatments (MHTs) was the strongest predictor of PPT, but a history of pregnancy loss is also another important risk factor. Overall, women with a prior pregnancy loss were 35% more likely to require a PPT. When the interactions of prior mental health and prior pregnancy loss are examined in greater detail, important effects of these combinations were revealed. About 58% of those whose first MHT was after a pregnancy loss required PPT. In addition, over 99% of women with a history of MHT one year prior to their first pregnancy loss required PPT after their first live births. These findings reveal that pregnancy loss (natural or induced) is a risk factor for PPT, and that the timing of events and the time span for considering prior mental health in research on pregnancy loss can significantly change observed effects. Clinicians should screen for a convergence of a history of MHT and prior pregnancy loss when evaluating pregnant women, in order to make appropriate referrals for counseling.
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Raghavan V, Khan HA, Seshu U, Rai SP, Durairaj J, Aarthi G, Sangeetha C, John S, Thara R. Prevalence and risk factors of perinatal depression among women in rural Bihar: A community-based cross-sectional study. Asian J Psychiatr 2021; 56:102552. [PMID: 33454561 PMCID: PMC7896100 DOI: 10.1016/j.ajp.2021.102552] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/05/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Perinatal depression (PND) is one of the most common mental disorders occurring during the perinatal period among women. Few studies examined prevalence and risk factors of PND from rural settings in India. This study aimed to estimate the prevalence of perinatal depression and identify social risk factors for it among women from rural Bihar. MATERIALS AND METHODS A cross sectional study was conducted in a community setting in rural areas of Bihar. All perinatal women were screened through a door to door survey and recruited after obtaining informed consent. A semi-structured proforma was used to collect sociodemographic characteristics and family related variables. Edinburgh postnatal depression scale (EPDS) was used to screen for perinatal depression. RESULTS A total of 564 perinatal women were recruited into the study. The estimated prevalence of PND was 23.9 % (95 % CI: 20.6,27.6). Multivariate analysis showed perinatal depression was associated with physical illness in the mother, previous history of abortion, poor financial status and ill-treatment by in-laws. CONCLUSION Prevalence of perinatal depression among women is high in rural settings of North India. A multitude of factors ranging from physical, obstetric, economic and family related confer a high risk for PND. Comprehensive interventions are needed to address these risk factors of perinatal depression.
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Affiliation(s)
- Vijaya Raghavan
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India.
| | - Homam A Khan
- Innovators In Health (India) Nagar Panchayat, Ward 02, Thana: Dalsinghsarai, Distt: Samastipur, Bihar, 848114, India
| | - Uttara Seshu
- Innovators In Health (India) Nagar Panchayat, Ward 02, Thana: Dalsinghsarai, Distt: Samastipur, Bihar, 848114, India
| | - Surya Prakash Rai
- Innovators In Health (India) Nagar Panchayat, Ward 02, Thana: Dalsinghsarai, Distt: Samastipur, Bihar, 848114, India
| | - Jothilakshmai Durairaj
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India
| | - G Aarthi
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India
| | - C Sangeetha
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India
| | - Sujit John
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India
| | - R Thara
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India
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Leach LS, Poyser C, Fairweather‐schmidt K. Maternal perinatal anxiety: A review of prevalence and correlates. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12058] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Liana S. Leach
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia,
| | - Carmel Poyser
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia,
| | - Kate Fairweather‐schmidt
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia,
- School of Psychology, Flinders University, Adelaide, South Australia, Australia,
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Arach AAO, Nakasujja N, Nankabirwa V, Ndeezi G, Kiguli J, Mukunya D, Odongkara B, Achora V, Tongun JB, Musaba MW, Napyo A, Zalwango V, Tylleskar T, Tumwine JK. Perinatal death triples the prevalence of postpartum depression among women in Northern Uganda: A community-based cross-sectional study. PLoS One 2020; 15:e0240409. [PMID: 33048971 PMCID: PMC7553273 DOI: 10.1371/journal.pone.0240409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/26/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Deaths during the perinatal period remain a big challenge in Africa, with 38 deaths per 1000 pregnancies in Uganda. The consequences of these deaths can be detrimental to the women; some ending up with postpartum depression. We examined the association between perinatal death and postpartum depression among women in Lira district, Northern Uganda. METHODS We conducted a community-based cross-sectional study of 1,789 women. Trained research assistants screened women for postpartum depressive symptoms on day 50 postpartum using the Edinburgh postpartum depression scale (EPDS). Socio-demographic, economic, birth and survival status of the neonate were collected during pregnancy and within one week postpartum. We used generalized estimating equation for the Poisson family with a log link using Stata to estimate the prevalence ratio of the association between postpartum depressive symptoms (EPDS scores ≥14) and perinatal death. Mothers who lost their babies between 7-49 days postpartum were excluded. RESULTS Of the 1,789 participants symptomatically screened for postpartum depression, 377 (21.1%) [95% confidence interval (95%CI): 17.2%, 23.0%] had probable depressive symptoms. The prevalence of postpartum depressive symptoms among the 77 women who had experienced perinatal death (37 stillbirths and 40 early neonatal deaths (≤7 days of life)) was 62.3% [95% CI: 50.8%, 72.6%] compared to 19.2% [95% CI: 17.4%, 21.2%], among 1,712 with live infants at day 50 postpartum. Women who had experienced a perinatal death were three times as likely to have postpartum depressive symptoms as those who had a live birth [adjusted prevalence ratio 3.45 (95% CI: 2.67, 4.48)]. CONCLUSIONS The prevalence of postpartum depressive symptoms, assessed by EPDS, was high among women who had had a perinatal death in Northern Uganda. Women experiencing a perinatal death need to be screened for postpartum depressive symptoms in order to intervene and reduce associated morbidity.
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Affiliation(s)
- Anna Agnes Ojok Arach
- Faculty of Health Sciences, Department of Nursing and Midwifery, Lira University, Lira, Uganda
- * E-mail:
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Victoria Nankabirwa
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Kiguli
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Beatrice Odongkara
- Department of Paediatrics and Child Health, Gulu University, Gulu, Uganda
| | - Vincentina Achora
- Department of Obstetrics and Gynaecology, Gulu University, Gulu, Uganda
| | - Justin Bruno Tongun
- Department of Paediatrics and Child Health, University of Juba, Juba, South Sudan
| | - Milton Wamboko Musaba
- Faculty of Health Sciences, Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
| | - Agnes Napyo
- Faculty of Health Sciences, Department of Public Health, Busitema University, Tororo, Uganda
| | - Vivian Zalwango
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - James K. Tumwine
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Development, validation and reliability testing of ‘Perinatal Bereavement Care Confidence Scale (PBCCS)’. Women Birth 2020; 33:e311-e319. [DOI: 10.1016/j.wombi.2019.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/12/2019] [Accepted: 07/01/2019] [Indexed: 11/23/2022]
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Duran S. Postpartum Specific Anxiety Scale (PSAS): Reliability and validity of the Turkish version. Perspect Psychiatr Care 2020; 56:95-101. [PMID: 31001847 DOI: 10.1111/ppc.12385] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aims to conduct reliability and validity study of the Turkish version of the Postpartum Specific Anxiety Scale (PSAS), which determines the anxiety of women in the postpartum period. DESIGN AND METHODS This methodological study included 275 women. RESULTS The scale had a single factor structure, which had the factor load in the appropriate range (0.30-0.58). The Cronbach's alpha was determined as 0.91, and the item total score correlations ranged between 0.25 and 0.54. The test-retest coefficient was determined as 0.93. PRACTICE IMPLICATIONS The Turkish version of the PSAS was evaluated and it was found that it could be used as a valid and reliable measurement tool in Turkish women.
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Affiliation(s)
- Songül Duran
- Department of Nursing, Trakya University Keşan Hakkı Yörük School of Health, Edirne, Turkey
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Abu-Raisi SS, Ibrahim SA, Ajina MA, Ibrahim EA, Almulhim AY, Aljalal MA, Almajed ZS. Temporomandibular Disorder among Women Who Experienced Posttraumatic Stress Disorder after a Miscarriage. J Int Soc Prev Community Dent 2019; 9:445-452. [PMID: 31620376 PMCID: PMC6792305 DOI: 10.4103/jispcd.jispcd_394_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 04/30/2019] [Indexed: 12/19/2022] Open
Abstract
Objectives: This study intended to understand the risk of developing temporomandibular disorder among Saudi women who experienced a miscarriage. Materials and Methods: Two hundred and eight Saudi women from several hospitals’ gynecologic clinics in two areas in Saudi Arabia were screened to fill out the Impact of Events Scale-Revised (self-reporting questionnaire) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for posttraumatic stress disorder and a structured temporomandibular joint disorder (TMD) Questionnaire (Research Diagnostic Criteria for Temporomandibular Disorders). A single examiner did the clinical examination for temporomandibular joint (TMJ). One-hundred and fifty-eight of the participants were divided into two groups. Group A (85 participants) included females who had had a previous miscarriage, whereas Group B (73 participants) included females who had not had a miscarriage. IBM SPSS version 22.0 was used to conduct a nonparametric Chi-square test to find the significance of any observed differences. Results: Almost 40% of the participants had symptoms that qualified for possible TMD. Around 73% of the miscarried Saudi women in Group A showed symptoms of TMD. Furthermore, approximately 38% of the participants in Group B developed significant symptoms of TMD. The Chi-square test (Chi-test = 22.03 with P = 0.0001) shows highly significant association between treatment groups (control and study) and temporomandibular joint disorder group and non temporomandibular joint disorder group. Conclusion: Women who suffer from spontaneous single or recurrent miscarriages are advised to seek a dental specialist for diagnosis and prevention devices such as a night guard.
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Affiliation(s)
- Sarah Samer Abu-Raisi
- Department of the Prosthetic Dental Science, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Shikha A Ibrahim
- Dental Intern, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Manal A Ajina
- Dental Intern, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Esraa A Ibrahim
- Dental Intern, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Afnan Y Almulhim
- Dental Intern, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Maryam A Aljalal
- Dental Intern, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Zainab S Almajed
- Dental Intern, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
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Prevalence and risk factors of postpartum depression within one year after birth in urban slums of Dhaka, Bangladesh. PLoS One 2019; 14:e0215735. [PMID: 31048832 PMCID: PMC6497249 DOI: 10.1371/journal.pone.0215735] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 04/08/2019] [Indexed: 11/29/2022] Open
Abstract
Postpartum depression (PPD) is a serious pubic health concern and known to have the adverse effects on mother’s perinatal wellbeing; and child’s physical and cognitive development. There were limited literatures on PPD in Bangladesh, especially in urban slum context. The aim of this study was to assess the burden and risk factors of PPD among the urban slum women. A cross-sectional study was conducted between November-December 2017 in three urban slums on 376 women within first 12 months of postpartum. A validated Bangla version of Edinburgh Postnatal Depression Scale was used to measure the depression status. Respondent’s socio-economic characteristics and other risk factors were collected with structured validated questionaire by trained interviewers. Unadjusted Prevalence Ratio (PR) and Adjusted Prevalence Ratio (APR) were estimated with Generalized Linear Model (GLM) and Generalized Estimating Equation (GEE) respectively to identify the risk factors of PPD. The prevalence of PPD was 39.4% within first 12 months following the child birth. Job involvement after child delivery (APR = 1.9, 95% CI = 1.1, 3.3), job loss due to pregnancy (APR = 1.5, 95% CI = 1.0, 2.1), history of miscarriage or still birth or child death (APR = 1.4, 95% CI = 1.0, 2.0), unintended pregnancy (APR = 1.8, 95% CI = 1.3, 2.5), management of delivery cost by borrowing, selling or mortgaging assets (APR = 1.3, 95% CI = 0.9, 1.9), depressive symptom during pregnancy (APR = 2.5, 95% CI = 1.7, 3.8) and intimate partner violence (APR = 2.0, 95% CI = 1.2, 3.3), were identified as risk factors. PPD was not associated with poverty, mother in law and any child related factors. The burden of postpartum depression was high in the urban slum of Bangladesh. Maternal mental health services should be integrated with existing maternal health services. Research is required for the innovation of effective, low cost and culturally appropriate PPD case management and preventive intervention in urban slum of Bangladesh.
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Hernández-Martínez A, Rodríguez-Almagro J, Molina-Alarcón M, Infante-Torres N, Rubio-Álvarez A, Martínez-Galiano JM. Perinatal factors related to post-traumatic stress disorder symptoms 1-5 years following birth. Women Birth 2019; 33:e129-e135. [PMID: 30954482 DOI: 10.1016/j.wombi.2019.03.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/13/2019] [Accepted: 03/13/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The relationship between perinatal variables and post-traumatic stress disorder (PTSD) symptoms was studied. However, the role of some variables in PTSD symptoms is unclear. AIM Determine the prevalence of PTSD symptoms after 1 year postpartum and their relationship with perinatal variables. METHODS A cross-sectional study with 1531 puerperal women in Spain. Data were collected on socio-demographic variables, perinatal variables (maternal characteristics, procedures during labour and birth, birth outcomes and time since birth) and the newborn. An online questionnaire was used, which included the Perinatal Post-traumatic Stress Questionnaire (PPQ). Crude and adjusted odds ratios (OR) were calculated using binary logistic regression. FINDINGS 7.2% (110) of the women were identified as being at risk for probable PTSD symptoms. Protective factors were having a birth plan respected (aOR 0.44; 95%CI 0.19-0.99), use of epidural analgesia (aOR 0.44; 95%CI 0.24-0.80) and experiencing skin-to-skin contact (aOR 0.33; 95%CI 0.20-0.55). Risk factors were instrumental birth (aOR 3.32; 95%CI1.73-3.39), caesarean section (aOR 4.80; 95%CI 2.51-9.15), receiving fundal pressure (aOR 1.72; 95%CI 1.08-2.74) and suffering a third/fourth degree perineal tear (aOR 2.73; 95%CI 1.27-5.86). The area under the model's ROC curve was 0.82 (95%CI 0.79-0.83). CONCLUSIONS Women who experience a normal birth, are psychologically prepared for birth (for example, through use of a birth plan), experience skin-to-skin contact with their newborn, and had a sense of physical control through the use of epidural analgesia, are less likely to experience childbirth as traumatic.
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Women’s Experiences of Utilizing Religious and Spiritual Beliefs as Coping Resources After Miscarriage. RELIGIONS 2019. [DOI: 10.3390/rel10030185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Religious and spiritual beliefs enable some bereaved women to cope better with the devastating effects of the loss of a baby through miscarriage. The aim of this study is to explore the experiences of women’s utilization of religious and spiritual beliefs as coping resources after miscarriage. Heideggerian interpretive phenomenological approach guided the study. Data were collected using audio-recorded, semi-structured interviews with 10 women and analyzed thematically using the method developed by van Manen. Data analysis revealed three themes: (a) feelings of grief (b) finding meaning in loss and the purpose of life and (c) religious and spiritual beliefs as coping resources. Religious and spiritual beliefs play a major role in the lives of many individuals, and act as coping resources for many women who have experienced a miscarriage. Bereavement care providers’ understanding of religious and spiritual values of women who have experienced a miscarriage is crucial to meeting their spiritual care needs.
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Ladhani NNN, Fockler ME, Stephens L, Barrett JF, Heazell AE. No 369 - Prise en charge de la grossesse aprés une mortinaissance. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1684-1700. [DOI: 10.1016/j.jogc.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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No. 369-Management of Pregnancy Subsequent to Stillbirth. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1669-1683. [DOI: 10.1016/j.jogc.2018.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Reardon DC. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med 2018; 6:2050312118807624. [PMID: 30397472 PMCID: PMC6207970 DOI: 10.1177/2050312118807624] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/26/2018] [Indexed: 12/26/2022] Open
Abstract
The abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts. When interpreting the data, abortion and mental health proponents are inclined to emphasize risks associated with abortion, whereas abortion and mental health minimalists emphasize pre-existing risk factors as the primary explanation for the correlations with more negative outcomes. Still, both sides agree that (a) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion; (b) the abortion experience directly contributes to mental health problems for at least some women; (c) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion; and (d) it is impossible to conduct research in this field in a manner that can definitively identify the extent to which any mental illnesses following abortion can be reliably attributed to abortion in and of itself. The areas of disagreement, which are more nuanced, are addressed at length. Obstacles in the way of research and further consensus include (a) multiple pathways for abortion and mental health risks, (b) concurrent positive and negative reactions, (c) indeterminate time frames and degrees of reactions, (d) poorly defined terms, (e) multiple factors of causation, and (f) inherent preconceptions based on ideology and disproportionate exposure to different types of women. Recommendations for collaboration include (a) mixed research teams, (b) co-design of national longitudinal prospective studies accessible to any researcher, (c) better adherence to data sharing and re-analysis standards, and (d) attention to a broader list of research questions.
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Ezzeddin N, Jahanihashemi H, Zavoshy R, Noroozi M. The Prevalence of Postpartum Depression and Its Association with Food Insecurity among Mothers Referring to Community Health Centers. IRANIAN JOURNAL OF PSYCHIATRY 2018; 13:280-287. [PMID: 30627202 PMCID: PMC6320385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/25/2018] [Accepted: 07/01/2018] [Indexed: 11/18/2022]
Abstract
Objective: Postpartum depression (PPD) is a condition which may compromise both maternal and neonatal health. The present study was conducted to determine the prevalence of PPD and its association with demographic, socioeconomic, obstetric, and household food security status. Method : This cross sectional study was conducted in community health centers in west of Tehran. A total of 325 women were selected by stratified sampling method from community health centers. A sociodemographic questionnaire, USDA 18-item questionnaire, and Edinburgh Postnatal Depression Scale (EPDS) questionnaire were used for data collection. Data were analyzed using both descriptive and analytic analyses, such as chi-squared test and logistic regression in SPSS 22. Results: The prevalence of PPD and food insecurity among the studied population was 35.4% and 34.2%, respectively. The results of this study revealed a significant association among PPD and food insecurity (OR = 6.690, CI = 3.118-14.353, p<0.001), the levels of economic satisfaction (OR = 3.419, CI = 1.241-9.420, P = 0.017), pregnancy loss (OR = 1.899, CI = 1.006-3.582, p = 0.048), and pregnancy complications (OR = 1.853, CI = 1.083-3.170, P = 0.024). Conclusion: Based on the results of this study, household food insecurity may predispose mothers to PPD. Moreover, it was observed that mothers with poor economic satisfaction were more likely to be depressed. Histories of pregnancy loss and pregnancy complications were other risk factors for PPD.
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Affiliation(s)
- Neda Ezzeddin
- Department of Community Nutrition, School of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Jahanihashemi
- Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Roza Zavoshy
- Department of Nutrition, Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mostafa Noroozi
- Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
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Martínez AH, Almagro JR, Alarcón MM, Torres NI, Alvarez AR, Galiano JMM. WITHDRAWN: Post-traumatic stress disorder-related perinatal factors after the first postpartum year. Midwifery 2018. [DOI: 10.1016/j.midw.2018.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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The association between social support and postpartum depression in women: A cross sectional study. Women Birth 2018; 32:e238-e242. [PMID: 30274879 DOI: 10.1016/j.wombi.2018.07.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Prevalence of postpartum depression is estimated to be about 10-15% worldwide. Many risk factors are supposed to play a role leading a new mother to maternal postpartum depression which can considerably affect the baby, mother, family and also the society. OBJECTIVE To investigate the prevalence of maternal postpartum depression and its association with social support. METHODS Using a cross-sectional study, 200 new mothers who attended three teaching hospitals in Tehran, Iran were selected with a convenience sampling. Postpartum depression was assessed using the Iranian version of Edinburgh Postpartum Depression Scale and women's levels of social support were measured using the Iranian version of Social Support Questionnaire. RESULTS Prevalence of postpartum depression was 43.5% in new mothers. The mean (±Standard Deviation) score of social support network was 2.09±0.99; which is lower in depressed mothers in comparison to non-depressed mothers (1.78±0.87 vs. 2.33±1.00 respectively, P<0.001). A reverse significant association was found between social support and postpartum depression after adjusting for confounding variables such as past history of depression, illness of baby and medication consumption during pregnancy (Odds Ratio=0.47, 95% Confidence Interval=0.33-0.67). CONCLUSION The bigger the social network of a mother, the less postpartum depression occurs. It is suggested to educate the family about the very important role of social support and improve it in every aspect of health care in order to prevent postpartum depression.
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Azale T, Fekadu A, Hanlon C. Postpartum depressive symptoms in the context of high social adversity and reproductive health threats: a population-based study. Int J Ment Health Syst 2018; 12:42. [PMID: 30069229 PMCID: PMC6064119 DOI: 10.1186/s13033-018-0219-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/14/2018] [Indexed: 01/13/2023] Open
Abstract
Background Postpartum depression is an important but neglected public health issue in low- and middle-income countries. The aim of this study was to assess postpartum depressive (PPD) symptoms and associated factors in a rural Ethiopian setting characterized by high social adversity and reproductive health threats. We hypothesized that infant gender preference would be associated with PPD symptoms. Methods A cross-sectional, population-based study was conducted in Sodo district, southern Ethiopia, between March and June 2014. A total of 3147 postpartum women (one to 12 months after delivery) were recruited and interviewed in their homes. The questionnaire included demographic, reproductive health and psychosocial factors in addition to a culturally validated measure of depressive symptoms, the Patient Health Questionnaire. Scores of 5 or more were indicative of high levels of PPD symptoms. Results The prevalence of high PPD symptoms was 12.2%, with 95% confidence interval (CI) between 11.1 and 13.4. Of these, 12.0% of the study participants had suicidal ideation. Preference of the husband for a boy baby was associated with PPD symptoms in univariate analysis (crude odds ratio 1.43: 95% CI 1.04, 1.91) but became non-significant after adjusting for confounders. In the final multivariable analysis, rural residence [adjusted odds ratio (aOR) 2.56: 95% CI 2.56, 4.19], grand multiparity (aOR 2.00: 1.22, 3.26), perinatal complications (aOR: 2.55: 1.89, 3.44), a past history of abortion (aOR 1.50: 1.07, 2.11), experiencing hunger in the preceding 1 month (aOR 2.38: 1.75, 3.23), lower perceived wealth (aOR 2.11: 1.19, 3.76), poor marital relationship (aOR 2.47: 1.79, 3.42), and one or more stressful events in the preceding 6 months (aOR 2.36: 1.82, 3.06) were associated significantly with high PPD symptoms. Conclusion PPD symptoms affected more than one in 10 women in this Ethiopian community setting. Social adversity and reproductive health threats were associated with poorer mental health. Interventions focusing on poor rural women with low access to care are necessary. This research can serve as an entry point for the adaptation of a psychosocial intervention.
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Affiliation(s)
- Telake Azale
- 1Department of Health Education and Behavioral Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,5Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- 3Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia.,4Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,5Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- 2Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,5Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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A mixed methods sequential explanatory study of the psychosocial factors that impact on midwives' confidence to provide bereavement support to parents who have experienced a perinatal loss. Midwifery 2018; 64:69-76. [PMID: 29966879 DOI: 10.1016/j.midw.2018.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 06/09/2018] [Accepted: 06/12/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Perinatal bereavement is traumatic for many parents. Not only is the experience itself emotionally painful, the impact on their lives is made more difficult if midwives are unable to provide appropriate care to the parents. AIM OF THE STUDY To explore within an Irish context, the psychosocial factors that impact on midwives' confidence to provide bereavement support to parents who have experienced a perinatal loss. DESIGN A mixed methods sequential explanatory design was used to complete this two-phased study from August 2013 to July 2014. Ethical approval was granted from Ethics Committees of three maternity hospitals and a University in Ireland. The recruitment process for the survey occurred in August 2013 and July 2014 for the focus groups. METHODS A series of univariate and multivariate analysis were used to analyze the quantitative data using IBM Statistical Package for the Social Sciences (SPSS; version 20). The qualitative data were analyzed using qualitative content analysis. Steps were taken to ensure data validity and reliability. RESULTS The overall meta-inference of this study is that the majority of the midwives did not have adequate levels of confidence to provide bereavement support to grieving parents. The psychosocial factors that impact on midwives' confidence were identified as the midwives' awareness of the needs of bereaved parents, their own inner strength and the organizational support they received at their place of work. CONCLUSION Improving midwives' bereavement support knowledge and skills is essential for promoting their confidence. Midwives also need adequate emotional and practical support from their organizations.
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Weinreb L, Wenz-Gross M, Upshur C. Postpartum outcomes of a pilot prenatal care-based psychosocial intervention for PTSD during pregnancy. Arch Womens Ment Health 2018; 21:299-312. [PMID: 29116416 DOI: 10.1007/s00737-017-0794-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
This study examines postpartum posttraumatic stress disorder (PTSD) symptoms and secondary outcomes including postpartum depression and birth outcomes for pregnant women who screened positive for PTSD and received a psychosocial education intervention compared to women with PTSD in the usual prenatal care setting. All women entering prenatal care at two federally qualified health centers were screened for symptoms of current PTSD; one site was selected randomly to have prenatal care advocates deliver eight Seeking Safety topics for women with clinical or subclinical PTSD. Women were not blind to condition. Baseline and postpartum interviews, including demographic characteristics and assessment of mental health, social support, and coping skills, were conducted. Medical record data was collected to document preterm delivery and low birth weight. Of the 149 participants at baseline, 128 (86%) participated in the postpartum interview. Intervention women, compared to controls, significantly decreased PTSD symptoms, and showed a non-significant trend for improved social support. However, depression, coping, and birth outcomes did not differ. This study suggests some initial support for the Seeking Safety intervention in prenatal care settings and requires further research to determine the best approaches to its implementation.
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Affiliation(s)
- Linda Weinreb
- Family Medicine and Community Health, University of Massachusetts Medical School, Benedict Building A3-227 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Melodie Wenz-Gross
- Family Medicine and Community Health, University of Massachusetts Medical School, Benedict Building A3-227 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Carole Upshur
- Family Medicine and Community Health, University of Massachusetts Medical School, Benedict Building A3-227 55 Lake Avenue North, Worcester, MA, 01655, USA
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Chen L, Ding L, Qi M, Jiang C, Mao XM, Cai WZ. Incidence of and social-demographic and obstetric factors associated with postpartum depression: differences among ethnic Han and Kazak women of Northwestern China. PeerJ 2018; 6:e4335. [PMID: 29404223 PMCID: PMC5793707 DOI: 10.7717/peerj.4335] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/17/2018] [Indexed: 01/08/2023] Open
Abstract
Background Studies on postpartum depression (PPD) in China have focused primarily on women of Han ethnicity, whereas work on other ethnic groups has proven limited. This study explored the ethnic differences of associated social-demographic and obstetric factors for PPD between Han-majority and Kazak-minority women in northwestern China. Methods Han and Kazak women who received routine examinations at four hospitals in a multi-ethnic area of China six weeks after childbirth between March 2016 and December 2016 were included in the study. Data on the women’s socio-demographic characteristics, obstetric factors, and possible depression at six weeks after childbirth were collected. We examined the associated factors of PPD using multivariable logistic regression analyses by ethnic group. Results The overall incidence of PPD was 14.6% (184/1,263) at six weeks after childbirth. PPD was detected more frequently among Kazak (16.1%) than Han women (13.1%). Kazak women exhibited a higher risk of PPD (adjusted OR = 1.561, 95% CI [1.108–2.198], P = 0.011). Urinary incontinence (UI) represented a significant risk factor of PPD for Kazak compared with Han women (OR = 1.720, 95% CI [1.056–2.804], P = 0.003). In contrast, the presence of the mother-in-law as a caregiver after childbirth demonstrated a positive association with PPD among Han (OR = 2.600, 95% CI [1.499–4.512], P = 0.001), but not with Kazak women. Conclusions Kazak women were more likely to develop PPD than Han women, even after controlling for confounders. Moreover, distinct risk factors for PPD existed for Han and Kazak women. Future research that explores the relationships between Han women and their mothers-in-law as well as Kazak women’s attitudes toward UI could help us further understand PPD in these populations.
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Affiliation(s)
- Ling Chen
- Department of Nursing, Shenzhen hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Li Ding
- Department of Cardiology, Xinjiang Medical University Affiliated Second Hospital, Urumqi, China
| | - Ming Qi
- Department of Rehabilitation and Psychology, First Affiliated Hospital of College of Medicine, Shihezi University, Shihezi, China
| | - Chao Jiang
- Nursing Department, Fuyun People's Hospital, Altay, China
| | - Xin-Min Mao
- Reproductive Medicine Center, Xinjiang Medical University Affiliated First Hospital, Urumqi, China
| | - Wen-Zhi Cai
- Department of Nursing, Shenzhen hospital, Southern Medical University, Shenzhen, Guangdong, China
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