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Mehta-Lee SS, Echevarria GC, Brubaker SG, Yaghoubian Y, Long SE, Dolin CD. The Association between Psychosocial Stressors and Gestational Weight Gain: Analysis of the National Pregnancy Risk Assessment Monitoring System (PRAMS) Results from 2012 to 2015. Matern Child Health J 2024; 28:1250-1257. [PMID: 38427279 DOI: 10.1007/s10995-024-03923-5] [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] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Both psychosocial stress and gestational weight gain are independently associated with adverse maternal and fetal outcomes. Studies of the association between psychosocial stress and gestational weight gain (GWG) have yielded mixed results. The objective of this study was to evaluate the association between psychosocial stress and GWG in a large population-based cohort. METHODS Data from the nationally representative Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 7 questionnaire 2012-2015 was utilized. Maternal psychosocial stress was assessed through response to questions designed to examine four domains of psychosocial stress (i.e., traumatic, financial, emotional, partner-related) three months prior to or during pregnancy. GWG was categorized using pre-pregnancy BMI and total GWG into inadequate, adequate, or excessive according to the Institute of Medicine's GWG guidelines. Multinomial logistic regression was used to evaluate the association between psychosocial stressors and adequacy of GWG. Analyses took into account complex survey design. RESULTS All respondents who delivered ≥ 37 weeks gestation with GWG information available were included in the analysis (n = 119,183). After adjusting for confounders, patients who reported financial stress were more likely to experience excessive versus adequate GWG (RRR 1.09 [95%CI: 1.02-1.17]). Exposure to any of the stressor groups did not significantly increase the risk of inadequate GWG. CONCLUSIONS This large, population-based study revealed that among pregnant people in the US, exposure to financial stress is associated with higher risk of excessive GWG. Understanding the role stress plays in GWG will help to inform initiatives targeting this important aspect of prenatal care.
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Affiliation(s)
- Shilpi S Mehta-Lee
- Department of Obstetrics and Gynecology, New York University Langone Health/NYU Grossman School of Medicine, New York, NY, USA.
| | - Ghislaine C Echevarria
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai West, New York, NY, USA
| | - Sara G Brubaker
- Department of Obstetrics and Gynecology, New York University Langone Health/NYU Grossman School of Medicine, New York, NY, USA
| | - Yasaman Yaghoubian
- Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra, NorthwellHempstead, USA
| | - Sara E Long
- Department of Pediatrics, Division of Environmental Pediatrics, NYU Langone Medical Center, New York, NY, USA
| | - Cara D Dolin
- Division of Maternal-Fetal Medicine, Department of Reproductive Biology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Basile-Ibrahim B, Combellick J, Mead TL, Sorensen A, Batten J, Schafer R. The Social Context of Pregnancy, Respectful Maternity Care, Biomarkers of Weathering, and Postpartum Mental Health Inequities: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:480. [PMID: 38673391 PMCID: PMC11049830 DOI: 10.3390/ijerph21040480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
Background: Mental health disorders are the number one cause of maternal mortality and a significant maternal morbidity. This scoping review sought to understand the associations between social context and experiences during pregnancy and birth, biological indicators of stress and weathering, and perinatal mood and anxiety disorders (PMADs). Methods: A scoping review was performed using PRISMA-ScR guidance and JBI scoping review methodology. The search was conducted in OVID Medline and Embase. Results: This review identified 74 eligible English-language peer-reviewed original research articles. A majority of studies reported significant associations between social context, negative and stressful experiences in the prenatal period, and a higher incidence of diagnosis and symptoms of PMADs. Included studies reported significant associations between postpartum depression and prenatal stressors (n = 17), socioeconomic disadvantage (n = 14), negative birth experiences (n = 9), obstetric violence (n = 3), and mistreatment by maternity care providers (n = 3). Birth-related post-traumatic stress disorder (PTSD) was positively associated with negative birth experiences (n = 11), obstetric violence (n = 1), mistreatment by the maternity care team (n = 1), socioeconomic disadvantage (n = 2), and prenatal stress (n = 1); and inverse association with supportiveness of the maternity care team (n = 5) and presence of a birth companion or doula (n = 4). Postpartum anxiety was significantly associated with negative birth experiences (n = 2) and prenatal stress (n = 3). Findings related to associations between biomarkers of stress and weathering, perinatal exposures, and PMADs (n = 14) had mixed significance. Conclusions: Postpartum mental health outcomes are linked with the prenatal social context and interactions with the maternity care team during pregnancy and birth. Respectful maternity care has the potential to reduce adverse postpartum mental health outcomes, especially for persons affected by systemic oppression.
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Affiliation(s)
| | - Joan Combellick
- School of Nursing, Yale University, Orange, CT 06477, USA; (J.C.)
| | - Thomas L. Mead
- Biomedical Libraries, Dartmouth College, Hanover, NH 03755, USA;
| | - Alee Sorensen
- School of Nursing, Yale University, Orange, CT 06477, USA; (J.C.)
| | - Janene Batten
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT 06510, USA;
| | - Robyn Schafer
- Division of Advanced Nursing Practice, School of Nursing, Rutgers University, Newark, NJ 07107, USA;
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ 08901, USA
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3
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Schalla MA, Stengel A. The role of stress in perinatal depression and anxiety - A systematic review. Front Neuroendocrinol 2024; 72:101117. [PMID: 38176543 DOI: 10.1016/j.yfrne.2023.101117] [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: 08/24/2023] [Revised: 11/29/2023] [Accepted: 12/31/2023] [Indexed: 01/06/2024]
Abstract
Perinatal depression (PND) and anxiety affect around 20% of women, but available pharmacotherapy is not sufficiently effective in 20-60% of them, indicating a need for better understanding of these diseases. Since stress is a significant risk factor for PND, the aim was to examine the role of biological, environmental and psychological stress in PND and anxiety through a systematic literature search. Overall 210 studies were included, among which numerous rodent studies showed that perinatal stress induced depressive-like and anxious behavior, which was associated with HPA-axis alterations and morphological brain changes. Human studies indicated that the relationship between cortisol and perinatal depression/anxiety was not as clear and with many contradictions, although social and psychological stress were clearly positively associated with PND. Finally, oxytocin, synthetic neuroactive steroid and n-3 PUFA diet have been identified as potentially beneficial in the therapy of PND and anxiety, worth to be investigated in the future.
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Affiliation(s)
- M A Schalla
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; Department of Gynecology and Obstetrics, Helios Clinic, Rottweil, Germany
| | - A Stengel
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; German Center für Mental Health (DZPG), Site Tübingen, Germany.
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Lau E, Adams YJ. Predictors of Postpartum Depression Among Women with Low Incomes in the United States. MCN Am J Matern Child Nurs 2023; 48:326-333. [PMID: 37589952 DOI: 10.1097/nmc.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
PURPOSE To evaluate the predictors of postpartum depression and to examine the effects of maternal racial identity on postpartum depression among women with low incomes in the United States. STUDY DESIGN AND METHODS We conducted a secondary data analysis using baseline data from the Baby's First Years study, including postpartum women living below the federal poverty line who were recruited from four diverse communities in the United States. Postpartum depression symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Logistic regressions were performed to identify associations between pre-identified postpartum depression risk factors and postpartum depression among participants, followed by predictive margins analyses to elaborate on probability of postpartum depression across different racial identity groups in the sample. RESULTS The sample included 1,051 postpartum women. Almost one-half of participants identified as Black (45.9%), followed by White (20.7%), American Indian (1.8%), and Asian (1.3%). Prevalence of postpartum depression in the sample was 24%. Financial insecurity and alcohol use were positively associated with postpartum depression, whereas level of education and reported physical health were negatively associated with postpartum depression. Mothers who identified as Black had an 8.3% higher probability of postpartum depression than that of White mothers in the sample. CLINICAL IMPLICATIONS Nurses working with populations with low income should assess social determinants of health to provide holistic mental health care. Women with low incomes should be referred to resources which account for their financial burden. Racial disparities exist in perinatal care, and birth and postpartum mental health outcomes. It is crucial to address the systemic racism faced by Black mothers experiencing postpartum depression.
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Gifford JJ, Pluchino JR, Della Valle R, Van Weele B, Brezoczky E, Caulfield JI, Cavigelli SA, Schwarz JM. Effects of limited bedding and nesting on postpartum mood state in rats. J Neuroendocrinol 2023; 35:e13275. [PMID: 37186019 PMCID: PMC10524593 DOI: 10.1111/jne.13275] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/04/2023] [Accepted: 03/31/2023] [Indexed: 05/17/2023]
Abstract
This study examined the effect of limited bedding and nesting (LBN) stress on postpartum anhedonia, maternal behaviors, anxiety-like behaviors, and neuroendocrine and neuroimmune function as a potential model of postpartum depression. Dams underwent sucrose preference tests prior to breeding, during gestation and again postpartum, to examine the potential onset of anhedonia. On embryonic day 19, dams were placed into either a LBN or control housing condition. Contrary to our predictions, LBN stress had no effect on postpartum sucrose preference. We also found no effect of LBN condition on fecal estradiol or corticosterone levels, both of which increased at birth and decreased postpartum. Regardless of housing conditions, approximately 40% of new mothers exhibited a decrease in sucrose preference, while others show no change, suggesting an individual susceptibility to postpartum anhedonia. In a separate cohort of LBN and control dams, we measured pup retrieval, hoarding behavior, elevated plus maze (EPM), and marble burying. LBN dams exhibited increased anxiety, associated with decreased time spent in the open arms of the EPM. We also measured a significant increase in IL-6 expression in the dorsal hippocampus and medial prefrontal cortex of postpartum dams compared to nonpregnant dams. These findings suggest that while LBN stress has effects on anxiety and maternal care, it does not induce postpartum anhedonia. Rather, there are inherent differences in susceptibility to anhedonia in individual dams, and future studies should be conducted to better understand individual vulnerability and resilience to postpartum anhedonia.
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Affiliation(s)
- Janace J Gifford
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
| | - Jenna R Pluchino
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
| | - Rebecca Della Valle
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
| | - Brooke Van Weele
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
| | - Emma Brezoczky
- Department of Neuroscience, Claremont McKenna College, Claremont, California, USA
| | - Jasmine I Caulfield
- Department of Biobehavioral Health, Penn State University, State College, Pennsylvania, USA
| | - Sonia A Cavigelli
- Department of Biobehavioral Health, Penn State University, State College, Pennsylvania, USA
| | - Jaclyn M Schwarz
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
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Bossick AS, Painter I, Williams EC, Katon JG. Development of a Composite Risk Index of Reproductive Autonomy Using State Laws: Association With Maternal and Neonatal Outcomes. Womens Health Issues 2023:S1049-3867(23)00075-0. [PMID: 37120364 DOI: 10.1016/j.whi.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 02/17/2023] [Accepted: 03/24/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE We developed a composite index to quantify state legislation related to reproductive autonomy and examined its association with maternal and neonatal outcomes. We hypothesized that greater reproductive autonomy would be associated with lower rates of severe maternal morbidity (SMM), pregnancy-related mortality (PRM), preterm birth (PTB), and low birthweight. DESIGN A Delphi panel was used to inform development of the index. Restrictive policies were assigned values of -1 and enabling policies +1. Publicly available data were used to conduct a cross-sectional study among all live births in the 50 U.S. states to people aged 15 to 44 between January 1, 2016, and December 31, 2018, to examine the association between the risk index and PRM, SMM, PTB, and low birthweight. We used linear regression with state scores and quartiles, adjusted for state-level proportions of White, Black, and Hispanic live births; percent living in rural areas; percent of population foreign born; Health Resources and Services Administration spending on maternal and child health; and the Opportunity Index, a composite measure of indicators of the economy, education, and community. RESULTS From 2016 to 2018, there were 11,530,785 births, 2,846 pregnancy-related deaths, and 154,384 cases of SMM. The Delphi panel resulted in a summed state measure of 106 laws in 8 categories that could affect reproductive autonomy. In adjusted analyses, states in the most enabling (most reproductive autonomy) quartile had a 44.7 per 10,000 higher rate of SMM compared with the most restrictive quartile. However, the most enabling quartile was associated with a 9.87 per 100,000 lower rate of PRM and 0.67 per 100 lower rate of PTB compared with the most restrictive quartile (least reproductive autonomy). CONCLUSIONS A composite policy index of reproductive autonomy was found to be associated with higher rates of SMM but lower rates of PRM and PTB. Further research is needed to understand how reproductive autonomy in the cumulative index may influence these and other maternal and birth outcomes.
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Affiliation(s)
- Andrew S Bossick
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington; Henry Ford Health, Detroit, Michigan.
| | - Ian Painter
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington; Washington State Department of Health, Olympia, Washington
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington; U.S. Department of Veterans Affairs (VA), Health Services Research and Development (HSR&D), Center of Innovation for Veteran Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
| | - Jodie G Katon
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington; U.S. Department of Veterans Affairs (VA), Health Services Research and Development (HSR&D), Center of Innovation for Veteran Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
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7
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Zhu Y, Yin X, Qiu L, Sun N, An R, Gong Y. Association between breastfeeding and perinatal depressive symptoms: A 13-months cross-lagged analysis in China. Asian J Psychiatr 2023; 82:103474. [PMID: 36709612 DOI: 10.1016/j.ajp.2023.103474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023]
Abstract
Breastfeeding is associated with perinatal depressive symptoms, the directionality of this relationship, however, remains unclear. Therefore, the present study aimed to evaluate the longitudinal relationship between breastfeeding and perinatal depressive symptoms. A longitudinal study was conducted from September 2018 to August 2020 in two cities of China. Depressive symptoms and breastfeeding behaviors were investigated during the third trimester and at 1, 3, 6, and 12 months postpartum. A total of 856 women participated in the present study. The cross-lagged model revealed that after adjustments were made for covariates, depressive symptoms at 3 and 6 months postpartum predicted breastfeeding at 6 and 12 months postpartum, respectively. Additionally, prenatal and 1-month postpartum depressive symptoms were not found to predict breastfeeding. Nor was found that breastfeeding, in turn, predicted depressive symptoms. These results indicated that women who experienced depressive symptoms at 3 months postpartum were more likely to discontinue breastfeeding. The first 3-months postpartum period seems to be the optimal time to identify and treat depressive symptoms to maintain and increase breastfeeding rates. Early intervention of perinatal depressive symptoms is warranted.
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Affiliation(s)
- Yi Zhu
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
| | - Xiaoxv Yin
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
| | - Lei Qiu
- Department of Epidemiology, School of Public Health, Hainan Medical University, Xue Yuan Road 3, Haikou 571199, Hainan, PR China.
| | - Na Sun
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
| | - Rongrong An
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
| | - Yanhong Gong
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
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The Association between NICU Admission and Mental Health Diagnoses among Commercially Insured Postpartum Women in the US, 2010-2018. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101550. [PMID: 36291486 PMCID: PMC9600206 DOI: 10.3390/children9101550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/29/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
Maternal mental health (MH) conditions represent a leading cause of preventable maternal death in the US. Neonatal Intensive Care Unit (NICU) hospitalization influences MH symptoms among postpartum women, but a paucity of research uses national samples to explore this relationship. Using national administrative data, we examined the rates of MH diagnoses of anxiety and/or depression among those with and without an infant admitted to a NICU between 2010 and 2018. Using generalized estimating equation models, we explored the relationship between NICU admission and MH diagnoses of anxiety and/or depression, secondarily examining the association of NICU length of stay and race/ethnicity with MH diagnoses of anxiety and/or depression post NICU admission. Women whose infants became hospitalized in the NICU for <2 weeks had 19% higher odds of maternal MH diagnoses (aOR: 1.19, 95% CI: 1.14%−1.24%) and those whose infants became hospitalized for >2 weeks had 37% higher odds of maternal MH diagnoses (aOR: 1.37 95% CI: 1.128%−1.47%) compared to those whose infants did not have a NICU hospitalization. In adjusted analyses, compared to white women, all other race/ethnicities had significantly lower odds of receiving a maternal MH condition diagnosis [Black (aOR = 0.76, 0.73−0.08), Hispanic (aOR = 0.69, 0.67−0.72), and Asian (aOR: 0.32, 0.30−0.34)], despite higher rates of NICU hospitalization. These findings suggest a need to target the NICU to improve maternal MH screening, services, and support while acknowledging the influence of social determinants, including race and ethnicity, on health outcomes.
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Abdollahi F, Lye MS, Yazdani Cherati J, Zarghami M. Depressive symptoms in men immediately after birth. J Psychosom Res 2021; 151:110650. [PMID: 34739946 DOI: 10.1016/j.jpsychores.2021.110650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/08/2021] [Accepted: 10/10/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Depression is the second leading cause of morbidity worldwide. This study aimed to assess the prevalence and associated risk factors of paternal postpartum depressive symptoms (PPD). METHODS In a cross-sectional study, via a stratified random and convenience sampling method 591 couples who were referred to Mazandaran primary health centers between 2 and 8 weeks postpartum were recruited from March to October 2017. Couples were screened for depressive symptoms using Edinburgh Postnatal Depression Scale (EPDS). Fathers provided information on socio-demographic characteristics, life events, neonatal stressor, perceived stress (Perceived Stress Scale), social support (Multidimensional Scale of Perceived Social Support), and general health status using General Health Questionnaire (GHQ-12) as well. Data was analyzed using multiple logistic regression. RESULTS Overall, 93 fathers (15.7%) and 188 mothers (31.8%) reported depressive symptoms above the cut-off EPDS score of 12. In the multiple logistic regression model, older age, maternal depressive symptoms, higher GHQ-12 scores and increased recent life events were related to paternal PPD. A significant inverse association was found between number of children and paternal PPD. CONCLUSION Depressive symptoms especially in first-time fathers following the birth of a child are not uncommon. Creating opportunities for men to access special health care services, parental education to help adapting to parenthood, screening programs, and psychiatric/psychosocial interventions to decrease suffering of depression for both depressed parents are recommended.
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Affiliation(s)
- Fatemeh Abdollahi
- Department of Public Health, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran; Health Science Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Munn-Sann Lye
- Formerly, Department of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Malaysia
| | - Jamshid Yazdani Cherati
- Department of Biostatistics, Faculty of Health, Mazandaran University of Medical Science, Sari, Iran
| | - Mehran Zarghami
- Department of Psychiatry, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.
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10
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Gifford JJ, Pluchino JR, Della Valle R, Schwarz JM. Regional Differences in Various Risk Factors for Postpartum Depression: Applying Mixed Models to the PRAMS Dataset. Front Glob Womens Health 2021; 2:726422. [PMID: 34816242 PMCID: PMC8594048 DOI: 10.3389/fgwh.2021.726422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/04/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: The purpose of this study was to assess the association between various risk factors with postpartum depression severity using a large dataset that included variables such as previous mental health status, social factors, societal factors, health care access, and other state-wide or region-specific variables. Methods: We obtained the most recently available (2016–2017) dataset from the Pregnancy Risk Assessment Monitoring System (PRAMS), which is a dataset compiled by the Centers for Disease Control (CDC) that collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy from over 73,000 women in 39 states. We utilized a hierarchical linear model to analyze the data across various levels, with a symptom severity scale (0–8) as the dependent variable. Results: Of the 21 variables included in the final model, nine variables were statistically significant predictors of symptom severity. Statistically significant predictors of increased postpartum depression symptom severity included previous depression diagnosis and depression symptoms during pregnancy, baby not residing with mother, unintentional pregnancy, women with less than a high school degree and more than a college degree, Women Infants Children (WIC) enrollment, and married women. In contrast to these other factors, attendance at a postpartum follow up appointment was associated with significantly increased symptom severity. Age revealed an inverted curve in predicting postpartum symptom severity. Conclusions: There was no significant difference in symptom severity scores across the 39 participating states. Most notably, postpartum depression symptom severity was associated with previous depression diagnosis and previous symptom severity, but our results also reveal novel social and education factors that contribute to the support and well-being of the mother and child.
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Affiliation(s)
- Janace J Gifford
- Department of Psychology, University of Delaware, Newark, DE, United States
| | - Jenna R Pluchino
- Department of Psychology, University of Delaware, Newark, DE, United States
| | | | - Jaclyn M Schwarz
- Department of Psychology, University of Delaware, Newark, DE, United States
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11
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Valdes V, Berens AE, Nelson CA. Socioeconomic and psychological correlates of postpartum depression at 6 months in Dhaka, Bangladesh. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2021; 56:729-738. [PMID: 33331021 PMCID: PMC8451745 DOI: 10.1002/ijop.12735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/26/2020] [Indexed: 01/18/2023]
Abstract
To current study aimed to estimate the point prevalence and identify correlates of postpartum depression (PPD) in a sample of mothers in Dhaka. A total of 235 participants from low- and middle-SES neighbourhoods in Dhaka completed the Edinburgh Postnatal Depression Scale (EPDS) and other assessments of socioeconomic and psychological factors at 24 weeks postpartum. Regression models were fit to explore potential correlates of PPD. The estimated prevalence of high PPD risk in the current sample is 24.3%. In multivariable linear regression models, recent life events, perceived stress and household resources (e.g., access to cooking gas, telephone, furniture, electricity, television, etc.) were significantly associated with PPD. The association of social support with PPD when controlling for other variables was sensitive to the choice of social support measure, highlighting an important methodological issue. The point prevalence of PPD among poor, urban mothers in Bangladesh ranges from 12.3 to 28.5%, with psychological risk factors and household resources as strong correlates.
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Affiliation(s)
- Viviane Valdes
- Boston Children's HospitalHarvard Medical School, Labs of Cognitive NeuroscienceBostonUSA
| | - Anne E. Berens
- Boston Children's HospitalHarvard Medical School, Labs of Cognitive NeuroscienceBostonUSA
| | - Charles A. Nelson
- Boston Children's HospitalHarvard Medical School, Labs of Cognitive NeuroscienceBostonUSA
- Harvard Graduate School of EducationCambridgeMAUSA
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12
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Barrios YV, Maselko J, Engel SM, Pence BW, Olshan AF, Meltzer-Brody S, Dole N, Thorp JM. The relationship of cumulative psychosocial adversity with antepartum depression and anxiety. Depress Anxiety 2021; 38:1034-1045. [PMID: 34370895 DOI: 10.1002/da.23206] [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: 01/18/2021] [Revised: 06/30/2021] [Accepted: 07/20/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Exposure to multiple psychosocial risk factors may increase vulnerability for mental health conditions during pregnancy. This analysis examined the relationship of a novel psychosocial adversity index with the co-occurrence and persistence of depression and anxiety throughout pregnancy. METHODS This cross-sectional analysis included 1797 pregnant women screened in the second/third trimesters for depression and anxiety symptoms and for eight contextual and individual psychosocial factors. The factors were summed to create a psychosocial adversity index; reporting four or more factors indicated high adversity. Elevated symptoms in both trimesters indicated persistent depression/anxiety and elevated symptoms at the same trimester indicated comorbid symptoms. The associations between the psychosocial adversity index and mental health were estimated. RESULTS Compared with a low psychosocial adversity index, women reporting a high level of psychosocial adversities had 2.06 (95% confidence interval [CI]: 1.51-2.82) times higher adjusted odds of only depressive or anxiety symptoms, and 5.57 (95% CI: 3.95-7.85) times higher adjusted odds of comorbid symptoms. The associations for persistent symptoms were of similar direction and magnitude. CONCLUSION High psychosocial adversity was associated with persistent and comorbid depressive symptoms and anxiety during pregnancy. Assessing psychosocial adversity can help identify women at increased risk who would benefit from tailored mental health interventions.
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Affiliation(s)
- Yasmin V Barrios
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joanna Maselko
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Stephanie M Engel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Nancy Dole
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - John M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Dachew BA, Scott JG, Heron JE, Ayano G, Alati R. Association of Maternal Depressive Symptoms During the Perinatal Period With Oppositional Defiant Disorder in Children and Adolescents. JAMA Netw Open 2021; 4:e2125854. [PMID: 34591106 PMCID: PMC8485171 DOI: 10.1001/jamanetworkopen.2021.25854] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE An association between perinatal maternal depression and risk of oppositional defiant disorder (ODD) in offspring has not been established. Identifying early determinants of ODD can help inform preventative intervention efforts. OBJECTIVE To investigate the association between maternal perinatal depressive symptoms and the risk of ODD in offspring aged 7 to 15 years. DESIGN, SETTING, AND PARTICIPANTS This population-based longitudinal birth cohort study used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), in Bristol, UK. All pregnant women residents in Avon, UK, with expected delivery dates from April 1, 1991, to December 31, 1992, were invited to participate in the study. The study cohort ranged from approximately 8000 (at 7 years of age) to 4000 (at 15 years of age) mother-offspring pairs. Data were analyzed from November 2020 to July 2021. MAIN OUTCOMES AND MEASURES Maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS) antenatally at 18 and 32 weeks of gestation and postnatally at 8 weeks and 8 months. This study primarily used a cutoff score of 12 or more on the EPDS to identify mothers with symptoms of depression, and the continuous EPDS scores were used to confirm the results of the main analyses. Offspring ODD at 7, 10, 13, and 15 years of age were diagnosed using the parent-reported Development and Well-Being Assessment. RESULTS Of 7994 mother-offspring pairs for whom data were available on offspring ODD at 7 years, 4102 offspring (51.3%) were boys. The mean (SD) age of mothers was 28.6 (4.6) years. Maternal antenatal depressive symptoms (measured at 32 weeks of gestation) were associated with offspring ODD (adjusted odds ratio [AOR], 1.75; 95% CI, 1.33-2.31). Offspring of mothers with postpartum depressive symptoms at 8 weeks and 8 months were more than 2 times more likely to have a diagnosis of ODD over time (AOR at 8 weeks, 2.24 [95% CI, 1.74-2.90]; AOR at 8 months, 2.04 [95% CI, 1.55-2.68]), and maternal persistent depressive symptoms were associated with a 4-fold increased risk of offspring ODD (AOR, 3.59; 95% CI, 1.98-6.52). CONCLUSIONS AND RELEVANCE These findings suggest that perinatal depressive symptoms are associated with ODD in offspring and further support the need for early identification and management of prenatal and postnatal depression in women of childbearing age.
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Affiliation(s)
| | - James G. Scott
- QIMR Berghofer Medical Research Institute, Herston, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, Australia
- Metro North Mental Health, Royal Brisbane and Women’s Hospital, Herston, Australia
| | - Jon E. Heron
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Getinet Ayano
- School of Population Health, Curtin University, Perth, Australia
- Research Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Rosa Alati
- School of Population Health, Curtin University, Perth, Australia
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
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Aker AM, Vigod SN, Dennis CL, Kaster T, Brown HK. The association between asthma and perinatal mental illness: a population-based cohort study. Int J Epidemiol 2021; 51:964-973. [PMID: 34379748 DOI: 10.1093/ije/dyab160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Asthma is a risk factor for mental illness, but few studies have explored this association around the time of pregnancy. We studied the association between asthma and perinatal mental illness and explored the modifying effects of social and medical complexities. METHODS In a population-based cohort of 846 155 women in Ontario, Canada, with a singleton live birth in 2005-2015 and no recent history of mental illness, modified Poisson regression models were constructed to examine the association between asthma diagnosed before pregnancy and perinatal mental illness, controlling for socio-demographics and medical history. We explored the modifying effects of social and medical complexities using relative excess risk due to interaction. Additional analyses examined the association between asthma and perinatal mental illness by timing and type of mental illness. RESULTS Women with asthma were more likely than those without asthma to have perinatal mental illness [adjusted relative risk (aRR) 1.14; 95% (confidence interval) CI: 1.13, 1.16]. Asthma was associated with increased risk of diagnosis of mental illness prenatally (aRR 1.11; 95% CI: 1.08, 1.13) and post-partum (aRR 1.17; 95% CI: 1.15, 1.19) and specifically diagnoses of mood and anxiety disorders (aRR 1.14; 95% CI: 1.13, 1.16), psychotic disorders (aRR 1.20; 95% CI: 1.10, 1.31) and substance- or alcohol-use disorders (aRR 1.24; 95% CI: 1.14, 1.36). There was no effect modification related to social or medical complexity for these outcomes. CONCLUSIONS Women with asthma predating pregnancy are at slightly increased risk of mental illness in pregnancy and post-partum. A multidisciplinary management strategy may be required to ensure timely identification and treatment.
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Affiliation(s)
- Amira M Aker
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.,ICES, Toronto, Canada
| | - Simone N Vigod
- ICES, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tyler Kaster
- ICES, Toronto, Canada.,Centre for Addiction & Mental Health, Toronto, Canada
| | - Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.,ICES, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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15
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Ladyman C, Gander P, Huthwaite M, Sweeney B, Signal TL. Sleep HAPi: A Feasibility and Descriptive Analysis of an Early and Longitudinal Sleep Education Intervention for Pregnant Women. Behav Sleep Med 2021; 19:427-444. [PMID: 32497446 DOI: 10.1080/15402002.2020.1772265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Poor sleep and prior depression are key predictors of perinatal depression, with research suggesting depressive symptoms may emerge in early pregnancy. Sleep is a potentially modifiable risk factor for depression. This pilot study examined the feasibility and acceptability of a six-month sleep education intervention designed to optimize sleep and minimize depressive symptoms throughout pregnancy. Sleep measures and depressive symptoms are described from 12 weeks gestation to 12 weeks postpartum.Participants: A community sample of nulliparous pregnant women with a history of depression were recruited prior to 14 weeks gestation.Methods: An individualized sleep education program was developed and participants engaged in three trimester specific sleep education sessions. Feasibility and acceptability were determined via recruitment and retention rates and participant feedback. Depressive symptoms and sleep were measured at five time points throughout the study.Results: 22 women enrolled in the study and 15 completed the intervention. Participants reported the intervention as highly acceptable. There was minimal change in all dimensions of sleep across pregnancy, but sleep measures were significantly worse at six weeks postpartum and improved by 12 weeks postpartum. Depressive symptoms were significantly lower at the conclusion of the intervention and 12 weeks postpartum compared to trimester 1.Conclusions: This sleep education program appears feasible, acceptable and may be effective in minimizing depressive symptoms in pregnant women with a history of depression. Trials with larger and more diverse samples are warranted and further studies to ascertain efficacy should be undertaken with a control group.
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Affiliation(s)
- Clare Ladyman
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Philippa Gander
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Bronwyn Sweeney
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - T Leigh Signal
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
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16
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Ladyman C, Signal TL, Sweeney B, Jefferies M, Gander P, Paine SJ, Huthwaite M. Multiple dimensions of sleep are consistently associated with chronically elevated depressive symptoms from late pregnancy to 3 years postnatal in Indigenous and non-Indigenous New Zealand women. Aust N Z J Psychiatry 2021; 55:687-698. [PMID: 33176439 DOI: 10.1177/0004867420972762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Poor sleep and depressive symptoms are common throughout the perinatal period, but little is known about the extended time course of depression and the sleep dimensions associated with these trajectories. OBJECTIVE This study investigated different depression trajectories in New Zealand Māori and non-Māori women from late pregnancy to 3 years postnatal. Relationships between multiple dimensions of sleep and these depression trajectories were also investigated. METHODS Data from 856 women (30.6% Māori and 69.4% non-Māori) from the longitudinal Moe Kura cohort study were used. Depressive symptoms and multiple dimensions of sleep (quality, duration, latency, continuity and daytime sleepiness) were collected at 36 weeks' gestation, 12 weeks postnatal and 3 years postnatal. Trajectory analysis was completed using latent class analysis. RESULTS Latent class analysis revealed two distinct groups of depressive symptom trajectories: 'chronic high' and 'stable mild' for both Māori and non-Māori women. Māori women in both trajectories were more likely than non-Māori women to have clinically significant depressive symptoms at every time point. Poorer sleep quality, latency, continuity and greater daytime sleepiness were consistently associated with the chronic high depressive symptom trajectory at all three time points, after controlling for sociodemographic factors. CONCLUSION A significant proportion of Māori and non-Māori women experience chronically high depressive symptoms during the perinatal period and the following years. Across this extended time frame, Māori women have a higher probability of experiencing clinically significant depressive symptoms compared to non-Māori women. These persistent patterns of depressive symptoms occur concurrently with multiple dimensions of poor sleep. Given the well-described impact of maternal depression on the mother, child, family and community, this highlights the importance of healthcare professionals asking about mothers' sleep quality, continuity, latency and daytime sleepiness as potential indicators of long-term mood outcomes.
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Affiliation(s)
- Clare Ladyman
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - T Leigh Signal
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Bronwyn Sweeney
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Mona Jefferies
- Health Services Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Philippa Gander
- Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Sarah-Jane Paine
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine (Wellington), University of Otago, Wellington, New Zealand
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Vanderkruik R, Gonsalves L, Kapustianyk G, Allen T, Say L. Mental health of adolescents associated with sexual and reproductive outcomes: a systematic review. Bull World Health Organ 2021; 99:359-373K. [PMID: 33958824 PMCID: PMC8061667 DOI: 10.2471/blt.20.254144] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To systematically review the literature on the mental health of adolescents associated with sexual and reproductive outcomes, and compare the mental health outcomes with that of other age groups. Methods We searched seven databases for relevant peer-reviewed articles published between 1 January 2010 and 25 April 2019. Our inclusion criteria required that the study included age-disaggregated data on adolescents, and focused and assessed mental health outcomes associated with pregnancy or sexually transmitted infections. We extracted data on the specific health event, the mental health outcome and the method of measuring this, and comparisons with other age groups. Findings After initially screening 10 818 articles by title and abstract, we included 96 articles in our review. We observed that a wide-ranging prevalence of mental ill-health has been reported for adolescents. However, most studies of mental health during pregnancy did not identify an increased risk of depression or other mental disorders among adolescents compared with other age groups. In contrast, the majority of studies conducted during the postpartum period identified an increased risk of depression in adolescents compared with other age groups. Three studies reported on mental health outcomes following abortion, with varying results. We found no studies of the effect of sexually transmitted infections on mental health among adolescents. Conclusion We recommend that sexual and reproductive health services should be accessible to adolescents to address their needs and help to prevent any adverse mental health outcomes.
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Affiliation(s)
- Rachel Vanderkruik
- Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, United States of America
| | - Lianne Gonsalves
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Tomas Allen
- Department of Quality, Norms and Standards, World Health Organization, Geneva, Switzerland
| | - Lale Say
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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18
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Booth EJ, Kitsantas P, Min H, Pollack AZ. Stressful life events and postpartum depressive symptoms among women with disabilities. WOMEN'S HEALTH 2021; 17:17455065211066186. [PMID: 34904463 PMCID: PMC8679014 DOI: 10.1177/17455065211066186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: Although research evidence indicates positive associations between stressful
life events and postpartum depression, limited research assessed these
associations in women with disabilities. This study examined the effects of
stressful life events on postpartum depressive symptoms in women with
disabilities. Methods: Data from the 2012–2017 Massachusetts Pregnancy Risk Assessment Monitoring
System (n = 8453) were used in this study. Women were asked
if they experienced any life stressors (e.g. financial, traumatic,
relational, and emotional) during the 12 months prior to giving birth.
Disability was measured based on reports of emotional and physical
functioning. Descriptive statistics, bivariate, and binary logistic
regression analyses were conducted to estimate the effect of stressful life
events on postpartum depressive symptoms among women with and without
disabilities. Results: Findings show that 37.4% of women with disabilities had postpartum depressive
symptoms, which was significantly higher than 8.79% of women without
disabilities. Stressful life events were reported in 86.6% of women with
disabilities, compared to 66.6% for women without disabilities. Prevalence
of three or more stressful life events and postpartum depressive symptoms
was greater among women with disabilities (50.8% and 62.9%, respectively)
than women without disabilities (22.6% and 37.0%, respectively). Women with
disabilities experiencing six or more stressful life events were more likely
(odds ratio = 3.78, 95% confidence interval = [1.57–9.10]) to report
postpartum depressive symptoms, compared to those with no stressful life
events. Women with disabilities who experienced relational (odds ratio =
2.36, 95% confidence interval = [1.44–3.87]) and traumatic (odds ratio =
1.75, 95% confidence interval = [1.02–3.00]) life stressors had higher odds
for postpartum depressive symptoms relative to those reporting no such life
stressors. Conclusion: Women with disabilities are at an amplified risk for stressful life events
and postpartum depressive symptoms. Relational and traumatic stressful life
events particularly increase the odds for postpartum depressive symptoms
among this group of mothers. Early prenatal and postnatal screening for life
stressors and depressive symptoms, coupled with timely referral for
appropriate prenatal and postnatal care, are vital to mitigate the harmful
effects of depression among mothers with disabilities and the health of
their children.
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Affiliation(s)
- Edward J Booth
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Panagiota Kitsantas
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Hua Min
- Department of Health Administration and Policy, George Mason University, Fairfax, VA, USA
| | - Anna Z Pollack
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
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19
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Beasley DR. The Importance of Antepartum Maternal Depression Screening and Education: A Narrative Review of the Literature. J Psychosoc Nurs Ment Health Serv 2020; 58:19-23. [PMID: 32609862 DOI: 10.3928/02793695-20200624-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/02/2020] [Indexed: 11/20/2022]
Abstract
The purpose of this literature review is to explain the current practice of antepartum maternal depression screening and education. The American College of Obstetricians and Gynecologists recommends that pregnant women be screened at least once during the antepartum phase of pregnancy by their health care provider. The fact that many women present with depression or anxiety at several time points during pregnancy suggests that only one screening during pregnancy is not enough. Antepartum and postpartum depression education is lacking within the prenatal period. This lack of education may decrease self-identification, leading to the decreased screening of pregnant women. Antepartum depression has a high probability of becoming postpartum depression, which might have significant implications for early discovery during pregnancy. These circumstances make antepartum depression one of the most under-recognized and under-treated conditions. [Journal of Psychosocial Nursing and Mental Health Services, 58(10), 19-23].
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Kim P, Tribble R, Olsavsky AK, Dufford AJ, Erhart A, Hansen M, Grande L, Gonzalez DM. Associations between stress exposure and new mothers' brain responses to infant cry sounds. Neuroimage 2020; 223:117360. [PMID: 32927083 PMCID: PMC8291268 DOI: 10.1016/j.neuroimage.2020.117360] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/24/2020] [Accepted: 09/03/2020] [Indexed: 01/16/2023] Open
Abstract
Exposure to severe stress has been linked to negative postpartum outcomes among new mothers including mood disorders and harsh parenting. Non-human animal studies show that stress exposure disrupts the normative adaptation of the maternal brain, thus identifying a neurobiological mechanism by which stress can lead to negative maternal outcomes. However, little is known about the impact of stress exposure on the maternal brain response to infant cues in human mothers. We examined the association of stress exposure with brain response to infant cries and maternal behaviors, in a socioeconomically diverse (low- and middle-income) sample of first-time mothers (N=53). Exposure to stress across socioeconomic, environmental, and psychosocial domains was associated with reduced brain response to infant cry sounds in several regions, including the right insula/inferior frontal gyrus and superior temporal gyrus. Reduced activation in these regions was further associated with lower maternal sensitivity observed during a mother-infant interaction. The findings demonstrate that higher levels of stress exposure may be associated with reduced brain response to an infant’s cry in regions that are important for emotional and social information processing, and that reduced brain responses may further be associated with increased difficulties in developing positive mother-infant relationships.
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Affiliation(s)
- Pilyoung Kim
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States.
| | - Rebekah Tribble
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Aviva K Olsavsky
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States; University of Colorado Anschutz School of Medicine/Children's Hospital Colorado, 13123 E. 16th Avenue, CO 80045, United States
| | - Alexander J Dufford
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Andrew Erhart
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Melissa Hansen
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Leah Grande
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States
| | - Daniel M Gonzalez
- Department of Psychology, University of Denver, Denver, 2155 South Race Street, Denver, CO 80208-3500, United States; Harvard Medical School, Boston, 25 Shattuck St, Boston, MA 02115, United States
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21
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Abstract
Acculturation has been related to risk of postpartum depression (PPD) among immigrant women globally. The purpose of this study was to examine the relationship between acculturation and PPD symptoms among U.S. immigrant women of Arabic descent. A cross-sectional study was conducted with 115 postpartum immigrant women of Arabic descent. Women completed questionnaires including measures of acculturation [attraction to Arabic culture (AArC), attraction to American culture (AAmC), marginalization] and PPD symptoms (Edinburgh Postnatal Depression Scale-EPDS) between 1 and 12 months postpartum. Twenty-five percent of women (n = 29) had EPDS scores ≥ 10 that represent PPD symptoms. Women with higher marginalization reported more PPD symptoms (r = .25, p = .008). None of the acculturation factors correlated with PPD symptoms after adjustment for maternal sociodemographic and health characteristics. Higher education (p = .001), lower gestational age at birth (p < .05), and antenatal anxiety (p < .05) were correlated with PPD symptoms in multivariate analyses. Health care providers should identify and assess immigrant women of Arabic descent for antenatal anxiety as this may identify women at risk for development of PPD symptoms. Future studies need to examine acculturation in relation to mental health among immigrant women of Arabic descent.
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Moore Simas TA, Huang MY, Packnett ER, Zimmerman NM, Moynihan M, Eldar-Lissai A. Matched cohort study of healthcare resource utilization and costs in young children of mothers with postpartum depression in the United States. J Med Econ 2020; 23:174-183. [PMID: 31597499 DOI: 10.1080/13696998.2019.1679157] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: To assess healthcare resource utilization (HRU) and costs in children of mothers with and without postpartum depression (PPD).Methods: Administrative claims data from the IBM Watson Health MarketScan Databases (2010-2016) were used. Women with live births (index date = delivery date) were identified and linked to their newborns. The mother-child pairs were divided into PPD and non-PPD exposure cohorts based on claims for depression, mood or adjustment disorders, or anxiety identified in the mother between 15 and 365 days after delivery. Mother-child pairs with PPD exposure were propensity score matched 1:3 to mother-child pairs without PPD exposure. Children were required to have 24 months of continuous health plan enrolment following delivery. Additional comparisons were performed between mother-child pairs with and without preterm delivery.Results: Overall, 33,314 mother-child pairs with PPD exposure were propensity score matched to 102,364 mother-child pairs without PPD exposure. During the 24-month follow-up period, HRU across most service categories was significantly higher among children in the PPD exposure cohort than non-PPD exposure cohort. Among outpatient services, the percentages of children with a physician specialist service (68% versus 64%), early-intervention screening (40% versus 37%), and an emergency room visit (48% versus 42%) were greater in children of mothers with PPD (all p < .001). Furthermore, children of mothers with PPD incurred 12% higher total healthcare costs in the first 24 months of life compared to children of mothers without PPD ($24,572 versus $21,946; p < .001). After excluding mothers with preterm delivery, the proportion of children with ER visits, physician specialist services, and outpatient pharmacy claims was significantly higher in the PPD exposure cohort than non-PPD exposure cohort (all p < .001).Conclusion: The results of this analysis suggest that HRU and costs over the first 24 months of life in children of mothers with PPD exceeded that of children of mothers without evidence of PPD.
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Affiliation(s)
- Tiffany A Moore Simas
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry and Population & Quantitative Health Sciences, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, USA
| | - Ming-Yi Huang
- Health Economics Outcomes Research, Sage Therapeutics, Inc, Cambridge, MA, USA
| | | | | | | | - Adi Eldar-Lissai
- Health Economics Outcomes Research, Sage Therapeutics, Inc, Cambridge, MA, USA
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Hehlmann MI, Schaan V, Rubel J. Eine meta-analytische Untersuchung des sozioökonomischen Status als Risikofaktor für postpartale Depression. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2018. [DOI: 10.1026/1616-3443/a000491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Zusammenfassung. Theoretischer Hintergrund: 13 % aller Gebärenden leiden an postpartalen Depressionen (PPD), einer Krankheit mit bedeutsamen gesundheitlichen und sozialen Konsequenzen für die Betroffenen. Zurzeit werden PPD jedoch häufig spät erkannt und behandelt. Eine Früherkennung könnte durch die Identifikation spezifischer Vulnerabilitätsfaktoren erleichtert werden. Niedriger sozioökonomischen Status (SES) wurde als potenzieller Risikofaktor für Depressionen diskutiert ( Lorant et al., 2003 ). Fragestellung: Das Ziel der vorliegenden Meta-Analyse ist die systematische Untersuchung, ob niedriger SES mit einem erhöhten Risiko für die Entwicklung einer PPD einhergeht. Methode: Um die Vergleichbarkeit der eingeschlossenen Studien zu gewährleisten, werden die internationalen Empfehlungen zur Erfassung des SES von Jöckel et al. (1998) als Inklusionskriterium herangezogen. Die identifizierten Studien werden meta-analytisch zusammengefasst. Ergebnisse: Weder Bildung mit einem relativen Risiko (RR) = 1.14 (95 % KI = 0.95, 1.45) noch Einkommen mit RR = 1.32 (95 % KI = 0.99, 1.74) waren signifikant mit der Entwicklung einer PPD assoziiert. Schlussfolgerung: Es wurde kein Zusammenhang zwischen dem erhöhten Risiko eine PPD zu entwickeln und dem Bildungsniveau oder dem Einkommen gefunden. Die vorliegende Studie macht auf die gravierenden methodischen Mängel im Bereich der Forschung von PPD und dem SES aufmerksam.
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Lin Y, Hu W, Xu J, Luo Z, Ye X, Yan C, Liu Z, Tong S. Association between temperature and maternal stress during pregnancy. ENVIRONMENTAL RESEARCH 2017; 158:421-430. [PMID: 28689033 DOI: 10.1016/j.envres.2017.06.034] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 06/09/2017] [Accepted: 06/27/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Maternal psychological stress during pregnancy has essentially been conceptualized as a teratogen. However, little is known about the effect of temperature on maternal stress during pregnancy. The aim of this study is to investigate the relationship between temperature and maternal stress during pregnancy. METHODS In 2010, a total of 1931 eligible pregnant women were enrolled across Shanghai from four prenatal-care clinics during their mid-to-late pregnancy. Maternal life-event stress and emotional stress levels during pregnancy were assessed by the "Life Event Scale for Pregnant Women" (LESPW) and "Symptom Checklist-90-Revised Scale" (SCL-90-R), respectively. Exposure to ambient temperature was evaluated based on daily regional average in different moving average and lag days. The generalized estimating equations were used to evaluate the relationship between daily average temperature/temperature difference and maternal stress. RESULTS After adjusting for relevant confounders, an U-shaped relationship was observed between daily average temperature and maternal Global-Severity-Index (GSI) of the SCL-90-R. Cumulative exposures to extremely low temperatures (< P5, 1.4-10.5℃, lag 0-1 days, 0-2 days and 0-5 days) and extremely high temperatures (≥ P95, 31.2-34.1℃, lag 0-1 days and 0-2 days), and acute exposures to extremely low (lag day 0, 1, 2 and 3) and high (lag day 0, 1) temperatures, all induced higher risks of high GSI (the highest tertile), compared to the risk induced by exposed to an optimal temperature range (20-25℃) (P< 0.05). Increased temperature difference was associated with high maternal GSI (P< 0.05). However, non-significant associations were observed between daily average temperatures/temperature differences and maternal log-transferred LESPW scores. CONCLUSIONS Cumulative and acute exposures to extremely low/high temperatures may both induce emotional stress during pregnancy.
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Affiliation(s)
- Yanfen Lin
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Wenjing Hu
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Jian Xu
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
| | - Zhongcheng Luo
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Xiaofang Ye
- Shanghai Key Laboratory of Meteorology and Health, Shanghai 200135, China
| | - Chonghuai Yan
- Xinhua Hospital, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Zhiwei Liu
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Shilu Tong
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
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