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Franck LS, Gay CL, Hoffmann TJ, Kriz RM, Bisgaard R, Cormier DM, Joe P, Lothe B, Sun Y. Maternal mental health after infant discharge: a quasi-experimental clinical trial of family integrated care versus family-centered care for preterm infants in U.S. NICUs. BMC Pediatr 2023; 23:396. [PMID: 37563722 PMCID: PMC10413600 DOI: 10.1186/s12887-023-04211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Involvement in caregiving and tailored support services may reduce the risk of mental health symptoms for mothers after their preterm infant's neonatal intensive care unit (NICU) discharge. We aimed to compare Family-Centered Care (FCC) with mobile-enhanced Family-Integrated Care (mFICare) on post-discharge maternal mental health symptoms. METHOD This quasi-experimental study enrolled preterm infant (≤ 33 weeks)/parent dyads from three NICUs into sequential cohorts: FCC or mFICare. We analyzed post-discharge symptoms of perinatal post-traumatic stress disorder (PTSD) and depression using intention-to-treat and per protocol approaches. RESULTS 178 mothers (89 FCC; 89 mFICare) completed measures. We found no main effect of group assignment. We found an interaction between group and stress, indicating fewer PTSD and depression symptoms among mothers who had higher NICU-related stress and received mFICare, compared with mothers who had high stress and received FCC (PTSD: interaction β=-1.18, 95% CI: -2.10, -0.26; depression: interaction β=-0.76, 95% CI: -1.53, 0.006). Per protocol analyses of mFICare components suggested fewer PTSD and depression symptoms among mothers who had higher NICU stress scores and participated in clinical team rounds and/or group classes, compared with mothers who had high stress and did not participate in rounds or classes. CONCLUSION Overall, post-discharge maternal mental health symptoms did not differ between the mFICare and FCC groups. However, for mothers with high levels of stress during the NICU stay, mFICare was associated with fewer post-discharge PTSD and depression symptoms.
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Affiliation(s)
- Linda S Franck
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA.
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA
| | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, Office of Research, School of Nursing, UCSF, San Francisco, CA, USA
| | - Rebecca M Kriz
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), 2 Koret Way, N411F, Box 0606, San Francisco, CA, 94143, USA
| | - Robin Bisgaard
- Intensive Care Nursery, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Diana M Cormier
- NICU and Pediatrics, Community Regional Medical Center, Fresno, CA, USA
| | - Priscilla Joe
- Division of Neonatology, UCSF Benioff Children's Hospital, Oakland, CA, USA
| | | | - Yao Sun
- Division of Neonatology, Department of Pediatrics, UCSF, San Francisco, CA, USA
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White-Traut R, Gillette P, Simpson P, Zhang L, Nazarloo HP, Carter CS. Early Postpartum Maternal and Newborn Responses to Auditory, Tactile, Visual, Vestibular, and Olfactory Stimuli. J Obstet Gynecol Neonatal Nurs 2022; 51:402-417. [PMID: 35469779 DOI: 10.1016/j.jogn.2022.03.003] [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: 03/10/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To compare maternal psychological well-being, newborn behavior, and maternal and newborn salivary oxytocin (OT) and cortisol before and after two maternally administered multisensory behavioral interventions or an attention control group. DESIGN Randomized prospective clinical trial. SETTING U.S. Midwest community hospital. PARTICIPANTS Newborns and their mothers (n = 102 dyads) participated. Mothers gave birth vaginally at term gestation and had no physical or mental health diagnoses. Newborns with low Apgar scores, receipt of oxygen, suspected infection, or congenital anomalies were excluded. METHODS Dyads were randomly assigned to the auditory, tactile, visual, and vestibular (ATVV) intervention, the ATVV with odor from a baby lotion (ATVVO), or the attention control (AC) Group. Maternal psychological well-being, newborn behavior, and endocrine responses (salivary cortisol and OT) were measured before and after the intervention. RESULTS Newborns in the ATVV and ATVVO groups exhibited increases in potent engagement behaviors (p < .0001 and p = .001, respectively). Newborns in the AC group exhibited a decrease in potent engagement (p = .013) and an increase in potent disengagement (p = .029). Mothers in the ATVVO group exhibited an increase in OT (p = .01) and the largest change in OT (p = .02) compared to mothers in the ATVV and AC groups. We noted no change in maternal psychological well-being or newborn endocrine responses. CONCLUSION Inclusion of an odor via lotion with a behavioral intervention (ATVV) influenced maternal OT more than the behavioral intervention alone. Newborns were behaviorally responsive to the interventions; however, endocrine measures were not associated with intervention changes.
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3
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Haeusslein L, Gano D, Gay CL, Kriz RM, Bisgaard R, Vega M, Cormier DM, Joe P, Walker V, Kim JH, Lin C, Sun Y, Franck LS. Relationship between social support and post-discharge mental health symptoms in mothers of preterm infants. J Reprod Infant Psychol 2021:1-15. [PMID: 34587850 PMCID: PMC8960471 DOI: 10.1080/02646838.2021.1984404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Social support is associated with decreased symptoms of postpartum mood and anxiety disorders (PMAD) in mothers of healthy infants, but less is known about social support and PMADs in mothers with preterm infants. The purpose of this study was to examine the relationship between social support and symptoms of PMADs reported by mothers in the months following hospital discharge of their preterm infant. METHODS Mothers of infants less than 33 weeks gestational age were enrolled from neonatal intensive care units (NICU) at 6 sites. Mothers completed PMAD measures of depression, anxiety and post-traumatic stress approximately 3 months following their infant's discharge. Multivariable regression was used to evaluate relationships between social support and PMAD measures. RESULTS Of 129 mothers, 1 in 5 reported clinically significant PMAD symptoms of: depression (24%), anxiety (19%), and post-traumatic stress (20%). Social support was strongly inversely associated with all 3 PMADs. Social support explained between 21% and 26% of the variance in depression, anxiety and post-traumatic stress symptoms. CONCLUSION Increased social support may buffer PMAD symptoms in mothers of preterm infants after discharge. Research is needed to determine effective screening and interventions aimed at promoting social support for all parents during and following their infant's hospitalisation.
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Affiliation(s)
- Laurel Haeusslein
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Dawn Gano
- Department of Neurology and Pediatrics, UCSF, San Francisco, California, USA
| | - Caryl L Gay
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Rebecca M Kriz
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Robin Bisgaard
- Intensive Care Nursery, UCSF Benioff Children's Hospital, San Francisco, California, USA
| | - Myrna Vega
- Intensive Care Nursery, UCSF Benioff Children's Hospital, San Francisco, California, USA
| | - Diana M Cormier
- NICU and Pediatrics, Community Regional Medical Center, Fresno, California, USA
| | - Priscilla Joe
- Division of Neonatology, UCSFG Benioff Children's Hospital, Oakland, California, USA
| | - Valencia Walker
- Department of Pediatrics, Division of Neonatology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Jae H Kim
- Division of Neonatology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Carol Lin
- Division of Neonatology, Kaiser Permanente Santa Clara, California, USA
| | - Yao Sun
- Division of Neonatology, UCSF Benioff Children's Hospital, San Francisco, California, USA
| | - Linda S Franck
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, California, USA
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4
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Webb R, Smith AM, Ayers S, Wright DB, Thornton A. Development and Validation of a Measure of Birth-Related PTSD for Fathers and Birth Partners: The City Birth Trauma Scale (Partner Version). Front Psychol 2021; 12:596779. [PMID: 33746826 PMCID: PMC7966709 DOI: 10.3389/fpsyg.2021.596779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/08/2021] [Indexed: 12/02/2022] Open
Abstract
Research suggests that some fathers and birth partners can experience post-traumatic stress disorder (PTSD) after witnessing a traumatic birth. Birth-related PTSD may impact on many aspects of fathers’ and birth partners’ life, including relationship breakdown, self-blame and reducing plans for future children. Despite the potential impact on birth partners’ lives there is currently no measure of birth-related PTSD validated for use with birth partners. The current study therefore adapted the City Birth Trauma Scale for use with birth partners. The City Birth Trauma Scale (Partner version) is a 29-item questionnaire developed to measure birth-related PTSD according to DSM-5 criteria: stressor criteria (A), symptoms of re-experiencing (B), avoidance (C), negative cognitions and mood (D), and hyperarousal (E), as well as duration of symptoms (F), significant distress or impairment (G), and exclusion criteria or other causes (H). A sample of 301 fathers/birth partners was recruited online and completed measures of birth-related PTSD, bonding, and demographic details. Results showed the City Birth Trauma Scale (Partner version) had good reliability (α = 0.94) and psychometric and construct validity. The fathers/birth partners version has the same two-factor structure as the original scale: (1) general symptoms and (2) birth-related symptoms, which accounted for 51% of the variance. PTSD symptoms were associated with preterm birth and maternal and infant complications. Overall, the City Birth Trauma Scale (Partner version) provides a promising measure of PTSD following childbirth that can be used in research and clinical practice.
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Affiliation(s)
- Rebecca Webb
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, United Kingdom
| | - Ann M Smith
- Neonatal Intensive Care Unit, Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, United Kingdom
| | - Daniel B Wright
- Department of Educational Psychology and Higher Education, University of Nevada, Las Vegas, NV, United States
| | - Alexandra Thornton
- Perinatal Mental Health Service, West London NHS Trust, St Bernard's Hospital, London, United Kingdom
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Prevention of posttraumatic stress disorder in mothers of preterm infants using trauma-focused group therapy: Manual development and evaluation. Early Hum Dev 2021; 154:105282. [PMID: 33248796 DOI: 10.1016/j.earlhumdev.2020.105282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Preterm birth has been associated with a number of adverse maternal psychological outcomes. AIMS The current study aims to develop and evaluate the feasibility of a trauma-focused group intervention that is designed to reduce maternal symptoms of anxiety, depression, and posttraumatic stress in a sample of mothers of preterm infants hospitalized in a neonatal intensive care unit (NICU). STUDY DESIGN The study was a one-group pre-/post quasi-experimental design. Participants received a 6-session intervention targeting parental trauma. SUBJECTS English-speaking mothers (N = 19) greater than 18 years of age of infants 23-34 weeks gestational age hospitalized in the NICU at Lucile Packard Children's Hospital Stanford. OUTCOME MEASURES Beck Anxiety Inventory (BAI), Beck Depression Inventory, Second Edition (BDI-II), Davidson Trauma Scale (DTS). RESULTS Results from the study indicate that the intervention is feasible, able to be implemented with a high degree of fidelity, is rated as highly satisfactory by participants, and leads to statistically significant reductions in symptoms of anxiety, depression, and posttraumatic stress at 6-week and 6-month follow-ups. CONCLUSIONS Though encouraging, these findings are preliminary, and future studies should strive to reproduce these findings with a larger sample size and a comparison group.
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Moreyra A, Dowtin LL, Ocampo M, Perez E, Borkovi TC, Wharton E, Simon S, Armer EG, Shaw RJ. Implementing a standardized screening protocol for parental depression, anxiety, and PTSD symptoms in the Neonatal Intensive Care Unit. Early Hum Dev 2021; 154:105279. [PMID: 33339676 DOI: 10.1016/j.earlhumdev.2020.105279] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this paper is to describe the development of a standardized screening program for parents of infants in the Neonatal Intensive Care Unit (NICU) and to assess its implementation. The standardized screening protocol assessed parental mental health symptoms including depression, anxiety and trauma. Screening began at 14 days post NICU admission and was implemented as part of routine medical care for all caregivers with infants admitted to the NICU at two weeks of age. Screenings were facilitated by pediatric social workers and psychology postdoctoral fellows and included review of critical self-harm items. A total of 158 parents ages 18-42 years (mean = 31.04) were eligible for screening, with 150 completed screenings. Positive screens on any of the three measures resulted in a mental health referral. Approximately 27% of parents had a positive screen that resulted in a mental health referral. The standardized screening protocol was found to be feasible, widely accepted, and effective in establishing referrals for in house mental health services. This model can be used as an example to help other NICUs implement their own universal screening protocols.
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Affiliation(s)
- Angelica Moreyra
- Children's Hospital Los Angeles, Los Angeles, CA, USA; Stanford University School of Medicine, Palo Alto, CA, USA.
| | - LaTrice L Dowtin
- Stanford University School of Medicine, Palo Alto, CA, USA; PlayfulLeigh Psyched, LLC, Hyattsville, MD, USA.
| | - Maria Ocampo
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, CA, USA.
| | - Emily Perez
- Lucile Packard Children's Hospital, Palo Alto, CA, USA.
| | | | - Emily Wharton
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, CA, USA.
| | - Stephanie Simon
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, CA, USA.
| | - Erin G Armer
- Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Richard J Shaw
- Stanford University School of Medicine, Palo Alto, CA, USA.
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7
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Van Haeken S, Braeken MAKA, Nuyts T, Franck E, Timmermans O, Bogaerts A. Perinatal Resilience for the First 1,000 Days of Life. Concept Analysis and Delphi Survey. Front Psychol 2020; 11:563432. [PMID: 33224056 PMCID: PMC7670043 DOI: 10.3389/fpsyg.2020.563432] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/09/2020] [Indexed: 02/02/2023] Open
Abstract
Background The ability to cope with challenges and stress in life is generally understood as resilience. Pregnancy and parenthood are challenging times. The concept of resilience is receiving increasing interest from researchers, clinicians, and policy staff because of its potential impact on health, well-being, and quality of life. Nevertheless, the concept is less studied during the perinatal period. Objectives The aim of this study is to understand the concept of perinatal resilience, including the underlying processes and more specifically for the first 1,000 days of life. Methods A concept analysis according to the Walker and Avant (2011) framework was used, to investigate the basic elements of the concept. Concurrently, a two-round Delphi survey involving researchers, clinicians, epidemiologists, mothers, and fathers (N = 21), was conducted to prioritize the terms associated with perinatal resilience. Data collection took place between January and April 2019. Results Through concept analysis and Delphi survey, five defining attributes for perinatal resilience were identified: social support, self-efficacy, self-esteem, sense of mastery and personality. The additional terms, rated important by the Delphi survey, were linked to the consequences of being resilient during the perinatal period for the individual and his/her family. Specifically, highlighted were the experiences of families in personal growth and achieving family balance, adaptation, or acceptance. Conclusion Based on the results of the concept analysis and Delphi survey, we describe perinatal resilience for the first 1,000 days as a circular process towards a greater well-being in the form of personal growth, family balance, adaptation or acceptance, when faced with stressors, challenges or adversity during the perinatal period. The presence of resiliency attributes such as social support, sense of mastery, self-efficacy, and self-esteem enhance the capacity to be resilient and probably prevent mental health problems.
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Affiliation(s)
- Sarah Van Haeken
- Research & Expertise, Resilient People, UC Leuven-Limburg, Diepenbeek, Belgium.,Faculty of Medicine, Department of Development and Regeneration, Women and Child, KU Leuven, Leuven, Belgium
| | - Marijke A K A Braeken
- Research & Expertise, Resilient People, UC Leuven-Limburg, Diepenbeek, Belgium.,Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Tinne Nuyts
- Faculty of Medicine, Department of Development and Regeneration, Women and Child, KU Leuven, Leuven, Belgium
| | - Erik Franck
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium
| | - Olaf Timmermans
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium.,Professorship Healthy Region, HZ University of Applied Sciences, Vlissingen, Netherlands
| | - Annick Bogaerts
- Faculty of Medicine, Department of Development and Regeneration, Women and Child, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium
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Comparison of family centered care with family integrated care and mobile technology (mFICare) on preterm infant and family outcomes: a multi-site quasi-experimental clinical trial protocol. BMC Pediatr 2019; 19:469. [PMID: 31791285 PMCID: PMC6886221 DOI: 10.1186/s12887-019-1838-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022] Open
Abstract
Background Family Centered Care (FCC) has been widely adopted as the framework for caring for infants in the Neonatal Intensive Care Unit (NICU) but it is not uniformly defined or practiced, making it difficult to determine impact. Previous studies have shown that implementing the Family Integrated Care (FICare) intervention program for preterm infants in the NICU setting leads to significant improvements in infant and family outcomes. Further research is warranted to determine feasibility, acceptability and differential impact of FICare in the US context. The addition of a mobile application (app) may be effective in providing supplemental support for parent participation in the FICare program and provide detailed data on program component uptake and outcomes. Methods This exploratory multi-site quasi-experimental study will compare usual FCC with mobile enhanced FICare (mFICare) on growth and clinical outcomes of preterm infants born at or before 33 weeks gestational age, as well as the stress, competence and self-efficacy of their parents. The feasibility and acceptability of using mobile technology to gather data about parent involvement in the care of preterm infants receiving FCC or mFICare as well as of the mFICare intervention will be evaluated (Aim 1). The effect sizes for infant growth (primary outcome) and for secondary infant and parent outcomes at NICU discharge and three months after discharge will be estimated (Aim 2). Discussion This study will provide new data about the implementation of FICare in the US context within various hospital settings and identify important barriers, facilitators and key processes that may contribute to the effectiveness of FICare. It will also offer insights to clinicians on the feasibility of a new mobile application to support parent-focused research and promote integration of parents into the NICU care team in US hospital settings. Trial registration ClinicalTrials.gov, ID NCT03418870. Retrospectively registered on December 18, 2017.
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9
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The impact of decision quality on mental health following periviable delivery. J Perinatol 2019; 39:1595-1601. [PMID: 31209275 DOI: 10.1038/s41372-019-0403-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/29/2019] [Accepted: 04/11/2019] [Indexed: 11/08/2022]
Abstract
PURPOSE To assess the relationship between decision quality and mental health outcomes for women and their important others (IO) 3 months following periviable birth. METHOD Mental health outcomes were assessed prior to delivery and at 3 months postpartum using depression (PHQ-9), anxiety (GAD-7), and post-traumatic stress disorder (PTSD) (IES-22) scales. Decision quality was measured in terms of Decisional Conflict, Control, Regret, and Satisfaction with Decision. Descriptive analyses and linear regression modeling were conducted using SAS version 9.4. RESULT We recruited 30 eligible women and 16 IOs. Participants had mild anxiety and depression, and symptoms of PTSD were among bereaved parents. Participants with lower decision control had higher levels of depression (women: p = 0.014; IOs: p = 0.059) and anxiety (women: p = 0.053; IOs: p = 0.032). Depression was also associated with higher decisional regret (women: p = 0.073; IOs: p = 0.023). CONCLUSION Our findings suggest that decision quality is associated with mental health outcomes for families who experience periviable delivery.
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10
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Roberts L, Davis GK, Homer CSE. Depression, Anxiety, and Post-traumatic Stress Disorder Following a Hypertensive Disorder of Pregnancy: A Narrative Literature Review. Front Cardiovasc Med 2019; 6:147. [PMID: 31649935 PMCID: PMC6794436 DOI: 10.3389/fcvm.2019.00147] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/24/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction: Pregnancy and childbirth can be a source of anxiety and worry for women. This is probably more so for women with a complicated pregnancy. Anxiety and worry may contribute to, or exacerbate, mental health disorders including depression and post-traumatic stress disorder (PTSD). Mental health is an integral part of health and well-being and poor mental health can be detrimental to the woman's welfare and her infant's behavior and cognitive development. It may be undetected, potentially leading to a burden on the woman, her family, the health system, and society. Women with complicated pregnancies, such as those with hypertensive disorders of pregnancy (HDP), may be at greater risk of poor mental health. The aim of this review was to examine whether there is an association between depression, anxiety, and PTSD in postpartum women with a history of HDP. Methods: A narrative literature review was undertaken. Using the key search terms: preeclampsia, gestational hypertension, hypertensive disorders, pregnancy complications, depression, anxiety, and post-traumatic stress disorder; electronic databases were searched to determine what is known about depression, anxiety, and PTSD after HDP. Results: In total, 17 publications were included. The relationship between HDP and depression, anxiety, and PTSD was variable between studies and inconsistent. Although some studies reported no significant association, there is a trend for increased prevalence and symptom severity of depression, anxiety, and PTSD following HDP. This trend was particularly evident following the more severe presentations of HDP. It was uncertain whether this association was due to the hypertensive disorder itself, the sequelae of the HDP, such as giving birth to a preterm baby, or it predated the pregnancy. Conclusions: Women who experience HDP may be at increased risk of developing postpartum depression, anxiety, and PTSD. Awareness of, and screening for, these mental health disorders in the postpartum period will alert clinicians to the need for additional follow-up and referral for women following HDP. More research on the benefits and risks of such an approach is needed.
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Affiliation(s)
- Lynne Roberts
- Women's and Children's Health, St. George Hospital, Sydney, NSW, Australia.,Faculty of Health, University of Technology, Sydney, NSW, Australia.,St George and Sutherland Clinical School UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Greg K Davis
- Women's and Children's Health, St. George Hospital, Sydney, NSW, Australia.,Faculty of Health, University of Technology, Sydney, NSW, Australia.,St George and Sutherland Clinical School UNSW Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Caroline S E Homer
- Faculty of Health, University of Technology, Sydney, NSW, Australia.,Maternal and Child Health Program, Burnet Institute, Melbourne, VIC, Australia
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11
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Perinatal Posttraumatic Stress Disorder: A Review of Risk Factors, Diagnosis, and Treatment. Obstet Gynecol Surv 2019; 74:369-376. [DOI: 10.1097/ogx.0000000000000680] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Santoro E, Stagni-Brenca E, Olivari MG, Confalonieri E, Di Blasio P. Childbirth Narratives of Women With Posttraumatic Stress Symptoms in the Postpartum Period. J Obstet Gynecol Neonatal Nurs 2018; 47:333-341. [DOI: 10.1016/j.jogn.2018.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 11/26/2022] Open
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13
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Zhang D, Zhang J, Gan Q, Wang Q, Fan N, Zhang R, Song Y. Validating the Psychometric Characteristics of the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) in a Chinese Context. Arch Psychiatr Nurs 2018; 32:57-61. [PMID: 29413073 DOI: 10.1016/j.apnu.2017.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 07/19/2017] [Accepted: 09/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perinatal posttraumatic stress disorder (PPTSD) is a common stress-induced mental disorder worldwide. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) is an excellent questionnaire that measures the symptoms of PPTSD, but has not been translated into Chinese yet. OBJECTIVES The aims of this study were to develop a translated Chinese version of the (PPQ) and validate the psychometric characteristics of the PPQ in a Chinese context. METHODS After translation, back-translation, and expert discussion, 280 mothers at 1 to 18months postpartum filled out the questionnaires through the Internet. Then the reliability and validity of the translated questionnaire were tested. RESULTS The Chinese version of PPQ (PPQ-C) was composed of 14 items. Cronbach's α coefficient was 0.84, test-retest reliability was 0.88, and the content validity was 0.99. Exploratory factor analysis extracted three factors (representing "arousal", "avoidance" and "intrusion") accounted for 53.30% of the variance. The established 3 factors model was well fitted with the collected data (χ2=76.40, p<0.05). IMPLICATIONS FOR PRACTICE The PPQ-C is a short, reliable, and valid instrument that measures the symptoms of PPTSD, and it is recommend for clinical screening. IMPLICATIONS FOR RESEARCH Further research could involve diverse participants, as well as better adapt the PPQ-C to Chinese culture.
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Affiliation(s)
- Di Zhang
- WuHan University School of Health Sciences, 155 Donghu Rd., Wuchang District, WuHan 430071, PR China
| | - Jun Zhang
- WuHan University School of Health Sciences, 155 Donghu Rd., Wuchang District, WuHan 430071, PR China.
| | - Quan Gan
- Hubei Maternal and Child Health Hospital, 745 Wuluo Rd., Hongshan District, WuHan 430070, PR China
| | - Qiaoling Wang
- Wuhan Medical Care Center for Women and Children, 100 Hongkong Rd., Jiang'an District, WuHan 430015, PR China
| | - Nian Fan
- Wuhan Medical Care Center for Women and Children, 100 Hongkong Rd., Jiang'an District, WuHan 430015, PR China
| | - Rong Zhang
- Wuhan Medical Care Center for Women and Children, 100 Hongkong Rd., Jiang'an District, WuHan 430015, PR China
| | - Yayun Song
- WuHan University School of Health Sciences, 155 Donghu Rd., Wuchang District, WuHan 430071, PR China
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14
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Feeley N, Hayton B, Gold I, Zelkowitz P. A comparative prospective cohort study of women following childbirth: Mothers of low birthweight infants at risk for elevated PTSD symptoms. J Psychosom Res 2017; 101:24-30. [PMID: 28867420 DOI: 10.1016/j.jpsychores.2017.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Nancy Feeley
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada; Centre for Nursing Research, Jewish General Hospital, Montreal, Quebec, Canada; Lady Davis Institute, Jewish General Hospital, Montreal, Canada.
| | - Barbara Hayton
- Department of Psychiatry, Jewish General Hospital, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
| | - Ian Gold
- Department of Psychiatry, McGill University, Montreal, Canada; Department of Philosophy, McGill University, Montreal, Quebec, Canada
| | - Phyllis Zelkowitz
- Lady Davis Institute, Jewish General Hospital, Montreal, Canada; Department of Psychiatry, Jewish General Hospital, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada
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Navidian A, Saravani Z, Shakiba M. Impact of Psychological Grief Counseling on the Severity of Post-Traumatic Stress Symptoms in Mothers after Stillbirths. Issues Ment Health Nurs 2017; 38:650-654. [PMID: 28745912 DOI: 10.1080/01612840.2017.1315623] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Planned support and interventions are necessary in the care and support of women who have experienced stillbirth. The present study was conducted to determine the effect of psychological grief counseling on the symptom severity of post-traumatic stress disorder (PTSD) in mothers after stillbirths. This interventional study is semi-experimental. The study was conducted on 100 women who had recently had stillbirths. Eligible samples were selected and randomly divided into the two groups of intervention and control. The data collection tool was the PPQ,1 which was completed as a pre-test and post-test in both groups. The intervention group received four sessions of psychological grief counseling over two weeks, and the control group received only routine postnatal care. PTSD severity was evaluated in both groups at the end of the fourth week after the final session. The results showed that there was a statistically significant difference in the mean score of the severity of the PTSD symptoms in both groups after the intervention (P = 0.0001), which means that psychological grief counseling led to the reduction of PTSD severity in mothers. Given the positive impact of psychological grief counseling on reducing the severity of PTSD, integration of intensive psychological interventions in the maternity care system seems essential for faster transition of grief stages and for the prevention of severe cases of PTSD.
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Affiliation(s)
- Ali Navidian
- a Department of Counseling, Community Nursing Research Center , Zahedan University of Medical Sciences , Zahedan , Iran
| | - Zahra Saravani
- b Department of Midwifery, Nursing and Midwifery School , Zahedan University of Medical Sciences , Zahedan , Iran
| | - Mansour Shakiba
- c Department of Psychiatry , Zahedan University of Medical Sciences , Zahedan , Iran
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Spencer R, Ambler G, Brodszki J, Diemert A, Figueras F, Gratacós E, Hansson SR, Hecher K, Huertas-Ceballos A, Marlow N, Marsál K, Morsing E, Peebles D, Rossi C, Sebire NJ, Timms JF, David AL. EVERREST prospective study: a 6-year prospective study to define the clinical and biological characteristics of pregnancies affected by severe early onset fetal growth restriction. BMC Pregnancy Childbirth 2017. [PMID: 28114884 DOI: 10.1186/s12884‐017‐1226‐7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fetal growth restriction (FGR) is a serious obstetric condition for which there is currently no treatment. The EVERREST Prospective Study has been designed to characterise the natural history of pregnancies affected by severe early onset FGR and establish a well phenotyped bio-bank. The findings will provide up-to-date information for clinicians and patients and inform the design and conduct of the EVERREST Clinical Trial: a phase I/IIa trial to assess the safety and efficacy of maternal vascular endothelial growth factor (VEGF) gene therapy in severe early onset FGR. Data and samples from the EVERREST Prospective Study will be used to identify ultrasound and/or biochemical markers of prognosis in pregnancies with an estimated fetal weight (EFW) <3rd centile between 20+0 and 26+6 weeks of gestation. METHODS This is a 6 year European multicentre prospective cohort study, recruiting women with a singleton pregnancy where the EFW is <3rd centile for gestational age and <600 g at 20+0 to 26+6 weeks of gestation. Detailed data are collected on: maternal history; antenatal, peripartum, and postnatal maternal complications; health economic impact; psychological impact; neonatal condition, progress and complications; and infant growth and neurodevelopment to 2 years of corrected age in surviving infants. Standardised longitudinal ultrasound measurements are performed, including: fetal biometry; uterine artery, umbilical artery, middle cerebral artery, and ductus venosus Doppler velocimetry; and uterine artery and umbilical vein volume blood flow. Samples of maternal blood and urine, amniotic fluid (if amniocentesis performed), placenta, umbilical cord blood, and placental bed (if caesarean delivery performed) are collected for bio-banking. An initial analysis of maternal blood samples at enrolment is planned to identify biochemical markers that are predictors for fetal or neonatal death. DISCUSSION The findings of the EVERREST Prospective Study will support the development of a novel therapy for severe early onset FGR by describing in detail the natural history of the disease and by identifying women whose pregnancies have the poorest outcomes, in whom a therapy might be most advantageous. The findings will also enable better counselling of couples with affected pregnancies, and provide a valuable resource for future research into the causes of FGR. TRIAL REGISTRATION NCT02097667 registered 31st October 2013.
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Affiliation(s)
- Rebecca Spencer
- Institute for Women's Health, University College London, London, UK. .,Institute for Women's Health, University College London and NIHR University College London Hospitals Biomedical Research Centre, London, UK.
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Jana Brodszki
- Department of Clinical Sciences Lund, Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden
| | - Anke Diemert
- Obstetrics and Fetal Medicine Unit, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Francesc Figueras
- BCNatal, Hospital Clinic and Hospital Sant Joan de Deu, University of Barcelona, CIBERER and IDIBAPS, Barcelona, Spain
| | - Eduard Gratacós
- BCNatal, Hospital Clinic and Hospital Sant Joan de Deu, University of Barcelona, CIBERER and IDIBAPS, Barcelona, Spain
| | - Stefan R Hansson
- Department of Clinical Sciences Lund, Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden
| | - Kurt Hecher
- Obstetrics and Fetal Medicine Unit, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Neil Marlow
- Institute for Women's Health, University College London and NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Karel Marsál
- Department of Clinical Sciences Lund, Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden
| | - Eva Morsing
- Department of Clinical Sciences Lund, Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden
| | - Donald Peebles
- Institute for Women's Health, University College London and NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | | | - Neil J Sebire
- Paediatric and Developmental Pathology, Great Ormond Street Hospital, London, UK
| | - John F Timms
- Institute for Women's Health, University College London, London, UK
| | - Anna L David
- Institute for Women's Health, University College London and NIHR University College London Hospitals Biomedical Research Centre, London, UK
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17
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Spencer R, Ambler G, Brodszki J, Diemert A, Figueras F, Gratacós E, Hansson SR, Hecher K, Huertas-Ceballos A, Marlow N, Marsál K, Morsing E, Peebles D, Rossi C, Sebire NJ, Timms JF, David AL. EVERREST prospective study: a 6-year prospective study to define the clinical and biological characteristics of pregnancies affected by severe early onset fetal growth restriction. BMC Pregnancy Childbirth 2017; 17:43. [PMID: 28114884 PMCID: PMC5259830 DOI: 10.1186/s12884-017-1226-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 01/14/2017] [Indexed: 11/10/2022] Open
Abstract
Background Fetal growth restriction (FGR) is a serious obstetric condition for which there is currently no treatment. The EVERREST Prospective Study has been designed to characterise the natural history of pregnancies affected by severe early onset FGR and establish a well phenotyped bio-bank. The findings will provide up-to-date information for clinicians and patients and inform the design and conduct of the EVERREST Clinical Trial: a phase I/IIa trial to assess the safety and efficacy of maternal vascular endothelial growth factor (VEGF) gene therapy in severe early onset FGR. Data and samples from the EVERREST Prospective Study will be used to identify ultrasound and/or biochemical markers of prognosis in pregnancies with an estimated fetal weight (EFW) <3rd centile between 20+0 and 26+6 weeks of gestation. Methods This is a 6 year European multicentre prospective cohort study, recruiting women with a singleton pregnancy where the EFW is <3rd centile for gestational age and <600 g at 20+0 to 26+6 weeks of gestation. Detailed data are collected on: maternal history; antenatal, peripartum, and postnatal maternal complications; health economic impact; psychological impact; neonatal condition, progress and complications; and infant growth and neurodevelopment to 2 years of corrected age in surviving infants. Standardised longitudinal ultrasound measurements are performed, including: fetal biometry; uterine artery, umbilical artery, middle cerebral artery, and ductus venosus Doppler velocimetry; and uterine artery and umbilical vein volume blood flow. Samples of maternal blood and urine, amniotic fluid (if amniocentesis performed), placenta, umbilical cord blood, and placental bed (if caesarean delivery performed) are collected for bio-banking. An initial analysis of maternal blood samples at enrolment is planned to identify biochemical markers that are predictors for fetal or neonatal death. Discussion The findings of the EVERREST Prospective Study will support the development of a novel therapy for severe early onset FGR by describing in detail the natural history of the disease and by identifying women whose pregnancies have the poorest outcomes, in whom a therapy might be most advantageous. The findings will also enable better counselling of couples with affected pregnancies, and provide a valuable resource for future research into the causes of FGR. Trial registration NCT02097667 registered 31st October 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1226-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca Spencer
- Institute for Women's Health, University College London, London, UK. .,Institute for Women's Health, University College London and NIHR University College London Hospitals Biomedical Research Centre, London, UK.
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Jana Brodszki
- Department of Clinical Sciences Lund, Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden
| | - Anke Diemert
- Obstetrics and Fetal Medicine Unit, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Francesc Figueras
- BCNatal, Hospital Clinic and Hospital Sant Joan de Deu, University of Barcelona, CIBERER and IDIBAPS, Barcelona, Spain
| | - Eduard Gratacós
- BCNatal, Hospital Clinic and Hospital Sant Joan de Deu, University of Barcelona, CIBERER and IDIBAPS, Barcelona, Spain
| | - Stefan R Hansson
- Department of Clinical Sciences Lund, Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden
| | - Kurt Hecher
- Obstetrics and Fetal Medicine Unit, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Neil Marlow
- Institute for Women's Health, University College London and NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Karel Marsál
- Department of Clinical Sciences Lund, Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden
| | - Eva Morsing
- Department of Clinical Sciences Lund, Obstetrics and Gynecology, Skane University Hospital, Lund University, Lund, Sweden
| | - Donald Peebles
- Institute for Women's Health, University College London and NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | | | - Neil J Sebire
- Paediatric and Developmental Pathology, Great Ormond Street Hospital, London, UK
| | - John F Timms
- Institute for Women's Health, University College London, London, UK
| | - Anna L David
- Institute for Women's Health, University College London and NIHR University College London Hospitals Biomedical Research Centre, London, UK
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Dodgson JE, Oneha MF, Choi M. A Socioecological Predication Model of Posttraumatic Stress Disorder in Low-Income, High-Risk Prenatal Native Hawaiian/Pacific Islander Women. J Midwifery Womens Health 2016; 59:494-502. [PMID: 26227791 DOI: 10.1111/jmwh.12211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Only recently has perinatal posttraumatic stress disorder (PTSD) been researched in any depth; however, the causes and consequences of this serious illness remain unclear. Most commonly, childbirth trauma and interpersonal violence have been reported as contributing factors. However, not all Native Hawaiian/Pacific Islander (NHPI) women who experience these events experience PTSD. The factors affecting PTSD are many and complex, intertwining individual, family, and community contexts. Using a socioecological framework, 3 levels of contextual variables were incorporated in this study (individual, family, and social/community). The purpose of this study was to determine the socioecological predictors associated with prenatal PTSD among NHPI. METHODS A case-control design was used to collect retrospective data about socioecological variables from medical record data. The sample was low-income, high-risk NHPI women receiving perinatal health care at a rural community health center in Hawaii who screened positive (n = 55) or negative (n = 91) for PTSD. RESULTS Hierarchical logistic regression was conducted to determine socioecological predictors of positive PTSD screening. Although the majority of women (66.4%) experienced some form of interpersonal violence, a constellation of significant predictor variables from all 3 levels of the model were identified: depression (individual level), lack of family support and family stress (family level), and violence (social/community level). DISCUSSION Each of the predictor variables has been identified by other researchers as significantly affecting perinatal PTSD. However, it is because these variables occur together that a more complex picture emerges, suggesting the importance of considering multiple variables in context when identifying and caring for these women. Although additional research is needed, it is possible that the significant predictor variables could be useful in identifying women who are at higher risk for PTSD in other similar populations.
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Vesel J, Nickasch B. An Evidence Review and Model for Prevention and Treatment of Postpartum Posttraumatic Stress Disorder. Nurs Womens Health 2015; 19:504-525. [PMID: 26682658 DOI: 10.1111/1751-486x.12234] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Postpartum posttraumatic stress disorder (P-PTSD) is a variant of posttraumatic stress disorder (PTSD) that, although relatively prevalent, is under-researched. Up to one-third of women in the United States describe childbirth as traumatic, with 9 percent of women meeting the criteria for PTSD outlined by the American Psychiatric Association. These statistics are sobering in light of common use of analgesia during birth as well as hospital birth environments promoting family-centered maternity care. How can a seemingly natural event, such as childbirth, be associated with PTSD? This review includes a description of key variables associated with P-PTSD. Socioeconomic, environmental and genetic determinants are discussed, as are evidence-based prevention and treatment approaches.
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20
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Kim WJ, Lee E, Kim KR, Namkoong K, Park ES, Rha DW. Progress of PTSD symptoms following birth: a prospective study in mothers of high-risk infants. J Perinatol 2015; 35:575-9. [PMID: 25856762 DOI: 10.1038/jp.2015.9] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/03/2015] [Accepted: 01/20/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To understand how postpartum posttraumatic stress disorder (PTSD) symptoms in mothers of high-risk infants progress and identify what factors predict postpartum PTSD. STUDY DESIGN We prospectively obtained self-reported psychological data from neonatal intensive care unit discharged infants' mothers (NICU mothers) at the infants' corrected ages of 1 (T0), 3 (T1) and 12 months (T2) and mothers of healthy infants (controls). Maternal sociodemographic and infant-related factors were also investigated. RESULT PTSD was present in 25 and 9% of NICU mothers and controls, respectively. We identified four PTSD patterns: none, persistent, delayed and recovered. The postpartum PTSD course was associated with trait anxiety. Whether the infant was the first child who predicted PTSD at year 1 (adjusted odds ratio=7.62, 95% confidence interval=1.07 to 54.52). CONCLUSION Mothers of high-risk infants can develop early or late PTSD, and its course can be influenced by factors besides medical status. We therefore recommend regular screenings of postpartum PTSD.
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Affiliation(s)
- W J Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - E Lee
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - K R Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - K Namkoong
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - E S Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - D-w Rha
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
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21
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Greene MM, Rossman B, Patra K, Kratovil A, Khan S, Meier PP. Maternal psychological distress and visitation to the neonatal intensive care unit. Acta Paediatr 2015; 104:e306-13. [PMID: 25684177 DOI: 10.1111/apa.12975] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/30/2015] [Accepted: 02/09/2015] [Indexed: 12/15/2022]
Abstract
AIM To examine associations between maternal neonatal intensive care unit (NICU) visitation rates, maternal psychological distress ('distress') and preterm infant outcome post-NICU discharge in a contemporary cohort of very low birthweight (VLBW) infants. METHODS This was a prospective study of 69 mothers and their VLBW infants. Distress was assessed 1-month postbirth, 2 weeks prior to NICU discharge and after NICU discharge at 4-month corrected age (CA). Maternal NICU visitation rates were calculated for the first 2 weeks and 1-month postbirth as well as for the entire NICU hospitalization. Regression analyses adjusted for the impact of (i) maternal and infant characteristics and distress on maternal visitation rates and (ii) the impact of visitation on long-term maternal distress and rates of infant clinic attendance and rehospitalization. RESULTS Greater number of children in the home, maternal exposure to a greater number of potentially traumatic events prior to childbirth and lower maternal anxiety consistently predicted lower visitation rate. Lower maternal visitation rate predicted higher maternal depression scores at infants' 4-month CA visit. Maternal NICU visitation rate did not predict post-NICU discharge infant clinic attendance or rehospitalization. CONCLUSION Distress is an important predictor of visitation. In turn, visitation is associated with long-term maternal distress.
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Affiliation(s)
- Michelle M. Greene
- Department of Pediatrics and Behavioral Sciences; Rush University Medical Center; Chicago IL USA
| | - Beverly Rossman
- College of Nursing; Rush University Medical Center; Chicago IL USA
| | - Kousiki Patra
- Department of Pediatrics; Rush University Medical Center; Chicago IL USA
| | - Amanda Kratovil
- College of Nursing; Rush University Medical Center; Chicago IL USA
| | - Samah Khan
- Department of Pediatrics; Rush University Medical Center; Chicago IL USA
| | - Paula P. Meier
- College of Nursing; Rush University Medical Center; Chicago IL USA
- Department of Pediatrics; Rush University Medical Center; Chicago IL USA
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Di Blasio P, Miragoli S, Camisasca E, Di Vita AM, Pizzo R, Pipitone L. Emotional Distress Following Childbirth: An Intervention to Buffer Depressive and PTSD Symptoms. EUROPES JOURNAL OF PSYCHOLOGY 2015; 11:214-32. [PMID: 27247653 PMCID: PMC4873107 DOI: 10.5964/ejop.v11i2.779] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 02/25/2015] [Indexed: 11/20/2022]
Abstract
Childbirth for some women is a negative experience associated with depressive and post-traumatic symptoms. The preventive actions focusing on helping mothers to cope with negative emotions experienced after childbirth are strongly recommended. It is also recommended both to intervene early and on all women to avoid the risk that these symptoms can worsen in the months after childbirth. The intervention described in the current study is focalized on the elaboration of post-partum negative thoughts and emotion through a writing task, with the purpose to help new mothers to reflect, understand, evaluate and, thus, reformulate the stressful situation with new beliefs and emotions. 176 women aged from 19 to 43 years (M = 31.55, SD = 4.58) were assessed for depression and PTSD in the prenatal phase (T1). In about 96 hours after childbirth they were randomly assigned to either "Making Sense condition" (MS: in which they wrote about the thoughts and emotions connected with delivery and childbirth) or "Control-Neutral condition" (NC: in which they wrote about the daily events in behavioural terms) and then reassessed for depression and PTSD (T2). A follow up was conducted 3 months later (T3) to verify depression and posttraumatic symptoms. The results showed that depressive symptoms decreased both at 96 hours and at 3 months as a result of making-sense task. Regarding the posttraumatic symptoms the positive effect emerged at three months and not at 96 hours after birth.
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Risk factors for postpartum depressive symptoms in low-income women with very low-birth-weight infants. Adv Neonatal Care 2015; 15:E3-8. [PMID: 25626986 DOI: 10.1097/anc.0000000000000131] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study examined factors associated with postpartum depressive symptoms in mothers with premature infants in the neonatal intensive care unit (NICU). SUBJECTS A total of 113 new mothers with very low-birth-weight infants in their initial NICU admission were recruited from 2 urban hospitals servicing low-income minority communities. DESIGN This study employed a cross-sectional design. METHODS Data were collected during the infants' postpartum NICU admission and included maternal demographic information (eg, age, education, race, living with the baby's father), infant illness severity (Neurobiologic Risk Score from infant's medical record), and maternal psychological measures (the Center for Epidemiologic Studies Depression Scale, the Perinatal Posttraumatic Stress Questionnaire, and the State-Trait Anxiety Inventory). RESULTS The findings indicated that 47 (42%) women had elevated postpartum depressive symptoms and 33 (30%) women had elevated postpartum posttraumatic stress symptoms (PTSs). Factors associated with postpartum depressive symptoms included PTS, anxiety, maternal age, and whether the mother lived with the baby's father (F₄, ₁₀₄ = 52.27, P < .001). The severity of the infants' illness, parental stress, and maternal education were not associated with depressive symptoms among low-income mothers of NICU infants. CONCLUSIONS On the basis of our findings, we recommend that low-income women should be screened for symptoms of anxiety, posttraumatic stress, and postpartum depression on their infants' admission to the NICU. When this is not feasible, we advise NICU healthcare providers to assess women for familial support, maternal age, posttraumatic stress related to their infants birth, and anxiety to determine which mothers are at the greatest risk for postpartum depressive symptoms. Screening for postpartum depression in the NICU can aid in early identification and treatment, thereby decreasing negative consequences for mothers and their infants.
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Facteurs prédictifs de l’état de stress post-traumatique du postpartum chez la primipare. ACTA ACUST UNITED AC 2012; 41:553-60. [DOI: 10.1016/j.jgyn.2012.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 04/01/2012] [Accepted: 04/10/2012] [Indexed: 11/20/2022]
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Elmir R, Schmied V, Jackson D, Wilkes L. Between life and death: Women’s experiences of coming close to death, and surviving a severe postpartum haemorrhage and emergency hysterectomy. Midwifery 2012; 28:228-35. [DOI: 10.1016/j.midw.2010.11.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 11/02/2010] [Accepted: 11/13/2010] [Indexed: 12/20/2022]
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Bruner S, Corbett C, Gates B, Dupler A. Clinical significance as it relates to evidence-based practice. Int J Nurs Knowl 2012; 23:62-74. [PMID: 23281882 DOI: 10.1111/j.2047-3095.2012.01205.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE This paper analyzes the concept of clinical significance (CS) in relation to evidence-based practice (EBP). The purpose is to show that CS terminology is inconsistent in the nursing literature. It is argued that nursing outcomes and interventions that include findings of CS are difficult to interpret due to lack of an operational definition. It is further argued that the absence of a consistent operational definition is incompatible with EBPs which require standardization of terminology. DATA SOURCES The current literature and research studies, particularly from the electronic databases Cumulative Index to Nursing and Allied Health Literature, ISI Web of Knowledge, PubMed, and Cochrane Database of Systematic Reviews. DATA SYNTHESIS The disparate uses of CS negatively impact standardizing and quantifying research outcomes to discern EBPs. The authors propose a definition of CS inclusive of the multifarious uses that were revealed in the literature, and conclude that there is a need for professional nursing consensus to define the term. A standard operational definition of CS would enable consistency as clinicians interpret research findings and facilitate translating research to practice. CONCLUSIONS Given the centrality of CS to interpreting research findings and applying them to practice, there is a need to solidify the terminology of and measurements for CS in nursing. National nursing agencies, including The National Institute for Nursing Research and Sigma Theta Tau International, should make standardizing CS a high priority for targeted funding. One method of doing so would be to support a consensus convergence to review and select the optimal measures of CS for nursing research. Research to increase knowledge about what constitutes measurement and change, or CS from the patient perspective is needed. Editors and peer reviewers should encourage authors to include a discussion of CS. Discussions of CS should receive greater emphasis in research journals. It is hoped that the preliminary findings from the concept analysis presented in this article will facilitate the work of such a consensus forum. IMPLICATIONS FOR NURSING PRACTICE The most immediate and tangible advantages to a common conceptual definition and meaning of CS terminologies by nursing, regardless of which definition is selected, are less confusion and more clarity. Ultimately, the most enduring benefit of a common conceptual definition and measurement for CS is the bridge it provides between research and practice, and the facility with which it promotes the integration of research into EBP.
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Affiliation(s)
- Susan Bruner
- Spokane Resource Group, PLLC, Spokane, Washington, USA.
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Seng JS, Sperlich M, Rowe H, Cameron H, Harris A, Rauch SAM, Bell SA. The Survivor Moms’ Companion: Open Pilot of a Posttraumatic Stress Specific Psychoeducation Program for Pregnant Survivors of Childhood Maltreatment and Sexual Trauma. INTERNATIONAL JOURNAL OF CHILDBIRTH 2011. [DOI: 10.1891/2156-5287.1.2.111] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Survivor Moms’ Companion (SMC) is a fully manualized, 10-module self-study psychoeducation program developed to address the pregnancy-specific needs of traumatic stress-affected abuse survivors. It aims to improve affect regulation, reduce interpersonal reactivity, and support posttraumatic stress disorder (PTSD) symptom management despite the presence of triggers. An open pilot enrolled “survivor moms” prior to 28 weeks gestation and they completed baseline diagnostic telephone interviews, fidelity measures, pretest and posttest, and self-report measures assessing the efficacy of the proposed mechanisms of intervention effect. Of 57 eligible women invited to participate, 32 took up the intervention, 9 completed at least the core 4 modules, and 18 completed all 10 modules. Participant scores showed improvements in anger expression, interpersonal reactivity, and PTSD symptom management, suggesting that participation in the SMC is beneficial. Results will inform the protocol for a cluster randomized trial of the SMC.
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Erdem Y. Anxiety levels of mothers whose infants have been cared for in unit level-I of a neonatal intensive care unit in Turkey. J Clin Nurs 2010; 19:1738-47. [PMID: 20579208 DOI: 10.1111/j.1365-2702.2009.03115.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM In most cases, admission of an infant to the intensive care unit is unexpected and is stressful for their mothers. The aim of this study is to examine factors affecting anxiety level of mothers whose infant is admitted to the neonatal intensive care unit. BACKGROUND Anxiety disorders figure among the most frequent psychiatric disorders in the population, and anxiety symptoms are among the most common. DESIGN A descriptive correlational design. SETTING Neonatal intensive care unit of Women's Health and Diseases, Education and Research Hospital in Turkey. PARTICIPANTS A total of 151 women who had an infant in NICU. METHODS A questionnaire form was used and included two instruments. The first measured characteristics of mothers and infants, and the second was the 'State-Trait Anxiety Inventory'. RESULTS Of the mothers, 33.8% were between the ages 25-29, 41.7% of the subjects had a primary education, 89.4% were housewives, 64.9% had social security and 58.9% of subjects had low family incomes. Of the 151 subjects, 75.5% had planned their pregnancy, and 41.7% were primiparas. It was determined that maternal age, education, income; planned pregnancy, having complications of pregnancy, receiving antenatal care, type of labour, gestational age of the infant at birth, reasons for hospitalisation of the infant and birth weight did not affect maternal anxiety levels. Maternal anxiety was significantly (p < 0.05) related to the infants' gender and duration of hospitalisation, with statistically significant differences. RELEVANCE TO CLINICAL PRACTICE Anxiety in mothers was significantly higher if their infant was a boy. This finding can be a result of mother's cultural and religious values. A better understanding of the psychosocial aspects such as cultural values and norms affecting maternal and child health of the perinatal period will contribute to improved health care and better outcomes. Nurses will be better prepared to assist mothers of babies in the NICU to cope with the experience through exploration of these aspects of the mother, infant and experience.
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Affiliation(s)
- Yurdagül Erdem
- Ankara University, Faculty of Health Sciences, Nursing Department, Altindağ, Ankara, Turkey.
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