Reducing maternal anxiety and stress in pregnancy: what is the best approach?

How does COVID-19-related social media usage influence disordered eating? A daily diary study among Chinese adults during lockdown

BACKGROUND

Despite previous studies highlighting the benefits of social media use during the COVID-19 pandemic, particularly under lockdown, limited research has identified the potential detrimental consequences of social media use during lockdown. Therefore, the purpose of this study is to examine the effects of social media on mental health in particular situations and the mechanisms underlying these effects.

METHODS

A daily diary protocol was adopted. A total of 96 adults (Mage = 25.90 ± 8.32 years) were recruited from Xi'an, Shaanxi Province, China. COVID-19-related social media use, psychological distress, COVID-19-related stress and anxiety, and disordered eating were measured each day for a week. Multilevel path analyses for the nested data were conducted.

RESULTS

Daily COVID-19-related social media use was positively related to daily disordered eating (r = .13 p < .001). Furthermore, the multilevel path analysis showed that psychological distress and COVID-19-related stress and anxiety mediated the relationship between COVID-19-related social media use and disordered eating at the within-person level. However, only COVID-19-related-anxiety mediated the relationship at the between-person level.

CONCLUSIONS

Our findings contribute to the understanding of social media's impact during lockdown and provide implications for social media users, social media platform providers, mental health professionals, and governments regarding the correct and sustainable use of social media during the COVID-19 pandemic and in future public health emergencies.

On cloud nine? Maternal emotional wellbeing six weeks up to one year postpartum - A cross-sectional study

BACKGROUND

Little is known about the full scope of emotional wellbeing of mothers up to one year postpartum, to adequately support women during transition to motherhood. Reduced emotional wellbeing (REW) affects women's adaption to the changes and challenges in becoming a mother. We aimed to increase the knowledge and understanding of mothers' emotional wellbeing and the influencing factors.

METHODS

This cross-sectional study includes 385 Flemish mothers up to one year postpartum. Online data were collected with the General Health Questionnaire-12, Postpartum Bonding Questionnaire, Personal Well-Being Index-Adult, The Basic Psychological Needs Scale, Sense of Coherence-13 and Coping Operations Preference Enquiry.

RESULTS

A total of 63.9% of the participants reported REW. Mothers with REW more often had (a history of) psychological problems compared to mothers with healthy emotional wellbeing (p = 0.007). Multiple linear regression analysis showed negative associations between emotional wellbeing and satisfaction (p = 0.002; p < 0.001), comprehensibility (p = 0.013) and positive associations between emotional wellbeing and bonding (p < 0.001), manageability (p = 0.033), problem solving (p = 0.030) and avoidance (p = 0,011) - with an explained variance of 55.5%.

LIMITATIONS

Some limitations of our study are the GHQ-12 cut-off value, the nature and implication of (a history of) psychological problems and the self-selected population.

CONCLUSION

It would be of worth for midwives to discuss with mothers (to be) what to expect. This - to support mothers in making sense of their life as a mother and how various factors might influence their emotional wellbeing. The high prevalence of REW is worrying, but needs to be interpreted with caution.

Antenatal Fear of Childbirth as a Risk Factor for a Bad Childbirth Experience

Giving birth is one of the most impressive experiences in life. However, many pregnant women suffer from fear of childbirth (FOC) and experience labour in very different ways, depending on their personality, previous life experiences, pregnancy, and birth circumstances. The aim of this study was to analyse how fear of childbirth affects the childbirth experience and to assess the related consequences. For this, a descriptive cross-sectional study was carried out in a sample of 414 women between 1 July 2021 and 30 June 2022. The Birth Anticipation Scale (BAS) was used to measure fear of childbirth and the Childbirth Experience Questionnaire (CEQ-E) was applied to measure satisfaction with the childbirth experience. Fear of childbirth negatively and significantly predicted the childbirth experience. In addition, women who were more fearful of childbirth were found to have worse obstetric outcomes and a higher likelihood of having a caesarean delivery (p = 0.008 C. I 95%). Fear behaved as a risk factor for the birth experience, so the greater the fear, the higher the risk of having a worse birth experience (OR 1.1). Encouraging active listening and support strategies may increase pregnant women's confidence, thus decreasing their fear of the process and improving their childbirth experience.

Reconsidering fear of birth: Language matters

Interest in fear of childbirth has grown exponentially since the 1980s, but the landscape of birth has shifted considerably since then, with evolving feminism; moving from a patriarchal environment in a biomedical model of care to a holistic model which recognizes the birth and sexuality rights of women and birthing people. Distinguishing the spectrum of fear from low to high and severe is important rather than aggregating all individuals with fear of childbirth. However, the terms 'fear of childbirth' and 'tocophobia' have been used interchangeably. In this paper we urge clinicians to use the term 'tocophobia' with caution since it may be construed negatively and there is a limited understanding of the underpinning aetiology of tocophobia. Furthermore, using the label may be disempowering for women and birthing people making decisions about their birth. Further research is warranted to better understand the experience, refine and define the issue and meet the individual needs of people with fear of childbirth and tocophobia.

Psychometric adequacy of the Persian adapted version of the Tilburg pregnancy distress scale (P-TPDS)

Background

Pregnancy distress is a combination of anxiety, stress, and depression during pregnancy. The first step in preventing pregnancy distress is to identify women at risk. The present study assessed adaptation and psychometric adequency of the Persian Adapted Version of Tilburg Pregnancy Distress Scale (P-TPDS).

Methods

By Brislin’s translation guidelines, TPDS was translated to Persian. This was followed by determining the face validity of P-TPDS and evaluating construct validity using exploratory and confirmatory factor analyses. The Cronbach’s alpha coefficients and intra-class correlation coefficient (ICC) were used to estimate reliability.

Results

A final 16-item scale was loaded on four distinct constructs jointly accounting for 59.62% of variance. The factors were labelled as delivery-related worries, partner involvement, pregnancy-related worries, and social-related worries. The alpha coefficients for P-TPDS subscales ranged from 0.85 to 0.91 and ICC ranged from 0.70 to 0.77. All comparative indices of the model including CFI, IFI, NFI, and NNFI were above 0.9 showing the goodness of fit for the data with a RMSEA of 0.04, lower bound: 0.038.

Conclusions

The Persian adapted version of TPDS (P-TPDS) is a reliable and valid scale for assessing pregnancy distress among pregnant women in Iran.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03745-1.

Validation of the MGMQ in screening for emotional difficulties in women during pregnancy

BACKGROUND

Screening for emotional health difficulties in pregnant or postpartum women is becoming routine practice in health services. This screening is often done using the EPDS, usually using a screen positive score just to identify possible depression. This and other such scales often have a myriad of screen-positive scores, making them impractical within clinical settings. The recent MGMQ screens for a variety of negative moods, is brief, simple, and has just a few screen-positive thresholds.

METHOD

At recruitment 391 women attending routine antenatal clinics completed various mood questionnaires. Several weeks later they were re-contacted by phone, at which time 247-252 of them provided valid data on the MGMQ, EPDS, and a diagnostic interview for depression and anxiety disorders (numbers vary depending upon valid combinations).

RESULTS

The MGMQ showed good-excellent receiver operating characteristics (sensitivity specificity, positive predictive value) against diagnostic status for depression or anxiety disorders. It also showed good concurrent and concordant validity with the EPDS, and good discriminant validity between women with clinical and subclinical diagnostic caseness. Stability over several weeks was however low, indicating that, as with other measures, women's mood can naturally change during the perinatal period.

LIMITATIONS

The findings only apply to English-speaking antenatal women from Sydney, Australia.

CONCLUSION

The MGMQ has good psychometric properties when compared to the usual gold-standard applied to emotional health screening measures. Its brevity, simplicity to 'score' and interpret, together with its clinically useful questions, suggest it could be a practical alternative to other more complicated mood screening measures for perinatal women.

Promoting the well-being of mothers with multidisciplinary psychosocial interventions in the perinatal period

BACKGROUND

Antenatal depressive and anxiety symptoms are common and may persist over time after delivery, with negative consequences on the mothers and their children. Evidence on the efficacy of psychological and pharmacological interventions during pregnancy aimed at preventing post-partum depression is controversial.

METHODS

A consecutive sample of 318 women presenting for scheduled obstetric visits during pregnancy was screened for risk factors and anxiety or depressive symptoms. Based on the screening results, women were classified into three groups at increasing risk of post-partum depression (PPD) and were offered different interventions.

RESULTS

Depressive or anxiety symptoms were found in 91 (28.6%) women, 89 (28.0%) had low risk of PPD and 138 (43.4%) had no risk of PPD. The multidisciplinary psychosocial interventions offered to women with clinical symptoms were well accepted, with an uptake of 76/91 (83.5%). Thirty-three women who did not improve with psychotherapy were offered sertraline or paroxetine as a second-line treatment: 7 accepted and 26 (78.8%) refused. Eleven women already on medication at baseline continued their treatment along with the MPI. The MPI interventions had some positive effects in terms of post-partum recovery, symptom reduction, and in preventing a new onset of depression. Among the 227 non-symptomatic during pregnancy, only 5 (2.2%) developed symptoms in the post-partum period. At 12 months post-partum, 84.6% of women who were symptomatic at 2 months post-partum recovered.

LIMITATIONS

Our results should be interpreted in light of important limitations, including the lack of a control group that was not offered the MPI, the lack of information on the reasons for refusal and discontinuation and on the number of psychotherapy sessions attended.

CONCLUSIONS

Our findings underscore the potential usefulness of MPI in recognizing early signs or symptoms during pregnancy and the advantage of building specific interventions for preventing post-natal depression. The MPI has positive effects on women with depressive or anxiety symptoms during pregnancy, that however did not exceed significantly those observed in women who refused the intervention. Thus, in the absence of a control group, our results are preliminary and warrant confirmation and testing in future randomized clinical trials.

A comparison of the PHQ-2 and MGMQ for screening for emotional health difficulties during pregnancy

BACKGROUND

Routine screening for emotional health difficulties in women during pregnancy is now advocated in several countries. There is a need therefore to compare the performance of different self-report measures to accomplish this. This study reports on the comparative performance of two such measures- the well-established PHQ-2, which aims to detect depression, and the more recent MGMQ, which aims to detect a wide array of negative emotions.

METHOD

Women (N = 2292) attending a public hospital antenatal clinic over a 14-month period completed the two measures, either on their own (72%), verbally administered by the midwife (25%), or with an interpreter (3%).

RESULTS

Similar rates of women screened positive on each instrument (PHQ-2: 11.6%; MGMQ: 12.3%), but the overlap between the two measures was low. The PHQ-2 only detected 58% of the MGMQ screen positive women, while the MGMQ detected 89.5% of the PHQ-2 screen positive women. No clinically meaningful difference in screen positive rates on either measure was evident for the administration method.

LIMITATIONS

No demographic data were available apart from gestational age, and only about half the women presenting to the clinic during the time period were screened with the measures.

CONCLUSION

The MGMQ detected a greater proportion of women screening positive on the PHQ-2 than vice-versa. This is part due to the MGMQ's focus on a wider range of negative emotions than just depression. Accumulating evidence for this MGMQ indicates that clinical services can consider using this simple measure if they wish to screen for a broad range of negative emotions during pregnancy and postnatally.

Trajectories of anxiety and health related quality of life during pregnancy

Anxiety and health related Quality of Life (HRQoL) have emerged as important mental health measures in obstetric care. Few studies have systematically examined the longitudinal trajectories of anxiety and HRQoL in pregnancy. Using a linear growth modeling strategy, we analyzed the course of State-Trait Anxiety Inventory (STAI)- and Short Form (36) Health Survey (SF-36) scores between the 12th and the 36th week of gestation, in a sample of 355 women. We additionally analyzed the impact of depressive symptoms and a chronic medical condition (asthma), on STAI and SF-36 trajectory curves. STAI scores remained stable throughout pregnancy. A previous history of anxiety increased the overall STAI scores. Asthma and depressive symptoms scores had no impact on the STAI trajectory. Physical SF-36 scores decreased over the course of pregnancy, whereas mental SF-36 trended towards improvement. Asthma reduced physical SF-36 overall. While high depressive symptoms decreased the overall mental SF-36, they were also significantly associated with mental SF-36 improvements over time. Anxiety symptoms are stable during pregnancy and are not modulated by depressive symptoms or asthma. Physical HRQoL declines in pregnancy. In contrast, mental HRQoL appears to improve, particularly in women with high initial levels of depressive symptoms.