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Etyemez S, Mehta K, Tutino E, Zaidi A, Atif N, Rahman A, Malik A, Voegtline KM, Surkan PJ, Osborne LM. The immune phenotype of perinatal anxiety in an anxiety-focused behavioral intervention program in Pakistan. Brain Behav Immun 2024; 120:141-150. [PMID: 38777289 DOI: 10.1016/j.bbi.2024.05.028] [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: 02/07/2024] [Revised: 04/29/2024] [Accepted: 05/19/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Dysregulation of the immune system has been associated with psychiatric disorders and pregnancy-related complications, such as perinatal depression. However, the immune characteristics specific to perinatal anxiety remain poorly understood. In this study, our goal was to examine specific immune characteristics related to prenatal anxiety within the context of a randomized controlled trial designed to alleviate anxiety symptoms-the Happy Mother - Healthy Baby (HMHB) study in Rawalpindi, Pakistan. MATERIALS AND METHODS Pregnant women (n = 117) were followed prospectively in the 1st, 2nd, and 3rd trimesters (T1, T2, T3) and at 6 weeks postpartum (PP6). Each visit included a blood draw and anxiety evaluation (as measured by the anxiety subscale of the Hospital Anxiety and Depression Scale - HADS -using a cutoff ≥ 8). We enrolled both healthy controls and participants with anxiety alone; those with concurrent depression were excluded. RESULTS K-means cluster analysis revealed three anxiety clusters: Non-Anxiety, High and Consistent Anxiety, and Decreasing Anxiety. Principal components analysis revealed two distinct clusters of cytokine and chemokine activity. Women within the High and Consistent Anxiety group had significantly elevated chemokine activity across pregnancy (in trimester 1 (β = 0.364, SE = 0.178, t = 2.040, p = 0.043), in trimester 2 (β = 0.332, SE = 0.164, t = 2.020, p = 0.045), and trimester 3 (β = 0.370, SE = 0.179, t = 2.070, p = 0.040) compared to Non-Anxiety group. Elevated chemokine activity was associated with low birthweight (LBW) and small for gestational age (SGA). CONCLUSION Our findings reveal a unique pattern of immune dysregulation in pregnant women with anxiety in a Pakistani population and offer preliminary evidence that immune dysregulation associated with antenatal anxiety may be associated with birth outcomes. The dysregulation in this population is distinct from that in our other studies, indicating that population-level factors other than anxiety may play a substantial role in the differences found. (Clinicaltrials.gov # NCT04566861).
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Affiliation(s)
- Semra Etyemez
- Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, NY 10021, USA; Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Kruti Mehta
- Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, NY 10021, USA
| | - Emily Tutino
- Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, NY 10021, USA
| | - Ahmed Zaidi
- Human Development Research Foundation, Rawalpindi, Pakistan
| | - Najia Atif
- Human Development Research Foundation, Rawalpindi, Pakistan
| | - Atif Rahman
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Abid Malik
- Human Development Research Foundation, Rawalpindi, Pakistan
| | - Kristin M Voegtline
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, MD, USA; Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Lauren M Osborne
- Department of Obstetrics & Gynecology, Weill Cornell Medical College, New York, NY 10021, USA; Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA.
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Surkan PJ, Malik A, Perin J, Atif N, Rowther A, Zaidi A, Rahman A. Anxiety-focused cognitive behavioral therapy delivered by non-specialists to prevent postnatal depression: a randomized, phase 3 trial. Nat Med 2024; 30:675-682. [PMID: 38365951 PMCID: PMC11060845 DOI: 10.1038/s41591-024-02809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/09/2024] [Indexed: 02/18/2024]
Abstract
Anxiety experienced by women during pregnancy is highly prevalent, especially in resource-poor settings and strongly predicts postnatal common mental disorders (CMDs), anxiety and depression. We evaluated the effectiveness of an anxiety-focused early prenatal intervention on preventing postnatal CMDs. This study was a phase 3, two-arm, single-blind, randomized controlled trial conducted in Pakistan with women who were ≤22 weeks pregnant and had at least mild anxiety without clinical depression. Participants were randomized to the Happy Mother-Healthy Baby program, based on cognitive behavioral therapy, consisting of six one-on-one intervention sessions in pregnancy delivered by non-specialist providers, or to enhanced care alone. The primary outcome was major depression, generalized anxiety disorder or both at 6 weeks after delivery. Overall, 755 women completed postnatal assessments (380 (50.3%), intervention arm; 375 (49.7%) enhanced-care arm). The primary outcomes were met. Examined jointly, we found 81% reduced odds of having either a major depressive episode (MDE) or moderate-to-severe anxiety for women randomized to the intervention (adjusted odds ratio (aOR) = 0.19, 95% CI 0.14-0.28). Overall, 12% of women in the intervention group developed MDE at 6 weeks postpartum, versus 41% in the control group. We found reductions of 81% and 74% in the odds of postnatal MDE (aOR = 0.19, 95% CI 0.13-0.28) and of moderate-to-severe anxiety (aOR = 0.26, 95% CI 0.17-0.40), respectively. The Happy Mother-Healthy Baby program early prenatal intervention focusing on anxiety symptoms reduced postpartum CMDs. ClinicalTrials.gov identifier NCT03880032 .
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Affiliation(s)
- Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Abid Malik
- Human Development Research Foundation, Near Government Rural Health Centre Mandra, Rawalpindi, Pakistan
- Department of Public Mental Health, Health Services Academy, Islamabad, Pakistan
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Najia Atif
- Human Development Research Foundation, Near Government Rural Health Centre Mandra, Rawalpindi, Pakistan
| | - Armaan Rowther
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Psychiatry, Los Angeles County Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Ahmed Zaidi
- Human Development Research Foundation, Near Government Rural Health Centre Mandra, Rawalpindi, Pakistan
| | - Atif Rahman
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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Wang W, Yang F, Bai Y, Lu Y, Mao X. Association between domain-specific physical activity and mental health status after embryo transfer in IVF-ET-assisted pregnancy patients. Sci Rep 2024; 14:4928. [PMID: 38418518 PMCID: PMC10902343 DOI: 10.1038/s41598-024-55097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/20/2024] [Indexed: 03/01/2024] Open
Abstract
Physical activity has been shown to impact mental health in in vitro fertilization-embryo transfer (IVF-ET) patients, but the relationship between domain-specific physical activity and mental health in this population remains unclear. In a cross-sectional observational study, 208 patients undergoing IVF-ET with long-term ovulation induction cycles were recruited from a reproductive center. The International Physical Activity Questionnaire and the symptom checklist 90 (SCL-90) were used to assess physical activity levels and mental health status, respectively. Analyses of variance and linear regression analyses were conducted to identify the relationship between physical activity and mental health. There were differences between different physical activity level in times of transfers, years of infertility, and times of abortions. Patients with high levels of physical activity had fewer symptoms than those with low levels of physical activity. Occupation, transport and household physical activity had significant negative correlations with the respective SCL-90 factor scores. Linear regression analysis revealed that occupation physical activity was associated with lower depression and anxiety, and transport physical activity and household physical activity were associated with lower obsessive-compulsive, interpersonal sensitivity, depression, anxiety, and psychoticism scores. The study indicates that increased engagement in physical activity, specifically activities related to occupation, transportation, and household, may be associated with improved mental health among IVF-ET patients.
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Affiliation(s)
- Wei Wang
- Department of Psychology, Qilu Hospital of Shandong University, Wenhuaxi Road 107, Jinan, 250012, Shandong, China
| | - Fang Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Yunfeng Bai
- Department of Anesthesiology, Linyi People's Hospital, Linyi, China
| | - Yanxia Lu
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
| | - Xueqin Mao
- Department of Psychology, Qilu Hospital of Shandong University, Wenhuaxi Road 107, Jinan, 250012, Shandong, China.
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Haile TT, Kebede AA, Gessesse DN, Tsega NT, Aklil MB, Temesgan WZ, Anteneh TA, Tibebu NS, Alemu HN, Seyoum AT, Tiguh AE, Yismaw AE, Mihret MS, Nenko G, Wondie KY, Taye BT, Abegaz MY. Anxiety and associated factors in Northwest Ethiopian pregnant women: a broad public health concern. Front Public Health 2024; 11:1300229. [PMID: 38259803 PMCID: PMC10800707 DOI: 10.3389/fpubh.2023.1300229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/22/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Pregnancy-related anxiety is a prevalent mental health issue that mostly affects women in low-income countries such as Ethiopia. It has been linked to unfavorable pregnancy outcomes, such as miscarriage, prematurity, and low birth weight. However, it has often received less attention, and community-based evidence lacks its prevalence and associated factors. Thus, the purpose of this study was to assess the prevalence and associated factors of anxiety in Northwest Ethiopian pregnant women in Gondar city. Methods A community-based cross-sectional study was conducted from 1 July to 30 August 2021 in Gondar city. A cluster sampling technique was used to select a sample of 872 pregnant women, and in-person interviews were conducted to gather data. Descriptive and analytical statistical procedures were carried out. Results Of the participants, pregnancy-related anxiety was reported in 29.4% (95% CI: 26.3, 32.4) of women. The likelihood of having anxiety was higher among women who had known medical illness (AOR = 3.16; 95% CI: 1.8, 5.35), loneliness (AOR = 2.52; 95% CI: 1.34, 4.73), depression (AOR = 2.38; 95% CI: 1.48, 3.85), poor social support (AOR = 1.93; 95% CI: 1.21, 3.07), and intimate partner violence (AOR = 2.87; 95% CI: 2.04, 4.04). Conclusion In this study, three out of ten women have suffered from anxiety. It is strongly advised to identify and treat known medical illnesses early in pregnancy, enhance social support, diagnose and treat depression, and limit intimate partner violence through multimodal and integrative activities with concerned bodies.
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Affiliation(s)
- Tsion Tadesse Haile
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dereje Nibret Gessesse
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nuhamin Tesfa Tsega
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mastewal Belayneh Aklil
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubedle Zelalem Temesgan
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tazeb Alemu Anteneh
- Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Solomon Tibebu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haymanot Nigatu Alemu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmra Tesfahun Seyoum
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Agumas Eskezia Tiguh
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Engida Yismaw
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Goshu Nenko
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kindu Yinges Wondie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Birhan Tsegaw Taye
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Marta Yimam Abegaz
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sadat BN, Zahra M, Fatemeh T. Identifying effective factors to alleviate postnatal distress and coronavirus anxiety in mothers of hospitalized preterm neonates. BMC Pregnancy Childbirth 2023; 23:838. [PMID: 38057744 DOI: 10.1186/s12884-023-06131-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/15/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Given the critical importance of mental health in mothers of preterm neonates during the postpartum period for Population Youth Programs, our research aims to ascertain the correlation between postnatal distress and corona-induced anxiety in women who have hospitalized preterm neonates. METHODS This descriptive-analytical study was conducted with a sample of 275 mothers of preterm neonates, were hospitalized in Gorgan city in 2020. Data collection was facilitated through the Corona Anxiety (CA) and Postnatal Distress Measured Scale (PDM). For data analysis, Spearman's correlation and univariate and multiple linear regression were employed. RESULTS The average age of the participating mothers was 28.61 ± 6.173 years, and the average gestational age of the neonates was 32.8 ± 2.89 weeks. The study found a significant, positive correlation between CA and PDM. Controlling for other variables through multiple regression analysis, the factors that significantly influenced PDM were employment status (β = 3.88, p < 0.01), education level (β = 1.96, p = 0.032), and gestational age (β=-0.60, p < 0.001). Furthermore, number of living children (β=-4.77, p = 0.01), education (β=-2.37, p = 0.01), and gestational age (β=-0.91, p < 0.001) were the factors that were significantly associated with CA scores. CONCLUSIONS The correlation between CA and PDM suggests that preterm neonate's mothers experienced increased anxiety during the pandemic. Considering the factors influencing these anxieties, targeted programs should be developed to enhance the mental health of these mothers in future pandemics. The finding that women with more children experienced less CA could serve as evidence of the positive impact of having children on the mental health of women with premature infants during a pandemic.
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Affiliation(s)
- Borghei Narjes Sadat
- Reproductive Health, Counseling and Reproductive Health Research Center, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mehrbakhsh Zahra
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
- Department of Biostatistics and Epidemiology, School of Health, Golestan University of Medical sciences, Gorgan, Iran.
| | - Torklalebaq Fatemeh
- Faculty of Nursing and Midwifery, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Roddy Mitchell A, Gordon H, Atkinson J, Lindquist A, Walker SP, Middleton A, Tong S, Hastie R. Prevalence of Perinatal Anxiety and Related Disorders in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2343711. [PMID: 37976063 PMCID: PMC10656650 DOI: 10.1001/jamanetworkopen.2023.43711] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Anxiety disorders are associated with poor maternal and neonatal outcomes. Women in low- and middle-income countries (LMICs) are thought to be disproportionally burdened by these disorders, yet their prevalence is unclear. Objective To conduct a systematic review and meta-analysis to determine the prevalence of 6 anxiety and related disorders among perinatal women in LMICs. Data Sources Embase, MEDLINE, PsycINFO, Cochrane Library, CINAHL, and Web of Science databases were searched from inception until September 7, 2023. Study Selection Studies conducted in World Bank-defined LMICs and reporting prevalence of generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder, posttraumatic stress disorder, panic disorder, or adjustment disorder during the perinatal period (conception to 12 months post partum) using a validated method were included. Data Extraction and Synthesis This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Study eligibility, extracted data, and risk of bias of included studies were assessed by 2 independent reviewers. Random-effects meta-analysis was used to estimate pooled point prevalence. Subgroup analyses were performed by specific anxiety disorder. Main Outcomes and Measures Main outcomes were prevalence estimates of each anxiety disorder, measured as percentage point estimates and corresponding 95% CIs. Results At total of 10 617 studies were identified, 203 of which met the inclusion criteria and reported the outcomes of 212 318 women from 33 LMICs. Generalized anxiety disorder was the most reported (184 studies [90.6%]) and most prevalent disorder at 22.2% (95% CI, 19.4%-25.0%; n = 173 553). Posttraumatic stress disorder was the second most prevalent (8.3%; 95% CI, 5.0%-12.2%; 33 studies; n = 22 452). Adjustment disorder was least prevalent (2.9%; 95% CI, 0.0%-14.1%; 2 studies; n = 475). The prevalence of generalized anxiety varied by country income status, with the highest prevalence among lower-middle-income countries (27.6%; 95% CI, 21.6%-33.9%; 59 studies; n = 25 109), followed by low-income (24.0%; 95% CI, 15.3%-33.8%; 11 studies; n = 4961) and upper-middle-income (19.1%; 95% CI, 16.0%-22.4%; 110 studies; n = 138 496) countries. Conclusions and Relevance These findings suggest that 1 in 5 women living in LMICs experience anxiety disorders during pregnancy and post partum. Targeted action is needed to reduce this high burden.
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Affiliation(s)
- Alexandra Roddy Mitchell
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Hannah Gordon
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Jessica Atkinson
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Anthea Lindquist
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan P. Walker
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Anna Middleton
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Stephen Tong
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Roxanne Hastie
- Mercy Perinatal, Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia
- Mercy Hospital for Women, Heidelberg, Victoria, Australia
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Pellerone M, Martinez-Torvisco J, Razza SG, Commodari E, Miccichè S. Precursors of Prenatal Attachment and Anxiety during Pregnancy in Women Who Procreate Naturally and Pregnant Women following Assisted Reproduction Technology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6945. [PMID: 37887682 PMCID: PMC10606198 DOI: 10.3390/ijerph20206945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/21/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023]
Abstract
The process of adaptation of the woman to pregnancy seems to be influenced by many factors, such as the type of conception, the mother's age, the possible presence of other children, and socio-cultural factors. Women who conceived with an assisted reproductive technique are emotionally vulnerable; compared with pregnant women who procreated naturally, they manifest elevated anxiety, which seems to be correlated to the fright of being separated from their child. Objectives of the present research are as follows: (1) to analyze the relationship between age, gestational age, time expectancy, previous failed attempts, perception of a high-risk pregnancy, and presence of other children, with the level of maternal-fetal attachment (MFA); (2) explore the level of maternal-infant attachment and anxiety by comparing the control and experimental group; (3) to measure a possible relationship between anxiety levels and MFA in ART pregnant women; (4) to identify variables predictive of prenatal attachment. The study group is formed by ninety-five women aged between 18-42 years (M = 30.57; S.D. = 5.47), pregnant from the 23rd to the 37th week (M = 28.95; S.D. = 3.99); on which 50 women who procreate naturally and 45 pregnant women following assisted reproductive technology. They completed: Maternal-Fetal Attachment Scale (MFAS), State-Trait Anxiety Inventory (STAI), and ad hoc questionnaire to collect anamnestic data. The results show the presence of a correlation between gestational age and waiting period, between the number of assisted fertilization attempts with the worry about their ability to become pregnant, but a negative correlation between pregnancy weeks and the level of maternal-fetal attachment. The study shows the predictive role of anxiety on the MFA. The applications and indications for future research are analyzed.
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Affiliation(s)
- Monica Pellerone
- Faculty of Human and Social Sciences, Kore University of Enna, 94100 Enna, Italy; (S.G.R.); (S.M.)
| | - Juan Martinez-Torvisco
- Department of Cognitive, Social and Organizational Psychology, La Laguna University, 38200 Santa Cruz de Tenerife, Spain;
| | - Stesy Giuseppa Razza
- Faculty of Human and Social Sciences, Kore University of Enna, 94100 Enna, Italy; (S.G.R.); (S.M.)
| | - Elena Commodari
- Department of Educational Sciences, University of Catania, 95126 Catania, Italy;
| | - Sandra Miccichè
- Faculty of Human and Social Sciences, Kore University of Enna, 94100 Enna, Italy; (S.G.R.); (S.M.)
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Kumar S, Priyaranjan, Gautam A, Quazi SSN, Singh A, Ranjan R. Pregnant Women's Oral Health-Related Quality of Life and Lifestyle Factors. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S546-S549. [PMID: 37654279 PMCID: PMC10466520 DOI: 10.4103/jpbs.jpbs_456_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/01/2022] [Accepted: 01/26/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Pregnancy is often associated with a number of oral manifestations. There is a change in lifestyle factors and dental care during pregnancy. Aim We conducted this cross-sectional study to determine how lifestyle factors affect oral health-related quality of life (OHRQOL) in pregnant women residing in Bero block, Jharkhand. Methods The study included a total of 400 pregnant women aged 18-45. The assessment of lifestyle factors and OHRQOL was done using Health Practice Index (HPI) Index and Oral Health Impact Profile-14 (OHIP-14), respectively. Data was collected through face-to-face interviews. Results Forty percent of the pregnant women showed low OHRQOL. The majority of them were not using mouthwash and were brushing their teeth using faulty techniques. The results of logistic regression analysis showed that women with poor lifestyle scores (Odds Ratio [OR] =3.8, P-value <0.0001*), and systemic diseases (OR = 2.6, P-value < 0.001*) were more likely to have poor OHRQOL. Conclusion Pregnancy is associated with poor OHRQOL and poor lifestyle scores. Effective policies for oral health need to be drafted for this group.
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Affiliation(s)
- Sandeep Kumar
- Department of Public Health Dentistry, Dental College, RIMS, Ranchi, Jharkhand, India
| | - Priyaranjan
- Department of Public Health Dentistry, Dental College, RIMS, Ranchi, Jharkhand, India
| | | | | | - Anubhuti Singh
- Department of Conservative and Endodontics, Ranchi, Jharkhand, India
| | - Rajeev Ranjan
- Dental Surgeon, Community Health Centre, Bero, Jharkhand, India
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Studnicki J, Longbons T, Fisher J, Reardon DC, Skop I, Cirucci CA, Harrison DJ, Craver C, Tsulukidze M, Ras Z. A Cohort Study of Mental Health Services Utilization Following a First Pregnancy Abortion or Birth. Int J Womens Health 2023; 15:955-963. [PMID: 37342485 PMCID: PMC10278648 DOI: 10.2147/ijwh.s410798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/26/2023] [Indexed: 06/23/2023] Open
Abstract
Objective To determine whether exposure to a first pregnancy outcome of induced abortion, compared to a live birth, is associated with an increased risk and likelihood of mental health morbidity. Materials and methods Participants were continuously eligible Medicaid beneficiaries age 16 in 1999, and assigned to either of two cohorts based upon the first pregnancy outcome, abortion (n = 1331) or birth (n = 3517), and followed through to 2015. Outcomes were mental health outpatient visits, inpatient hospital admissions, and hospital days of stay. Exposure periods before and after the first pregnancy outcome, a total of 17 years, were determined for each cohort. Findings Women with first pregnancy abortions, compared to women with births, had higher risk and likelihood of experiencing all three mental health outcome events in the transition from pre- to post-pregnancy outcome periods: outpatient visits (RR 2.10, CL 2.08-2.12 and OR 3.36, CL 3.29-3.42); hospital inpatient admissions (RR 2.75, CL 2.38-3.18 and OR 5.67, CL 4.39-7.32); hospital inpatient days of stay (RR 7.38, CL 6.83-7.97 and OR 19.64, CL 17.70-21.78). On average, abortion cohort women experienced shorter exposure time before (6.43 versus 7.80 years), and longer exposure time after (10.57 versus 9.20 years) the first pregnancy outcome than birth cohort women. Utilization rates before the first pregnancy outcome, for all three utilization events, were higher for the birth cohort than for the abortion cohort. Conclusion A first pregnancy abortion, compared to a birth, is associated with significantly higher subsequent mental health services utilization following the first pregnancy outcome. The risk attributable to abortion is notably higher for inpatient than outpatient mental health services. Higher mental health utilization before the first pregnancy outcome for birth cohort women challenges the explanation that pre-existing mental health history explains mental health problems following abortion, rather than the abortion itself.
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Affiliation(s)
| | | | - John Fisher
- Charlotte Lozier Institute, Arlington, VA, USA
| | | | - Ingrid Skop
- Charlotte Lozier Institute, Arlington, VA, USA
| | | | - Donna J Harrison
- American Association of Pro-Life Obstetricians and Gynecologists, Eau Claire, MI, USA
| | | | - Maka Tsulukidze
- Department of Health Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Zbigniew Ras
- Computer Science Department, University of North Carolina at Charlotte, Charlotte, NC, USA
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10
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Mahini E, Hakimi S, Shahrokhi H, Salahi B, Baniadam KO, Ranjbar F. Evaluation of factors related to maternal anxiety during pregnancy among women referred to Tabriz primary care centers. BMC Psychiatry 2023; 23:329. [PMID: 37165314 PMCID: PMC10170804 DOI: 10.1186/s12888-023-04823-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 04/27/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Maternal anxiety during pregnancy is sometimes considered a normal mechanism to overcome the mother's mental preoccupation with having a child. However, stress and anxiety might become a medical condition, becoming so severe as to affect the mother's mental health. Therefore, the present study aimed to investigate factors related to maternal anxiety during pregnancy in women referring to prenatal primary care centers in Tabriz. METHODS The target population in the present cross-sectional study was the pregnant women referring to primary care centers affiliated with Tabriz University of Medical Sciences in 2018-2019 (n = 533). Sampling was carried out using the random cluster technique (separately for municipal centers). The data were collected using the study tools, including a questionnaire on demographic data, prenatal anxiety screening scale (PASS), and researcher-made questions on maternal anxiety during pregnancy. RESULTS In the present study, 37.5% of pregnant women had anxiety. Of all the demographic and background variables, income (P = 0.015), a history of preterm delivery (P = 0.018), and unintended pregnancy (P = 0.022) were significantly related to anxiety. Of the variables of income, a history of preterm delivery, and unintended pregnancy in the regression model, the odds of anxiety were 41% lower in pregnant women with somewhat adequate income than those with inadequate income after correcting for other variables (P = 0.011). In addition, the variable of unintended pregnancy increased the odds of anxiety up to 49% after correcting for other variables (P = 0.023). CONCLUSION The present study showed that income and unintended pregnancy significantly affect maternal anxiety during pregnancy. TRIAL REGISTRATION The protocol of the study was approved by the Ethics Committee of Tabriz University of Medical Sciences under the code (IR.TBZMED.REC.1398.161).
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Affiliation(s)
- Elmira Mahini
- Medical School, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sevil Hakimi
- Research Center of Psychiatry & Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Shahrokhi
- Research Center of Psychiatry & Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behnaz Salahi
- Research Center of Psychiatry & Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khatereh Olad Baniadam
- Clinical Research Development Unit, Razi hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Ranjbar
- Research Center of Psychiatry & Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
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Mamuk R, Akbulut Ş, Erdoğan A. Evaluation of the association between fear of COVID-19 and pregnancy distress. Afr Health Sci 2023; 23:59-71. [PMID: 37545897 PMCID: PMC10398489 DOI: 10.4314/ahs.v23i1.8] [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] [Indexed: 08/08/2023] Open
Abstract
Background Mental health problems experienced during pregnancy negatively affect both maternal and fetal wellbeing. Objective This study aimed to investigate the relationship between fear of COVID-19 and pregnancy distress in healthy pregnant women living in Turkey. Methods A descriptive, relational/cross-sectional study was conducted by interviewing 363 pregnant women in person. Data were collected using a personal information form, the Fear of COVID-19 Scale (FCV-19S), and the Tilburg Pregnancy Distress Scale (TPDS). Results The mean FCV-19S score was 19.03±5.65 and the mean TPDS score was 19.97±7.97. According to the TPDS cut-off score, 19.0% of the participants were at risk of pregnancy distress. There was a significant positive correlation between FCV-19S and TPDS scores (r = 0.263, p<0.05). According to the regression analysis, age (β= -0.217), years of education (β= -0.272), and number of births (β= 0.502) were associated with fear of COVID-19, and fear of COVID-19 was associated with TPDS scores (β= 0.369) (p<0.05). Conclusion The pregnant women in this study had moderate fear of COVID-19. Compared to the literature data, the prevalence of pregnancy distress was slightly higher than pre-COVID-19 reports but quite low compared to other studies conducted during the pandemic.
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Affiliation(s)
- Rojjin Mamuk
- Nursing Department, Faculty of Health Sciences, Eastern Mediterranean University. Famagusta, North Cyprus
| | - Şahide Akbulut
- Nursing Department, Faculty of Health Sciences, Batman University, Batman, Turkey
| | - Ayfer Erdoğan
- Nursing Department, Sabahattin Zaim University, Istanbul, Turkey
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12
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Effects of Benson Relaxation Technique and Music Therapy on the Anxiety of Primiparous Women Prior to Cesarean Section: A Randomized Controlled Trial. Anesthesiol Res Pract 2022; 2022:9986587. [PMID: 36589598 PMCID: PMC9803568 DOI: 10.1155/2022/9986587] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/25/2022] Open
Abstract
Background and Aims Primiparous women experience high levels of anxiety before cesarean section. Therefore, this research aimed to investigate the effects of the Benson Relaxation Technique (BRT) and Music Therapy (MT) on the anxiety of primiparous women prior to cesarean section. Methods A randomized controlled trial was carried out on 105 women scheduled for cesarean section. They were randomly assigned into three groups: BRT, MT, and control (n = 35 per group). The women in the BRT and MT groups performed exercises and listened to music, respectively, for 20 minutes prior to cesarean section. The State Anxiety Inventory was used to measure the women's anxiety in the groups before and after the intervention. Results Within-group comparisons showed that the women in the BRT (t = 5.61, p < 0.001, effect size (Cohen's d) = 0.94) and MT (t = 3.83, p = 0.001, d = 0.64) groups had significantly lower anxiety after the interventions compared to before the interventions. Also, between-group comparisons revealed that anxiety after the intervention was significantly lower in the BRT and MT groups compared to the control group (p = 0.007). Conclusions Although both of the BRT and MT helped with the reduction of anxiety among primiparous women before cesarean section, the BRT was shown more effective. These nonpharmacologic methods are safe and cost-effective and can improve well-being among women undergoing this invasive procedure. They can be used along with pharmacologic methods for reducing overreliance on medications.
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Zhao W, Zhao Y, Wang P, Zhou Y, Meng X, Ma W, Li J, Zhang Y. PM 2.5 exposure associated with prenatal anxiety and depression in pregnant women. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 248:114284. [PMID: 36395653 DOI: 10.1016/j.ecoenv.2022.114284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Associations of air pollution with anxiety and depression were found in previous studies. However, whether air pollution exposure during pregnancy contributes to prenatal anxiety and depression or not is under-investigated. In this study, we aimed to analyze associations between fine particulate matter (PM2.5) exposure with anxiety and depression during pregnancy and to explore the critical window of PM2.5 exposure. METHODS This study was based on the Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC). We used a gap-filling random forest model to estimate PM2.5 exposure concentration during pregnancy of each participant. The Self-Rating Anxiety Scale (SAS) and the Center for Epidemiological Survey-Depression Scale (CES-D) were used to quantify the anxiety and depression levels in late pregnancy. Covariate information was obtained from medical records and questionnaires. We performed generalized linear regression and logistic regression models to assess the association and the critical window. RESULTS Totally 3731 pregnant women were included, with the age of 28.85 ± 3.97 years old. Anxiety and depression rates were 10.8 % and 11.5 % respectively, according to the cut-off value of SAS and CES-D. Generalized linear regression results showed that the increase of PM2.5 concentration in three stages (gestational 0-13 weeks, 0-26 weeks, 0-36 weeks) was related to the increase of scale score. The PM2.5 concentration in 0-13 weeks could increase the risk of anxiety and depression by approximately 23 % and 25 %, respectively. And the gestational weeks 4th-13th were the suspicious critical window of PM2.5 exposure. CONCLUSION The increased risk of anxiety or depression was related to PM2.5 exposure during pregnancy, especially early pregnancy.
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Affiliation(s)
- Wenxuan Zhao
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Yue Zhao
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Pengpeng Wang
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Yuhan Zhou
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xia Meng
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
| | - Wenjuan Ma
- Minhang Hospital, Fudan University, Shanghai, China.
| | - Jiufeng Li
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China.
| | - Yunhui Zhang
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), China; Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China.
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Margawati A, Syauqy A, Utami A, Hananingtyas A, Zaimatussoleha C. Anxiety among Pregnant Women in Rural-Urban Area Indonesia during the COVID-19 Pandemic in Semarang, Indonesia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: About 10% of pregnant women in the world experience emotional changes. Changes that occur during the pandemic, can increase anxiety, including in pregnant women. This study aimed to analyze factors associated with anxiety levels in pregnant women during the COVID-19 pandemic in Semarang, Indonesia.
METHODS: This study was an observational study with a cross-sectional design. The sampling technique was cluster sampling. The research subjects were 238 pregnant women. The research variables included the mother’s characteristics, hemoglobin, knowledge related to nutrition and COVID-19, and anxiety. Anxiety levels were measured using the Hamilton Rating Scale for Anxiety (HRSA) questionnaire. Data analysis used a multivariate logistic regression test.
RESULTS: This study showed that 20.2% of subjects had mild to moderate to severe anxiety levels. The results of the multivariate analysis, subjects with low COVID-19 knowledge had higher odds of anxiety levels (OR 2.407; 95% CI: 1.202 – 4.820; p-value 0.042), and subjects with gravida in the first time or ≥ fourth times had higher odds of anxiety levels (OR 2.366; 95% CI 1.199 – 4.670; p-value 0.013).
CONCLUSION: Pregnant women with low COVID-19 knowledge and gravida for the first time or ≥ fourth times were found associated with anxiety during the COVID-19 pandemic in Semarang, Indonesia.
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15
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Liu S, Xia D, Wang Y, Xu H, Xu L, Yuan D, Liang A, Chang R, Wang R, Liu Y, Chen H, Hu F, Cai Y, Wang Y. Predicting the risk of HIV infection among internal migrant MSM in China: An optimal model based on three variable selection methods. Front Public Health 2022; 10:1015699. [PMID: 36388367 PMCID: PMC9641070 DOI: 10.3389/fpubh.2022.1015699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction Internal migrant Men who have sex with men (IMMSM), which has the dual identity of MSM and floating population, should be more concerned among the vulnerable groups for HIV in society. Establishing appropriate prediction models to assess the risk of HIV infection among IMMSM is of great significance to against HIV infection and transmission. Methods HIV and syphilis infection were detected using rapid test kits, and other 30 variables were collected among IMMSM through questionnaire. Taking HIV infection status as the dependent variable, three methods were used to screen predictors and three prediction models were developed respectively. The Hosmer-Lemeshow test was performed to verify the fit of the models, and the net classification improvement and integrated discrimination improvement were used to compare these models to determine the optimal model. Based on the optimal model, a prediction nomogram was developed as an instrument to assess the risk of HIV infection among IMMSM. To quantify the predictive ability of the nomogram, the C-index measurement was performed, and internal validation was performed using bootstrap method. The receiver operating characteristic (ROC) curve, calibration plot and dynamic component analysis (DCA) were respectively performed to assess the efficacy, accuracy and clinical utility of the prediction nomogram. Results In this study, 12.52% IMMSMs were tested HIV-positive and 8.0% IMMSMs were tested syphilis-positive. Model A, model B, and model C fitted well, and model B was the optimal model. A nomogram was developed based on the model B. The C-index of the nomogram was 0.757 (95% CI: 0.701-0.812), and the C-index of internal verification was 0.705. Conclusions The model established by stepwise selection methods incorporating 11 risk factors (age, education, marriage, monthly income, verbal violence, syphilis, score of CUSS, score of RSES, score of ULS, score of ES and score of DS) was the optimal model that achieved the best predictive power. The risk nomogram based on the optimal model had relatively good efficacy, accuracy and clinical utility in identifying internal migrant MSM at high-risk for HIV infection, which is helpful for developing targeted intervention for them.
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Affiliation(s)
- Shangbin Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danni Xia
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuxuan Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huifang Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lulu Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dong Yuan
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Ajuan Liang
- Renji Hospital, Affiliated With the School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Ruijie Chang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongxi Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujie Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Hu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Fan Hu
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Yong Cai
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Ying Wang
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Ahmed M, Amin F, Taj A, Durrani N. Antenatal anxiety and depression: Frequency and correlates during the COVID-19 pandemic in Pakistan. J Family Med Prim Care 2022; 11:6407-6415. [PMID: 36618208 PMCID: PMC9810941 DOI: 10.4103/jfmpc.jfmpc_911_22] [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: 04/23/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Context Mental health ailments like anxiety and depression are common during the antenatal period. Uncertainty during COVID-19 pandemic has markedly increased its prevalence in the general population. Pregnancy, being emotionally and physically exhausting, makes mothers more susceptible to developing mental disorders like anxiety and depression. Aims To investigate prevalence and associated risk factors of antenatal anxiety and depression among women in Karachi, Pakistan. Settings and Design This cross-sectional study was conducted in the department of obstetrics and gynecology during May 2020 till May 2021. Methods and Material The study explored anxiety, depression, and associated factors in pregnant women attending antenatal clinics at a tertiary care hospital located in Karachi, Pakistan, during the COVID-19 pandemic by using the hospital anxiety and depression scale (HADS) as a screening tool. Statistical Analysis Data was entered in SPSS version 21 for statistical analysis. Results A total of 390 patients were enrolled in the study with mean age of 28.06 ± 4.52 years. Mean week of pregnancy at the time of enrolment into the study was 32.7 ± 3.1. Prevalence of anxiety and depression was 46.7% and 33.1%, respectively. On multivariable analysis, polyhydramnios was a risk factor of anxiety, whereas low income and unplanned pregnancy were substantially linked to depression. Fear of visiting doctor was a common risk factor for both anxiety and depression. Conclusion In a catastrophe like the COVID-19 pandemic, attempts to address heightened anxiety during antenatal visits will undoubtedly benefit maternal and fetal mental health. As a response, strategies to manage high anxiety symptoms should be taken into consideration.
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Affiliation(s)
- Marium Ahmed
- Department of Family Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan,Address for correspondence: Dr. Marium Ahmed, Department of Family Medicine, Liaquat National Hospital, Stadium Road, Karachi, Pakistan. E-mail:
| | - Faridah Amin
- Department of Community Health Department, The Indus Hospital Network, Karachi, Pakistan
| | - Aisha Taj
- Department of Obstetrics and Gynecology, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Noureen Durrani
- Department of Publication, Liaquat National Hospital and Medical College, Karachi, Pakistan
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Cognitive Behavioral Training and Positive Psychology Training for Pregnant Women’s Psychological Health. PSYCHOLOGICAL STUDIES 2022. [DOI: 10.1007/s12646-022-00673-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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18
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Freiberger A, Beckmann J, Freilinger S, Kaemmerer H, Huber M, Nagdyman N, Ewert P, Pieper L, Deppe C, Kuschel B, Andonian C. Psychosocial well-being in postpartum women with congenital heart disease. Cardiovasc Diagn Ther 2022; 12:389-399. [PMID: 36033219 PMCID: PMC9412213 DOI: 10.21037/cdt-22-213] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022]
Abstract
Background Improved treatment options for congenital heart disease (CHD) lead to a growing number of women with CHD at reproductive age. Due to physical and psychological burden, pregnancies in women with CHD often count for high-risk. Resulting emotional distress can adversely impact pregnancy, motherhood and fetal health. The present study aims to retrospectively investigate mental outcomes and indices of adjustment in women with CHD before, during and after pregnancy. The novel concept of illness identity is applied to explain how patients experience and integrate their CHD into their identities. Methods Patient-reported outcome measures on mental functioning and illness identity were assessed in a sample of 121 postpartum women with CHD [mean age: 42.7±9.2 (range, 27-81) years] at the German Heart Centre Munich between August and November 2021 in a cross-sectional design. Descriptive analyses, correlations and linear regression models were calculated. Results Retrospectively assessed prevalence of emotional distress before giving birth was high (47.0%) and peaked shortly after childbirth in terms of elevated symptoms of postpartum depression and trauma. During the course of maternity, emotional distress decreased significantly (24.1%, P<0.001). Overall, postpartum women demonstrated high scores in functional illness identity states (i.e., acceptance and enrichment) and low scores in dysfunctional states (i.e., rejection and engulfment). CHD severity was not directly associated with mental outcomes (P>0.05), whereas maternal cardiovascular risk, according to the WHO classification, was significantly associated with a higher prevalence of postpartum trauma (t=2.485, P=0.015). Conclusions Postpartum mental health problems, such as (postpartum) depression, anxiety, and posttraumatic stress can become a serious burden which might be detrimental to the mother's well-being and her infant's development. Present findings emphasise the urgent need for a holistic approach focusing on pregnant women with CHD starting at the prepartum stage to prevent adverse consequences and promote maternal well-being. Illness identity might become an important target construct for clinical practice as it may positively and enduringly influence mental well-being of pregnant women with CHD.
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Affiliation(s)
- Annika Freiberger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center, Technical University Munich, Munich, Germany
| | - Jürgen Beckmann
- Department of Sport and Health Sciences, Chair of Sport Psychology, Technical University, Munich, Germany.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center, Technical University Munich, Munich, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center, Technical University Munich, Munich, Germany
| | - Maximilian Huber
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center, Technical University Munich, Munich, Germany
| | - Nicole Nagdyman
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center, Technical University Munich, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center, Technical University Munich, Munich, Germany
| | - Lars Pieper
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center, Technical University Munich, Munich, Germany
| | - Charlotte Deppe
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Bettina Kuschel
- Department of Gynecology and Obstetrics, Klinikum Rechts der Isar Technical University Munich, Munich, Germany
| | - Caroline Andonian
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center, Technical University Munich, Munich, Germany.,Department of Sport and Health Sciences, Chair of Sport Psychology, Technical University, Munich, Germany
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Ngocho JS, Minja LM, Mwamba RN, Knettel BA, Kisigo GA, Mmbaga BT, Watt MH. Prevalence and predictors of depression among women attending antenatal care in Moshi, Tanzania: a cross-sectional study. BMC Pregnancy Childbirth 2022; 22:594. [PMID: 35883166 PMCID: PMC9316357 DOI: 10.1186/s12884-022-04917-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Antenatal depression in low-and middle-income countries is under-diagnosed and leads to poorer outcomes in the pregnancy and postpartum periods. The aim of this study was to quantify depressive symptoms among pregnant women in Moshi, Tanzania, and identify factors associated with probable depression. METHODS Between March and December 2019, we enrolled 1039 pregnant women attending their first antenatal care appointment at two government health facilities to complete an audio computer-assisted self-interview. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS), with a score > 13 indicating probable depression. A log-binomial regression model was used to identify factors associated with probable antenatal depression. RESULTS A total of 11.5% (119/1033) met criteria for probable depression. Depression was more common among women who were not married (16.5% vs. 7.9%, PrR = 1.5, 95% CI 1.0, 2.1) and women who reported a lifetime history of violence (22.6% vs. 5.3%, PrR = 3.3, 95% CI 2.2, 5.0). Depression was less common among women who reported more partner-specific support (PrR = 0.92, 95% CI 0.87, 0.96). CONCLUSIONS Screening pregnant women for depressive symptoms is an essential component of evidence-based maternity care and should be accompanied by appropriate support and resources. Women who are not married, have limited support from a partner, or have experienced violence are especially vulnerable to depressive symptomatology during pregnancy.
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Affiliation(s)
- James S Ngocho
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Linda M Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania.
| | - Rimel N Mwamba
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Brandon A Knettel
- Duke Global Health Institute, Duke University, Durham, NC, USA.,School of Nursing, Duke University, Durham, NC, USA
| | - Godfrey A Kisigo
- Center for Global Health, Weill Cornell Medicine, New York, NY, 10065, USA.,Mwanza Intervention Trials Unit, National Institute of Medical Research, Mwanza, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
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20
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Bishaw KA, Andalem A, Amha H, wondie T. Generalized Anxiety Disorder and Its Associated Factors Among Pregnant Women During COVID-19 at Public Health Facilities of East Gojjam Zone, 2020: A Multi-Center Cross-Sectional Study. Front Glob Womens Health 2022; 3:918332. [PMID: 35898577 PMCID: PMC9309208 DOI: 10.3389/fgwh.2022.918332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Pregnant women suffer from varying levels of generalized anxiety disorder that result in poor obstetrical outcomes. Therefore, this study aimed to assess the prevalence and factors associated with generalized anxiety disorder among pregnant women attending antenatal care during COVID-19 at the public health facilities in the east Gojjam zone. Methods A health facility-based cross-sectional study was conducted, from 1–30 December 2020. A total of 847 pregnant women were included in the study using a systematic random sampling technique. We used an interviewer-administered questionnaire to collect the data. Bivariate and multivariable logistic regression was used to identify factors associated with the outcome variable. Statistical significance was determined using a p-value < 0.05 and a 95% confidence level. Results The prevalence of generalized anxiety disorder was 43.7%, with a 95% CI (40.28–47.12). Having <3 the number of children (AOR: 1.53; 95% CI: 1.11–2.13, having a negative attitude about COVID (AOR: 1.47; 95% CI: 1.07–2.02 and having a high-risk perception about COVID (AOR: 1.86; 95% CI: 1.34–2.57 were factors significantly associated with generalized anxiety disorder. Conclusions The study found that the prevalence of generalized anxiety disorder was high. Having less than three children, having a negative attitude, and having a high-risk perception of COVID were independent risk factors of generalized anxiety disorder. Appropriate interventions should be considered to address generalized anxiety disorder during the pandemic.
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Affiliation(s)
- Keralem Anteneh Bishaw
- Department of Midwifery, College Health Science, Debre Markos University, Debre Markos, Ethiopia
- *Correspondence: Keralem Anteneh Bishaw
| | - Addisu Andalem
- Department of Midwifery, College Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Haile Amha
- Department of Nursing, College Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tirusew wondie
- Department of Nursing, College Health Science, Debre Markos University, Debre Markos, Ethiopia
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Neoh MJY, Airoldi L, Arshad Z, Bin Eid W, Esposito G, Dimitriou D. Mental Health of Mothers of Children with Neurodevelopmental and Genetic Disorders in Pakistan. Behav Sci (Basel) 2022; 12:bs12060161. [PMID: 35735371 PMCID: PMC9220268 DOI: 10.3390/bs12060161] [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: 04/19/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 12/10/2022] Open
Abstract
This study examined maternal mental health in mothers of children with neurodevelopmental and genetic disorders in Pakistan; maternal education and affiliate stigma were also tested. It was hypothesised that mothers of children with neurodevelopmental and genetic disorders would experience high levels of depression, anxiety and affiliate stigma, and that these variables would be mediated by the level of maternal education. Seventy-five mothers of children with neurodevelopmental and genetic disorders were recruited from “Special Needs” schools in Lahore and Islamabad. The results showed that the majority of mothers were clinically depressed and a large majority of mothers were clinically anxious. The distribution of mothers with clinical anxiety was significantly different among mothers with different levels of education (p < 0.05). Furthermore, mothers with higher levels of education had less affiliate stigma. This result suggests that maternal education may be a protective factor of mental health in mothers of children with neurodevelopmental and genetic disorders. Limitations, implications and future research are discussed.
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Affiliation(s)
| | - Livia Airoldi
- Department of Psychology and Cognitive Science, University of Trento, 38028 Rovereto, Italy; (L.A.); (G.E.)
| | - Zarah Arshad
- Sleep Education and Research Laboratory, UCL Institute of Education, University College London, London WC1H 0AA, UK; (Z.A.); (W.B.E.)
| | - Wasmiah Bin Eid
- Sleep Education and Research Laboratory, UCL Institute of Education, University College London, London WC1H 0AA, UK; (Z.A.); (W.B.E.)
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, 38028 Rovereto, Italy; (L.A.); (G.E.)
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, University College London, London WC1H 0AA, UK; (Z.A.); (W.B.E.)
- Correspondence:
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22
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Acheanpong K, Pan X, Kaminga AC, Liu A. Prevalence and risk factors of prenatal depression among pregnant women attending antenatal clinic at Adventist Hospital, Bekwai Municipality, Ghana. Medicine (Baltimore) 2022; 101:e28862. [PMID: 35451379 PMCID: PMC8913126 DOI: 10.1097/md.0000000000028862] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/31/2022] [Indexed: 01/04/2023] Open
Abstract
Depression, arising in the perinatal period are a major health issue in low- and middle-income countries. However, little attention has been paid in the research of depression symptoms. This study aimed to estimate the prevalence and risk factors of depression during pregnancy.A cross-sectional study was conducted in pregnant women attending antenatal clinic at Adventist Hospital in the Bekwai Municipality, Ghana, between February and May 2020. Information on sociodemographic, medical, and obstetric factors were collected from the antenatal booklet and prenatal depression symptoms was defined as a patient health questionnaire scores ≥10. Descriptive statistics, Chi-Squared test, and Fisher exact test were used to analyze dichotomous variables. Multivariate logistic regression model was applied to estimate the adjusted odds ratios (AOR) and 95% confidence interval (95% confidence interval [CI]) for risk factors associated with prenatal depression. All statistical analyses were performed using SPSS version 20.0.The prevalence of prenatal depression in this study was 26.9% (95% CI; 24.6%-29.2%). Advance maternal age ≥35years (AOR = 1.49, 95% CI 1.05-2.11, P < .026) and low educational attainment (AOR 2.15, 95% CI 1.23-2.34, P < .007) were significantly higher among women with parental depression compared with maternal age <35years and higher educational attainment respectively. Similarly, nulliparous women (AOR = 4.93, 95% CI 1.60-15.16, P < .005), primiparous women (AOR = 5.42, 95% CI 1.76-16.71, P < .003) and multiparous women (AOR = 4.79, 95% CI 1.61-14.22, P < .005) were significantly higher among women with parental depression compared with grand multiparous woman (≥7 deliveries). Finally, prenatal depression was found to be significantly associated with hypertension in pregnancy (AOR = 1.71, 95% CI: 1.12-2.60, P < .013).Depression during pregnancy is high in the study area and is significantly associated with advance maternal age, low educational attainment, parity less than 7 deliveries, and hypertension during pregnancy.
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Affiliation(s)
- Kwabena Acheanpong
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha Hunan, China
- Department of Public Health, Adventist University of Africa, Kenya
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xiongfeng Pan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha Hunan, China
| | - Atipasa Chiwanda Kaminga
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha Hunan, China
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha Hunan, China
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23
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Bilbul M, Caccese C, Horsley K, Gauvreau A, Gavanski I, Montreuil T, Konci R, Lai JK, Da Costa D, Zelkowitz P, Shen HC, Gryte KR, Larosa A, Brown RN, Suarthana E, Nguyen TV. Maternal anxiety, depression and vascular function during pregnancy. J Psychosom Res 2022; 154:110722. [PMID: 35114604 DOI: 10.1016/j.jpsychores.2022.110722] [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: 08/21/2020] [Revised: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aim to clarify whether type and timing of mental health symptoms in early pregnancy distinctly contribute to maternal-fetal vascular function, independent from the psychotropic medications given to treat these conditions. METHODS Data from a prospective cohort study (n = 1678) were used to test whether self-reported fears about giving birth and depressive symptoms prior to 16 weeks of gestation were associated with vascular outcomes predictive of hypertensive disorders of pregnancy (HDP) i.e., systolic and diastolic blood pressure (BP); uterine artery pulsatility index (UAPI); umbilical artery resistance index (UmbARI); and urine protein creatinine ratio. Multiple linear regressions models and mediation models were used to test for associations between predictors and outcomes, controlling for previously identified risk factors for vascular dysfunction such as maternal age and history of infertility. RESULTS Fears about giving birth in early pregnancy were inversely associated with UmbARI (β = -0.33, p = 0.03, df = 51) mid- to late-pregnancy (≥20 weeks). Depressive symptoms in early pregnancy were also inversely associated with maternal systolic BP (β = -0.13, p = 0.01, df = 387) and diastolic BP (β = -0.10, p = 0.04, df = 387) during the first trimester. CONCLUSIONS While fears about giving birth in early pregnancy were associated with lower vascular resistance in the fetal-placental unit, early depressive symptoms were associated with lower maternal vascular tone. At the very least, our results support the notion that early maternal psychological distress is unlikely to account for the development of HDP later during pregnancy and provide preliminary evidence to support distinct roles of pregnancy-related anxiety and depressive symptoms in maternal-fetal vascular function.
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Affiliation(s)
- Melanie Bilbul
- Department of Psychiatry, Icahn School of Medicine, New York, NY, USA; Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | - Kristin Horsley
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Alexandre Gauvreau
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | | | - Tina Montreuil
- Department of Psychiatry, McGill University, Montreal, QC, Canada; Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Rea Konci
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Jonathan K Lai
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Phyllis Zelkowitz
- Department of Psychiatry, McGill University, Montreal, QC, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Hao Cheng Shen
- Department of Medicine, Université de Montreal, Montreal, QC, Canada
| | | | - Amanda Larosa
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada; Neuroscience Division, Douglas Mental Health University Institute, Montreal, QC, Canada
| | | | - Eva Suarthana
- Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
| | - Tuong-Vi Nguyen
- Reproductive Psychiatry Program, McGill University Health Centre, Departments of Psychiatry and Obstetrics and Gynecology, Montreal, QC, Canada.
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Insan N, Weke A, Forrest S, Rankin J. Social determinants of antenatal depression and anxiety among women in South Asia: A systematic review & meta-analysis. PLoS One 2022; 17:e0263760. [PMID: 35139136 PMCID: PMC8827460 DOI: 10.1371/journal.pone.0263760] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 01/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background Pregnancy is a time of major psychological changes making pregnant women more susceptible to depression and anxiety. Prevalence is higher among women living in Bangladesh, India and Pakistan, compared to high-income countries, due to poor understanding and lack of mental health integration within antenatal care. Antenatal depression/anxiety is associated with adverse outcomes including postnatal depression, low birth weight and impaired fetal development. Existing systematic reviews provided only limited information on the social determinants of antenatal depression/anxiety in these South Asian countries. Objective This review aimed to identify, synthesise and appraise the evidence on the social determinants associated with antenatal depression and anxiety in women living in Bangladesh, India and Pakistan. Methods We searched five databases (MEDLINE, Embase, PsycINFO, Scopus, Web of Science) and PROSPERO. Observational studies published between 1st January 2000 and 4th January 2021 were included if they were in the English language, used validated tools for measuring depression/anxiety in pregnant women and reported statistical associations or raw numbers. Summary estimates were obtained using random-effects model. Heterogeneity and publication bias was measured using the I2 statistic and Egger’s test, respectively. This review was registered on PROSPERO (reference: CRD42020167903). Results We included 34 studies (with 27,379 women). Meta-analysis of Adjusted Odds Ratios (AOR) found that Intimate partner violence (AOR 2.48, 95% CI 1.41–4.33), unplanned pregnancy (AOR 1.53, 95% CI 1.28–1.83), male gender preference (AOR 3.06, 95% CI 1.40–6.72) and poor relationship with in-laws (AOR 2.69, 95% CI 1.25–5.80) were significantly associated with antenatal depression/anxiety. Conclusion The review identified a complex range of social determinants of antenatal depression and anxiety in Bangladesh, India and Pakistan. Screening tools to identify pregnant women at high risk should be integrated within antenatal care to prevent adverse outcomes. Knowledge of these social determinants will inform the development of such screening tools and interventions.
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Affiliation(s)
- Nafisa Insan
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
- * E-mail:
| | - Anthony Weke
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Simon Forrest
- Department of Sociology, Durham University, Durham, United Kingdom
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
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25
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Patabendige M, Wanniarachchi D, Weerasinghe M, Ruwanpathirana P, Jayasundara D, Jayawardane A. The sustained adverse impact of COVID-19 pandemic on mental health among pregnant women in Sri Lanka: a reassessment during the second wave. BMC Res Notes 2022; 15:3. [PMID: 34986872 PMCID: PMC8729090 DOI: 10.1186/s13104-021-05893-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To study the change in trend of antenatal mental health and associated factors among a cohort of pregnant women during the second wave of COVID-19 using Hospital Anxiety and Depression Scale (HADS). Previous study using the same scale, during the first wave reported a higher prevalence of anxiety and depression. Results A descriptive cross-sectional study was carried out at the two large maternity hospitals in Colombo, Sri Lanka: Castle Street Hospital for Women (CSHW) and De Soysa Hospital for Women (DSHW). Consecutively recruited 311 women were studied. Out of which, 272 (87.5%) were having uncomplicated pregnancies at the time of the survey and 106 (34.1%) were either anxious, depressed, or both. Prevalence of anxiety was 17.0% and depression 27.0%. Overall, continuing COVID-19 pandemic increased antenatal anxiety and depression. The trend was to aggravate depression more intensively compared to anxiety in this cohort of women studied. Special support is needed for pregnant mothers during infectious epidemics taking more attention to antenatal depression.
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Affiliation(s)
| | | | | | | | - Dmcs Jayasundara
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Asanka Jayawardane
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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26
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Tamiru D, Misgana T, Tariku M, Tesfaye D, Alemu D, Weldesenbet AB, Gebremichael B, Dheresa M. Prevalence and Associated Factors of Common Mental Disorders Among Pregnant Mothers in Rural Eastern Ethiopia. Front Psychiatry 2022; 13:843984. [PMID: 35418883 PMCID: PMC8995426 DOI: 10.3389/fpsyt.2022.843984] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/01/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Antenatal common mental disorder is a significant public health issue, especially in low- and middle-income countries with an extensive treatment gap. Common mental disorders have multifaceted implications on maternal and fetal health outcomes during pregnancy with long-running economic and social sequels. This study aimed to determine the prevalence of common mental disorder and associated factors among pregnant mothers in eastern Ethiopia, Kersa and Haramaya Health, and Demographic surveillance sites. METHODS A community-based cross-sectional study was conducted in Kersa and Haramaya health and demographic surveillance sites from January 30 to April 30, 2021. World Health Organization Self-Reporting Questionnaire (SRQ-20) was used to measure common mental disorder among 1,015 randomly selected pregnant women. Data were collected face-to-face using open data kit software. Logistic regression was fitted to identify factors associated with common mental disorders. RESULTS The overall prevalence of common mental disorders (SRQ > 6) among pregnant women was 37.5% (95% CI: 34.5, 40.5). Current substance use (AOR = 1.99, 95% CI 1.37, 2.88), intimate partner violence (AOR = 2.67, 95% CI 2.02, 3.53), null parity (AOR = 3.10, 95% CI 1.65, 5.84), gestational age [first trimester (AOR = 2.22, 95% CI 1.01, 4.93) and third trimester (AOR = 1.74, 95% CI 1.31, 2.31)], history of abortion (AOR = 2.03, 95% CI 1.27, 3.24), and absence of antenatal care follow-up (AOR = 1.43, 95% CI 1.08, 1.89) were significantly associated with common mental disorder during pregnancy. CONCLUSION Common mental disorders are prevalent among pregnant women in the study area with significant correlates. Administration of regular screening programs for maternal mental health conditions in rural, low-income communities, integrating into primary health care settings is imperative to reduce the risk.
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Affiliation(s)
- Dawit Tamiru
- Department of Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Misgana
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mandaras Tariku
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dejene Tesfaye
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Daniel Alemu
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adisu Birhanu Weldesenbet
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Berhe Gebremichael
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Cena L, Gigantesco A, Mirabella F, Palumbo G, Camoni L, Trainini A, Stefana A. Prevalence of comorbid anxiety and depressive symptomatology in the third trimester of pregnancy: Analysing its association with sociodemographic, obstetric, and mental health features. J Affect Disord 2021; 295:1398-1406. [PMID: 34583842 DOI: 10.1016/j.jad.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 08/09/2021] [Accepted: 09/12/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Little is known about the prevalence of comorbid anxiety and depression (CAD) during pregnancy and its risk factors. The aims of this study are to determine the prevalence of CAD in the third trimester of pregnancy and analyse its association with socio-demographic, obstetric, and mental health features. METHODS In a sample of 934 Italian pregnant women, CAD was defined as having (1) a score of ≥ 10 on the EPDS - depression subscale and/or on the PHQ-9, and (2) a score of ≥ 40 on the State-Trait Anxiety Inventory State and/or a score of ≥ 6 on the EPDS - anxiety subscale. Logistic regression analyses were used to identify socio-demographic, obstetrics, and mental health risk factors of CAD. RESULTS The prevalence of CAD was 6.8%. Age between 30 and 35 years (OR=3.01, 95% CI: 1.22-7.45) compared to younger age, current sleep disorders (OR=7.88, 95% CI: 3.83-16.23), and preconception mood disorders (OR=2.76, 95% CI: 1.31-5.84) were associated with higher odds of CAD. Conversely, the presence of no or few economic problems (OR=0.21, 95% CI: 0.07-0.65; OR=0.26, 95% CI: 0.09-0.77) and the perception of enough or more than enough practical support from friends or relatives (OR=0.32, 95% CI: 0.13-0.80; OR=0.22, 95% CI: 0.09-0.53) were associated with lower odds of developing CAD. LIMITATIONS The cross-sectional design; the use of self-report questionnaires. CONCLUSION CAD is relatively common among third-trimester antepartum women. The provision of economic/practical support may reduce CAD prevalence and its direct and indirect costs.
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Affiliation(s)
- Loredana Cena
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy.
| | - Antonella Gigantesco
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Fiorino Mirabella
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Gabriella Palumbo
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Laura Camoni
- Center for Behavioural Sciences and Mental Health, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Alice Trainini
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy
| | - Alberto Stefana
- Observatory of Perinatal Clinical Psychology, Department of Clinical and Experimental Sciences, Section of Neuroscience, University of Brescia, viale Europa 11, 25123 Brescia, Italy
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28
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Luo Z, Xue L, Ma L, Liu Z. Comorbid Anxiety and Depression and Related Factors Among Pregnant and Postpartum Chinese Women During the Coronavirus Disease 2019 Pandemic. Front Psychol 2021; 12:701629. [PMID: 34733199 PMCID: PMC8558209 DOI: 10.3389/fpsyg.2021.701629] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/09/2021] [Indexed: 01/09/2023] Open
Abstract
Objective: To identify the prevalence of comorbid anxiety and depression (CAD) and analyze the relationship between CAD and sociodemographic and obstetric-related variables in pregnant and postpartum Chinese women during the COVID-19 pandemic. Methods: Participants were 2,237 pregnant and postpartum women (aged 19-47 years) who visited various medical institutions in China between February 28, 2020, and April 26, 2020. They were asked to complete an online survey assessing the anxiety and depression, obstetric characteristics, and sociodemographic variables. The women were grouped into the following categories in accordance with the Generalized Anxiety Disorder Scale-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9): (a) CAD, (b) "anxiety only," (c) "depression only," and (d) "no depression or anxiety." After estimating the prevalence of CAD, "anxiety only," and "depression only," we carried out chi-squared tests and multiple logistic regression analysis to examine the related factors between these groups of pregnant and postpartum Chinese women. Results: Comorbid anxiety and depression, "anxiety only," and "depression only," occurred in 6.3, 5.8, and 3.9% of participants, respectively. The prevalence rates of CAD during the first, second, and third trimesters of pregnancy and the postpartum period were found to be 7.4, 6.5, 5.7, and 8.2%, respectively. The factors that differed among the groups were age (p < 0.05), marital status (p < 0.001), level of education (p < 0.05), family support (p < 0.001), and total live births (p < 0.001). "Poor family support" (odds ratio (OR): 1.90; 95% confidence interval (CI): 1.30-2.78; p = 0.0009) and "no birth" (OR: 1.91; 95% CI: 1.32-2.75; p = 0.0006) remained significant factors for the CAD group, while "poor family support" (OR: 2.16; 95% CI: 1.34-3.47; p = 0.0015) remained a significant factor for the "depression only" group when their results were compared to those of the "no depression or anxiety" group in the multiple logistic regression analysis. Conclusion: Pregnant and postpartum Chinese women with poor family support and primipara are at high risk for CAD during the COVID-19 pandemic. These results support the need for targeted perinatal programs to address CAD in pregnant and postpartum women during the pandemic period.
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Affiliation(s)
- Zheng Luo
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Luyao Xue
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Li Ma
- Beijing Key Laboratory of Learning and Cognition, School of Psychology, Capital Normal University, Beijing, China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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29
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Shakarami A, Mirghafourvand M, Abdolalipour S, Jafarabadi MA, Iravani M. Comparison of fear, anxiety and self-efficacy of childbirth among primiparous and multiparous women. BMC Pregnancy Childbirth 2021; 21:642. [PMID: 34548055 PMCID: PMC8456545 DOI: 10.1186/s12884-021-04114-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/10/2021] [Indexed: 01/21/2023] Open
Abstract
Background The aim of this study was to compare fear of childbirth, state and trait anxiety, and childbirth self-efficacy among primiparous and multiparous women in Ahvaz, southwest of Iran. Methods This cross-sectional study was conducted with 200 pregnant women (100 primiparous and 100 multiparous women) who had been admitted to the maternity ward of hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. The instruments used for data collection in this study included a demographic questionnaire, Delivery Fear Scale (DFS), Spielberger's State-Trait Anxiety Inventory (STAI), and Childbirth Self-Efficacy Inventory (CBSEI). The data were analyzed by chi-square test and independent t-test. Also, the univariate general linear model was used by adjusting for the socio-demographic and obstetric characteristics that were considered as possible confounding variables. Results The mean score of DFS in primiparous women was significantly higher than that of multiparous women. The mean of the overall score of childbirth self-efficacy of primiparous women was significantly lower than that of multiparous women. The mean score of the outcome expectancies and self-efficacy expectancies was significantly lower in primiparous women compared with multiparous women. There was no statistically significant difference between the two groups in terms of the mean score of STAI. After adjusting for possible confounding variables, the differences between the two groups in terms of fear of childbirth scores, overall childbirth self-efficacy score and self-efficacy expectancies remained significant. Conclusion Given the high fear of childbirth and low childbirth self-efficacy in primiparous women compared to the multiparous women, appropriate interventions should be adopted by health care providers in order to reduce fear and improve childbirth self-efficacy in primiparous women.
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Affiliation(s)
- Aazam Shakarami
- Midwifery Department, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Somyieh Abdolalipour
- Midwifery Department, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.,Center for the development of Interdisciplinary Research in Islamic Sciences and Health Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mina Iravani
- Midwifery Department, Reproductive Health Promotion Research Center, Faculty of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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30
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Malekpoorafshar M, Salehinejad P, Pouya F, Khezri Moghadam N, Shahesmaeili A. A Shift Toward Childbearing in One-Child Families Through a Mindfulness-Based Stress Reduction Program: A Randomized Controlled Trial. J Family Reprod Health 2021; 15:19-27. [PMID: 34429733 PMCID: PMC8346737 DOI: 10.18502/jfrh.v15i1.6070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: Fertility patterns are a key to the estimation of future population size, but they are restricted by serious indecision. One-child families are one of these patterns that is caused by a set of factors and one of these factors is the fear of re-pregnancy. In this regard, this study aimed to use a mindfulness-based stress reduction (MBSR) program to reduce the fear of women who have been experiencing anxiety after their first pregnancy and delivery. Materials and methods: This interventional study was conducted on 67 one-child women, who at least 6 years have been passed since the birth of their child and according to the short form of the Pregnancy Related Anxiety Questionnaire (PRAQ-17), have been experienced anxiety. These women were randomly divided into control and intervention groups. For the intervention group, the MBSR program was conducted in 8 sessions, once every week, each session lasting 2.5 hours. At the end of the program, a second PRAQ-17 was completed by both groups. Results: The findings showed that the MBSR approach in the intervention group significantly decreased the anxiety score in total (p=0.001) and individually in all subcategories. Conclusion: The MBSR approach can reduce the anxiety of one-child women who have experienced anxiety after their pregnancy and childbirth. Thus, using this method in helping women with pregnancy-related anxiety is recommended to increase the birth rate.
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Affiliation(s)
- Mojgan Malekpoorafshar
- Department of Midwifery, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Salehinejad
- Department of Midwifery, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran.,Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Pouya
- Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Armita Shahesmaeili
- World Health Organization Collaborating Center for HIV Surveillance Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Daykan Y, Tamir Yaniv R, Yagur Y, Pomeranz M, Arbib N, Klein Z, Schonman R. Did COVID-19 quarantine redirect habitual patient visits in the gynecology emergency room? J Gynecol Obstet Hum Reprod 2021; 50:102199. [PMID: 34329799 PMCID: PMC8314788 DOI: 10.1016/j.jogoh.2021.102199] [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: 05/12/2021] [Revised: 06/01/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022]
Abstract
Objective COVID-19 pandemic caused a dramatic decline in the gynecology emergency department (ED) visits. The Israeli government took a determined step of quarantine to suppress and control the spread. This study evaluates the effect of the COVID -19 quarantine on gynecology emergency department (ED) visits compared to the previous year. Materials and methods A retrospective case-control study was conducted during the first half-year of the COVID-19 pandemic and focused on the quarantine during April. In order to identify differences in the population's epidemiology and changes in the amount and type of emergency gynecological visits and surgeries, we compared patients during April 2020 (COVID-19 quarantine) to those who visited the gynecology ED during April 2019. Results During January–June 2020 period, there was an overall 3707 patient visits in the gynecology ED, which represents a 22.8% decrease in patient visits compared to the previous year (2019, 4803 patients). There was a 36% decrease in the gynecology ED visits during the quarantine period. Patient demographics were similar between groups. Visits of nulliparous women were more common in the study group (p = .0001) and self-referral (p = .017). More post-operative complications and fewer patients with abdominal pain were admitted to the study group (p = .034 and p = .054, respectively). During the study, the hospitalization rate did not change 18.2% vs. 17.5% (p = 0.768). Hospitalization duration was significantly longer in the COVID-19 quarantine (2.8 ± 1.3 vs. 3.1 ± 1.5, p < 0.001). There was no significant difference among surgical procedure incidents. Conclusion Visits in the gynecology ED service decreased during the COVID-19 quarantine without compromising the treatment of gynecology emergencies. Many gynecologic complaints can be managed in community care settings without referral to an ED.
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Affiliation(s)
- Yair Daykan
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel.
| | - Rina Tamir Yaniv
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Yael Yagur
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Meir Pomeranz
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Nissim Arbib
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Zvi Klein
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Ron Schonman
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
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Atif M, Halaki M, Raynes-Greenow C, Chow CM. Perinatal depression in Pakistan: A systematic review and meta-analysis. Birth 2021; 48:149-163. [PMID: 33580505 DOI: 10.1111/birt.12535] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate the prevalence and associated risk factors of perinatal depression in Pakistan. METHODS We conducted a systematic search of Medline, PsycINFO, CINAHL, EMBASE, and Global health, up through May 31, 2019. Studies reporting on the prevalence of perinatal depression in Pakistan with or without associated risks factors were included. RESULTS Forty-three studies reporting data from 17 544 women met the eligibility criteria and were included. Overall, the pooled prevalence of antenatal depression was 37% (95% CI: 30-44), while that of postnatal depression was 30% (95% CI: 25-36). The prevalence of perinatal depression in women residing in urban areas and those living in rural settings was not significantly different. The most frequently reported risk factors for antenatal depression were intimate partner violence and poor relationship with spouse, and that reported for postnatal depression was low-income level. An unintended pregnancy was significantly associated with perinatal depression in Pakistan. CONCLUSIONS We identified variability in prevalence rate of perinatal depression in Pakistan. It is difficult to gauge the true magnitude of this problem potentially due to differing risk factors between the antenatal and postnatal periods and the lack of uniformity of data collection protocols and procedures. The high prevalence rates of 30%-37% compared to global estimates suggest policy makers and stakeholders should direct additional resources toward improving perinatal mental health in Pakistan.
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Affiliation(s)
- Maria Atif
- Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Halaki
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Camille Raynes-Greenow
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chin-Moi Chow
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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Okafor CN, Barnett W, Zar HJ, Nhapi R, Koen N, Shoptaw S, Stein DJ. Associations of Emotional, Physical, or Sexual Intimate Partner Violence and Depression Symptoms Among South African Women in a Prospective Cohort Study. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP5060-NP5083. [PMID: 30160637 PMCID: PMC6486451 DOI: 10.1177/0886260518796522] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Violence against women remains a significant public health problem globally. The majority of longitudinal studies documenting the negative impact of intimate partner violence (IPV) on the mental health of women come from high-income countries. The aim of this study was to investigate the longitudinal association between emotional, physical, or sexual IPV and depression symptoms among South African women in a prospective cohort study. Participants were 981 South African women enrolled in the Drakenstein Child Health Study-a cohort study investigating the early life determinants of child health. Interview data from four time-points (antenatal care visit, 6 months, 12 months, and 18 months postpartum) were included. The primary independent variable was self-reported emotional, physical, and sexual IPV in the past 12 months. Depressive symptoms were assessed at each time-point with the Edinburgh Postnatal Depression Scale (EPDS); a cutoff score of ⩾13 was used to define significant depression symptoms. We used pooled-multivariable logistic regression models to determine associations between the three different forms of IPV and significant depression symptoms while adjusting for time-fixed and time-updated covariates. The mean age of the sample at antenatal care visit was 27 years (standard deviation = 6.0). In the adjusted model including all forms of IPV and adjusting for sociodemographic and clinical characteristics, substance use, and childhood trauma, emotional (adjusted odds ratio [aOR] =1.55, 95% confidence interval (CI): [1.02, 2.34]; p = .039)] and sexual (aOR = 2.02, 95% CI: [1.10, 3.72]; p < .001) IPV were significantly associated with significant depression symptoms. The relationship between physical IPV and significant depression symptoms was not statistically significant (aOR = 0.68, 95% CI: [0.44, 1.05]; p = .485). Our study confirms findings from high-income countries of the association between IPV and depressive symptoms among women in South Africa. Routine screening for IPV, including emotional IPV and intervention programs for IPV among women, is needed in South Africa.
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Affiliation(s)
- Chukwuemeka N Okafor
- Divison of Infectious Diseases, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Whitney Barnett
- Department of Pediatrics & Child Health, Red Cross Children's Hospital, University of Cape Town, South Africa
- South African Medical Research Council Unit on Child & Adolescent Health, Cape Town, South Africa
| | - Heather J Zar
- Department of Pediatrics & Child Health, Red Cross Children's Hospital, University of Cape Town, South Africa
- South African Medical Research Council Unit on Child & Adolescent Health, Cape Town, South Africa
| | - Raymond Nhapi
- Department of Pediatrics & Child Health, Red Cross Children's Hospital, University of Cape Town, South Africa
- South African Medical Research Council Unit on Child & Adolescent Health, Cape Town, South Africa
| | - Nastassja Koen
- Department of Psychiatry & Mental Health, University of Cape Town, South Africa
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Steve Shoptaw
- David Geffen School of Medicine, Department of Family Medicine & Department of Psychiatry, Univerisy of Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry & Mental Health, University of Cape Town, South Africa
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
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Generalized anxiety symptoms among women attending antenatal clinic in Mwanza Tanzania; a cross-sectional study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Li C, Huo L, Wang R, Qi L, Wang W, Zhou X, Zhou Y, Zhang X. The prevalence and risk factors of depression in prenatal and postnatal women in China with the outbreak of Corona Virus Disease 2019. J Affect Disord 2021; 282:1203-1209. [PMID: 33601697 PMCID: PMC7800140 DOI: 10.1016/j.jad.2021.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 01/03/2021] [Accepted: 01/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The prevalence of depression increase with the outbreaks of epidemic disease. The prevalence of depression during the outbreak of Corona Virus Disease 2019 (COVID-19) in prenatal and postnatal women was examined in China. METHODS 2201 prenatal and postnatal women in mainland China were recruited in this cross-sectional study from February 28th to April 26th, 2020. The Patient Health Questionnaire (PHQ-9) was used to assess depression in prenatal and postnatal women. RESULTS The prevalence rate of depression was 35.4%. The risk factors for depression included drinking (p = 0.04; adjusted OR = 2.81, 95%CI: 1.26~6.24), nausea and vomiting during pregnancy (p < 0.001; adjusted OR = 3.54, 95%CI: 1.10~11.44), pregnancy's influence on mobility (p = 0.02; adjusted OR = 1.42, 95%CI: 1.11~1.83), anxiety (p < 0.001; adjusted OR = 1.66, 95%CI: 1.57~1.75), insomnia (p < 0.001; adjusted OR = 1.17, 95%CI: 1.14~1.21) and daily attention to fetal movement (p < 0.001; adjusted OR = 0.41, 95%CI: 0.31~0.56). LIMITATIONS This study used a cross-sectional design, and cannot compare changes in the incidence of depression before and after the COVID-19 outbreak. CONCLUSIONS During the COVID-19 outbreak, the prevalence rate of depression among Chinese prenatal and postnatal women was 35.4%. Moreover, anxiety, insomnia, drinking, nausea and vomiting during pregnancy, as well as the impaired movement and less daily monitoring of fetal movement were risk factors for depression.
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Affiliation(s)
- Chuanxiao Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China,Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
| | - Lijuan Huo
- Department of Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Qi
- School of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, 430023, China
| | - Wenjia Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xin Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Yongjie Zhou
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Khan R, Waqas A, Mustehsan ZH, Khan AS, Sikander S, Ahmad I, Jamil A, Sharif M, Bilal S, Zulfiqar S, Bibi A, Rahman A. Predictors of Prenatal Depression: A Cross-Sectional Study in Rural Pakistan. Front Psychiatry 2021; 12:584287. [PMID: 34566707 PMCID: PMC8461022 DOI: 10.3389/fpsyt.2021.584287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To determine the prevalence and association of prenatal depression with socioeconomic, demographic and personal factors among pregnant women living in Kallar Syedan, Rawalpindi, Pakistan. Methods: Five hundred women in the second and third trimester of pregnancy, living in Kallar Syedan, a rural area of district Rawalpindi Pakistan, were included in the study. Depression was assessed using "Patient health questionnaire" (PHQ9) in Urdu, with a cut-off score of 10. Multi-dimensional scale of perceived social support (MSPSS) was used to assess perceived social support. Life Events and Difficulties Schedule (LEDS) were used to measure stressful life events in past 1 year. Tool to assess intimate partner violence (IPV) was based on WHO Multi Country Study on "Women's Health and Domestic Violence against Women." Results: Prevalence of prenatal depression was found to be 27%. Number of pregnancies was significantly associated with prenatal depression (p < 0.01). Women living in a joint family and those who perceived themselves as moderately satisfied or not satisfied with their life in the next 4 years were found to be depressed (p < 0.01, OR 6.9, CI 1.77-26.73). Depressive symptomatology in women who experienced more than five stressful life events in last 1 year was three times higher (p < 0.001, OR 3.2, CI 1.68-5.98) than in women with 1-2 stressful events. Women who were supported by their significant others or their family members had 0.9 times (p < 0.01, OR 0.9, CI 0.85-0.96) less chance of getting depressed. Pregnant women who were psychologically abused by their partners were 1.5 times more depressed (p < 0.05 CI 1.12-2.51). Odds of having depression was also high in women who had less mean score of MSSI (p < 0.05, OR 1.1, CI 1.01-1.09). Women who had suitable accommodation had 0.5 times less chance of having depression than others (p < 0.05, OR 0.5, CI 0.27-0.92). Conclusion: Over a quarter of the women in the study population reported prenatal depression, which were predicted predominantly by psychosocial variables.
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Affiliation(s)
- Rukhsana Khan
- Department of Community Medicine Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Ahmed Waqas
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom.,Human Development Research Foundation, Islamabad, Pakistan
| | - Zille Huma Mustehsan
- Department of Community Medicine Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Amna Saeed Khan
- Department of Community Medicine Fazaia Medical College, Air University, Islamabad, Pakistan
| | - Siham Sikander
- Human Development Research Foundation, Islamabad, Pakistan.,Health Services Academy, Islamabad, Pakistan
| | - Ikhlaq Ahmad
- Human Development Research Foundation, Islamabad, Pakistan.,Health Services Academy, Islamabad, Pakistan
| | - Anam Jamil
- Human Development Research Foundation, Islamabad, Pakistan
| | - Maria Sharif
- Human Development Research Foundation, Islamabad, Pakistan
| | - Samina Bilal
- Human Development Research Foundation, Islamabad, Pakistan
| | | | - Amina Bibi
- Human Development Research Foundation, Islamabad, Pakistan
| | - Atif Rahman
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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Motegi T, Watanabe Y, Fukui N, Ogawa M, Hashijiri K, Tsuboya R, Sugai T, Egawa J, Araki R, Haino K, Yamaguchi M, Nishijima K, Enomoto T, Someya T. Depression, Anxiety and Primiparity are Negatively Associated with Mother-Infant Bonding in Japanese Mothers. Neuropsychiatr Dis Treat 2020; 16:3117-3122. [PMID: 33364763 PMCID: PMC7751780 DOI: 10.2147/ndt.s287036] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/27/2020] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Postpartum depression is a well-known risk factor, and postpartum anxiety and parity are potential risk factors, for mother-infant bonding disorder. However, few studies have focused on the relationships among these factors and mother-infant bonding. This cross-sectional study explored the associations between depression, anxiety and parity, and mother-infant bonding. MATERIALS AND METHODS Japanese mothers, both primiparas and multiparas, completed the Mother-to-Infant Bonding Scale (MIBS) and the Hospital Anxiety and Depression Scale (HADS) one month after childbirth. We performed a stepwise multiple regression analysis with the forward selection method to assess the effects of HADS anxiety and depression scores and parity as independent variables on mother-infant bonding as the dependent variable. RESULTS A total of 2379 Japanese mothers (1116 primiparas and 1263 multiparas) took part in the study. MIBS score (2.89 ± 2.68 vs 1.60 ± 2.11; p < 0.0001) was significantly higher in primiparas than in multiparas. HADS anxiety (6.55 ± 4.06 vs 4.63 ± 3.41; p < 0.0001) and depression (6.56 ± 3.43 vs 5.98 ± 3.20; p < 0.0001) scores were also significantly higher in primiparas than in multiparas. A stepwise multiple regression analysis with the forward selection method revealed that HADS depression and anxiety scores and parity were significantly associated with MIBS score (p = 0.003, 0.015 and 0.023). CONCLUSION Depression, anxiety and primiparity were negatively associated with mother-infant bonding one month after childbirth.
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Affiliation(s)
- Takaharu Motegi
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuichiro Watanabe
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Naoki Fukui
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Maki Ogawa
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Koyo Hashijiri
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryusuke Tsuboya
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takuro Sugai
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jun Egawa
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Rie Araki
- Nursing, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kazufumi Haino
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masayuki Yamaguchi
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Koji Nishijima
- General Center for Perinatal, Maternal and Neonatal Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Takayuki Enomoto
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshiyuki Someya
- Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Leach LS, Poyser C, Fairweather‐schmidt K. Maternal perinatal anxiety: A review of prevalence and correlates. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12058] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Liana S. Leach
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia,
| | - Carmel Poyser
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia,
| | - Kate Fairweather‐schmidt
- Centre for Research on Ageing, Health and Wellbeing, The Australian National University, Canberra, Australian Capital Territory, Australia,
- School of Psychology, Flinders University, Adelaide, South Australia, Australia,
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Zelalem ED, Asaye MM, Mihret MS. Antenatal depression and its correlates on northwestern Ethiopian women: community-based cross-sectional study. Pan Afr Med J 2020; 36:239. [PMID: 33708330 PMCID: PMC7908391 DOI: 10.11604/pamj.2020.36.239.19890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 06/21/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction mental health during pregnancy is a very important but neglected problem in most African countries including Ethiopia. In general, there was a scarce of studies on antenatal depression at the community level in Ethiopia. Therefore, this study was aimed at assessing the prevalence and correlates of antenatal depression among postpartum women in Gondar city, Northwest Ethiopia. Methods a community-based cross-sectional study was conducted in Gondar city among 526 women from July 01st to 30th/2018. A cluster sampling technique was employed and an interviewer-administered semi-structured questionnaire was utilized to collect the data. The data were entered into Epi-info version 7.0 and exported to SPSS version 20. Both bivariate and multivariable logistic regression analyses were performed. The level of statistical significance was declared based on the AOR with 95% CI and P-value ≤0.05. Results the prevalence of ante partum depression was 24.1% (95% CI: 20.5-27.5) and it was independently predicted by relatives’ mental illness (AOR = 2.30; 95% CI: 1.17-4.53), sex preference (AOR = 1.80; 95% CI: 1.07-3.02), lack of relatives’ support (AOR = 2.07; 95% CI: 1.12-3.87), unhappy marriage (AOR = 2.94; 95% CI: 1.81-4.76), history of depression (AOR = 5.23; 95% CI: 2.87-9.50) and no or one alive child (AOR = 1.78; 95% CI: 1.13-2.79). Conclusion the prevalence of ante partum depression was high and connected to poor psycho-social experiences. Therefore, building-up of family's network, fortifying relatives' support, resolving unhappy spousal relationships, and assuming early screening and intervention would degrade its burden.
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Affiliation(s)
| | - Mengstu Melkamu Asaye
- Department of Women and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Perinatal Mental Illness in the Middle East and North Africa Region-A Systematic Overview. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155487. [PMID: 32751384 PMCID: PMC7432515 DOI: 10.3390/ijerph17155487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 12/16/2022]
Abstract
Aims: Perinatal mental illness (PMI) is associated with a high risk of maternal and infant morbidity. Recently, several systematic reviews and primary studies have explored the prevalence and risk factors of PMI in the Middle East and North Africa (MENA) region. To our knowledge, there has been no critical analysis of the existing systematic reviews (SRs) on this topic in the MENA region. Our systematic overview primarily aimed to synthesize evidence from the published SRs on PMI in the MENA countries focusing on a) the prevalence of PMI and b) the risk factors associated with PMI. Methods: We conducted a systematic overview of the epidemiology of PMI in the Middle East and North Africa region by searching the PubMed, Embase, and PsycInfo databases for relevant publications between January 2008 and July 2019. In addition to searching the reference lists of the identified SRs for other relevant SRs and additional primary studies of relevance (those which primarily discussed the prevalence of PMI and/or risk and protective factors), between August and October 2019, we also searched Google Scholar for relevant studies. Results: After applying our inclusion and exclusion criteria, 15 systematic reviews (SRs) and 79 primary studies were included in our overview. Studies utilizing validated diagnostic tools report a PMI prevalence range from 5.6% in Morocco to 28% in Pakistan. On the other hand, studies utilizing screening tools to detect PMI report a prevalence range of 9.2% in Sudan to 85.6% in the United Arab Emirates. Wide variations were observed in studies reporting PMI risk factors. We regrouped the risk factors applying an evidence-based categorization scheme. Our study indicates that risk factors in the relational, psychological, and sociodemographic categories are the most studied in the region. Conversely, lifestyle-related risk factors were less studied. Conclusions: Our systematic overview identifies perinatal mental illness as an important public health issue in the region. Standardizing approaches for estimating, preventing, screening, and treating perinatal mental illness would be a step in the right direction for the region.
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Rowther AA, Kazi AK, Nazir H, Atiq M, Atif N, Rauf N, Malik A, Surkan PJ. "A Woman Is a Puppet." Women's Disempowerment and Prenatal Anxiety in Pakistan: A Qualitative Study of Sources, Mitigators, and Coping Strategies for Anxiety in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144926. [PMID: 32650551 PMCID: PMC7400614 DOI: 10.3390/ijerph17144926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/05/2020] [Accepted: 06/29/2020] [Indexed: 12/19/2022]
Abstract
Common mental disorders are highly prevalent among pregnant women in low- and middle-income countries, yet prenatal anxiety remains poorly understood, particularly in the sociocultural context of South Asia. Our study explored sources, mitigators, and coping strategies for anxiety among symptomatic pregnant women in Pakistan, particularly in relation to autonomy in decision-making and social support. We interviewed 19 pregnant married women aged 18–37 years recruited from 2017–2018 at a public hospital in Rawalpindi who screened positive for anxiety. Thematic analysis was based on both inductive emergent codes and deductive a priori constructs of pregnancy-related empowerment. Gender norms emerged as an important dimension of Pakistani women’s social environment in both constraining pregnancy-related agency and contributing to prenatal anxiety. Women’s avenues of self-advocacy were largely limited to indirect means such as appeals to the husband for intercession or return to her natal home. The levels of autonomy during pregnancy depended on the area of decision-making, and peer/family support was a critical protective factor and enabling resource for maternal mental health. Women’s disempowerment is a key contextual factor in the sociocultural experience of prenatal maternal anxiety in South Asia, and further examination of the intersections between empowerment and perinatal mental illness might help inform the development of more context-specific preventive approaches.
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Affiliation(s)
- Armaan A Rowther
- Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD 21205, USA; (A.K.K.); (P.J.S.)
- Correspondence:
| | - Asiya K Kazi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD 21205, USA; (A.K.K.); (P.J.S.)
| | - Huma Nazir
- Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan; (H.N.); (M.A.); (N.A.); (N.R.); (A.M.)
| | - Maria Atiq
- Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan; (H.N.); (M.A.); (N.A.); (N.R.); (A.M.)
| | - Najia Atif
- Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan; (H.N.); (M.A.); (N.A.); (N.R.); (A.M.)
| | - Nida Rauf
- Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan; (H.N.); (M.A.); (N.A.); (N.R.); (A.M.)
| | - Abid Malik
- Human Development Research Foundation House No 06, Street No 55, F-7/4, Islamabad 44000, Pakistan; (H.N.); (M.A.); (N.A.); (N.R.); (A.M.)
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St., Baltimore, MD 21205, USA; (A.K.K.); (P.J.S.)
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Surkan PJ, Hamdani SU, Huma ZE, Nazir H, Atif N, Rowther AA, Chaudhri R, Zafar S, Mullany LC, Malik A, Rahman A. Cognitive-behavioral therapy-based intervention to treat symptoms of anxiety in pregnancy in a prenatal clinic using non-specialist providers in Pakistan: design of a randomised trial. BMJ Open 2020; 10:e037590. [PMID: 32300002 PMCID: PMC7200036 DOI: 10.1136/bmjopen-2020-037590] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Prenatal anxiety is a prevalent condition that is harmful for women and a strong predictor of postpartum depression. This trial assesses an intervention initiated in early pregnancy to mid pregnancy among women with clinical or subclinical symptoms of anxiety in Pakistan. METHODS AND ANALYSIS: Happy Mother, Healthy Baby (HMHB) is a phase three, two-arm, single-blind, individual randomised clinical trial conducted in the outpatient department of Holy Family Hospital, a large public tertiary care facility affiliated with Rawalpindi Medical University (RMU). Pregnant women (enrolled at ≤22 weeks of gestation) receive six individual HMHB sessions based on cognitive-behavioral therapy (CBT) and relaxation techniques that are administered by non-specialist providers and tailored to address anxiety symptoms. Two to six booster sessions are given between the fifth consecutive weekly core session and the sixth core session that occurs in the third trimester. Apart from baseline data, data are collected in the third trimester, at birth and at 6-weeks postpartum. Primary outcomes include diagnoses of postpartum common mental disorders. Secondary outcomes include symptoms of anxiety and of depression, and birth outcomes including small-for-gestational age, low birth weight and preterm birth. An economic analysis will determine the cost effectiveness of the intervention. ETHICS Ethics approval was obtained from the Johns Hopkins Bloomberg School of Health Institutional Review Board (Baltimore, USA), the Human Development Research Foundation Ethics Committee (Islamabad, Pakistan), the RMU Institutional Research Forum (Rawalpindi, Pakistan) and the National Institute of Mental Health-appointed Global Mental Health Data Safety and Monitoring Board. DISSEMINATION Results from this trial will build evidence for the efficacy of a CBT-based intervention for pregnant women delivered by non-specialised providers. Identification of an evidence-based intervention for anxiety starting in early pregnancy to mid pregnancy may be transferable for use and scale-up in other low-income and middle-income countries. TRIAL REGISTRATION NUMBER NCT03880032.
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Affiliation(s)
- Pamela J Surkan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Syed Usman Hamdani
- Human Development Research Foundation, Rawalpindi, Pakistan
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Zill-E Huma
- Human Development Research Foundation, Rawalpindi, Pakistan
| | - Huma Nazir
- Human Development Research Foundation, Rawalpindi, Pakistan
| | - Najia Atif
- Human Development Research Foundation, Rawalpindi, Pakistan
| | - Armaan A Rowther
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rizwana Chaudhri
- Department of Gynaecology and Obstetrics, Holy Family Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Shamsa Zafar
- Human Development Research Foundation, Rawalpindi, Pakistan
- Department of Obstetrics and Gynaecology, Air University, Islamabad, Pakistan
| | - Luke C Mullany
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Abid Malik
- Human Development Research Foundation, Rawalpindi, Pakistan
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Atif Rahman
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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Koirala P, Chuemchit M. Depression and Domestic Violence Experiences Among Asian Women: A Systematic Review. Int J Womens Health 2020; 12:21-33. [PMID: 32021490 PMCID: PMC6970613 DOI: 10.2147/ijwh.s235864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/03/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the association of postpartum depression with domestic violence experiences among women in Asia. Background Postpartum depression (PPD) is an important cause of maternal morbidity as well as mortality. There is increasing evidence that domestic violence (DV) increases the risk of PPD. Methods We performed literature searches using the databases PUBMED, SCOPUS, Web of Science and Google Scholar, for studies published between January 2010 and May 2019. The keywords “postpartum”, “postnatal”, “depression”, and “violence” were used. Observational studies conducted within Asia, and written in the English language, were included. Results In the 38 studies included in this review (with 37,087 participants), the prevalence of PPD ranged between 8.2% to 70% and that of DV between 6.1% to 67.4%. There were 1.6 to 7.1 higher odds of PPD among sufferers of DV. Intimate partner violence (IPV) was the most relevant factor that women experiencing psychological abuse (which was the most prevalent form of IPV) were more at risk for, and violence/intimidation by other family members was also associated with PPD. Domestic violence increased the risk of suicidal ideation in PPD. Discussion The findings of the review unequivocally shows the association between domestic violence and PPD. Maternal mental health is a neglected area of healthcare in many parts of Asia. Likewise, domestic violence is a readily recognized, but inadequately addressed social issue. We recommend that healthcare workers be trained to recognize and support the women who are vulnerable to violence and depression during pregnancy and postpartum. Policies need to be developed at national and global levels to tackle these issues with utmost urgency.
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Affiliation(s)
- Pallavi Koirala
- College of Public Health Sciences, Chulalongkorn University, Patumwan, Bangkok 10330, Thailand
| | - Montakarn Chuemchit
- College of Public Health Sciences, Chulalongkorn University, Patumwan, Bangkok 10330, Thailand
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Woldetsadik AM, Ayele AN, Roba AE, Haile GF, Mubashir K. Prevalence of common mental disorder and associated factors among pregnant women in South-East Ethiopia, 2017: a community based cross-sectional study. Reprod Health 2019; 16:173. [PMID: 31779669 PMCID: PMC6883571 DOI: 10.1186/s12978-019-0834-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 11/05/2019] [Indexed: 12/03/2022] Open
Abstract
Background Mothers suffering from common mental disorder (CMD), such as anxiety and depression may not be able to function properly, which could adversely affect the mother-infant bond and even result in increased infant morbidity and mortality. The purpose of this study was to assess the prevalence of CMD and its determinants among pregnant women in Southeast Ethiopia. Methods Data was collected from 743 pregnant women via interview-administered, standardised questionnaires during Dec–Jan 2017. The WHO Self-Reported Questionnaire (SRQ) was used to screen CMD. Multivariate logistic regression was conducted and ORs and 95% confidence intervals were calculated. Results The prevalence of CMD during pregnancy was 35.8% (95% CI: 34–38%) and the main determinants of CMD were: illiteracy, presence of health risk, financial instability, physical or emotional abuse, having sexual intercourse without her willingness, family history of psychiatric illness and history of chronic medical illness. Conclusion CMD prevalence during pregnancy was high, indicating a need to regularly screen pregnant women for CMD and its determinants as part of routine obstetric care.
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Affiliation(s)
- Ashenafi Mekonnen Woldetsadik
- Department of Midwifery, Madda Walabu University, Goba Referral Hospital, School of Health Science, Bale Goba, Ethiopia
| | - Abebaw Nigussie Ayele
- Department of Physiology, Madda Walabu University, Goba Referral Hospital, School of Medicine, Bale Goba, Ethiopia
| | - Adem Esmael Roba
- Department of Nursing, Madda Walabu University, Goba Referral Hospital, School of Health Science, Bale Goba, Ethiopia
| | - Genet Fikadu Haile
- Department of Midwifery, Madda Walabu University, Goba Referral Hospital, School of Health Science, Bale Goba, Ethiopia
| | - Khan Mubashir
- Department of Biochemistry, Madda Walabu University, Goba Referral Hospital, School of Medicine, Bale Goba, Ethiopia.
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Lee KW, Ching SM, Hoo FK, Ramachandran V, Chong SC, Tusimin M, Mohd Nordin N. Prevalence and factors associated with depressive, anxiety and stress symptoms among women with gestational diabetes mellitus in tertiary care centres in Malaysia: a cross-sectional study. BMC Pregnancy Childbirth 2019; 19:367. [PMID: 31638930 PMCID: PMC6805560 DOI: 10.1186/s12884-019-2519-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 09/20/2019] [Indexed: 12/16/2022] Open
Abstract
Background Research on antenatal depressive, anxiety and stress symptoms among women with gestational diabetes mellitus (GDM) is lacking in Malaysia. This study aimed to determine the prevalence and factors associated with antenatal depressive, anxiety and stress symptoms among Malaysian women with GDM. Methods This was a descriptive, cross-sectional study of 526 women with GDM. Depressive, anxiety and stress symptoms are defined as the final score in mild to extremely severe risk in the severity rating scale. Data analysis was performed using SPSS v.21, while multiple logistic regression was used to identify predictors of depressive, anxiety and stress symptoms. Results Prevalence of anxiety symptoms was highest (39.9%), followed by depressive symptoms (12.5%) and stress symptoms (10.6%) among women with GDM. According to multiple logistic regression analyses, younger age (OR = 0.955, 95% CI = 0.919–0.993), comorbidity with asthma (OR = 2.436, 95% CI = 1.219–4.870) and a family history of depression and anxiety (OR = 4.782, 95% CI = 1.281–17.853) had significant associations with antenatal anxiety symptoms. Being non-Muslim (OR = 2.937, 95% CI = 1.434–6.018) and having a family history of depression and anxiety (OR = 4.706, 95% CI = 1.362–16.254) had significant associations with antenatal depressive symptoms. Furthermore, being non-Muslim (OR = 2.451, 95% CI = 1.273–4.718) had a significant association with antenatal stress symptoms. Conclusions Within a population of women with GDM in Malaysia, those at higher risk of having depressive, anxiety and stress symptoms can be identified from several baseline clinical characteristics. Clinicians should be more alert so that the high-risk patients can be referred earlier for further intervention.
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Affiliation(s)
- Kai Wei Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia. .,Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia. .,Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.
| | - Fan Kee Hoo
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | - Vasudevan Ramachandran
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | - Seng Choi Chong
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | - Maiza Tusimin
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | - Noraihan Mohd Nordin
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
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Braun-Lewensohn O, Abu-Kaf S, Al-Said K. Women in Refugee Camps: Which Coping Resources Help Them to Adapt? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203990. [PMID: 31635399 PMCID: PMC6843964 DOI: 10.3390/ijerph16203990] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/13/2019] [Accepted: 10/17/2019] [Indexed: 02/05/2023]
Abstract
: The present study aimed to explore the coping resources and mental health of women who have fled Syria to a neighboring European country. To that end, we examined the roles of sociodemographic factors, situational factors, and personal and community sense of coherence (SOC and ComSOC, respectively) in mental-health outcomes. One hundred and eleven refugee women aged 19-70 filled out self-reported questionnaires during August 2018 in a refugee camp in Greece. The questionnaires asked the participants for demographic information (i.e., age, level of education level, and time spent in the camp) and also addressed the situational factors of having received aid from various organizations, appraisal of danger during the war in Syria, and exposure to war experiences, as well as the coping resources of SOC and ComSOC. The results show that time spent in the camp, appraisal of danger, SOC, and ComSOC all play significant roles in predicting the variance of various mental-health outcomes. Together, those factors predict 56% of anxiety, 53% of depression, and 58% of somatization. SOC was also found to mediate the relationships between time spent in the camp and outcome variables, as well as the relationships between the appraisal of danger and the outcome variables. This indicates that SOC is crucial for good adaptation. These results will be discussed in light of the salutogenic theory.
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Affiliation(s)
- Orna Braun-Lewensohn
- Conflict Management and Resolution Program, Department of Multidisciplinary Studies, Ben-Gurion University of the Negev, Beersheba 8410501, Israel.
| | - Sarah Abu-Kaf
- Conflict Management and Resolution Program, Department of Multidisciplinary Studies, Ben-Gurion University of the Negev, Beersheba 8410501, Israel.
| | - Khaled Al-Said
- Conflict Management and Resolution Program, Department of Multidisciplinary Studies, Ben-Gurion University of the Negev, Beersheba 8410501, Israel.
- Kay Academic College of Education, Beersheba 84536, Israel.
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Haritonova NK, Kachaeva MA, Kazakovtsev BA, Vasianina VI, Shishkina OA. [Depression in women - the victims of domestic violence (forensic psychiatry aspects)]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:34-38. [PMID: 31006789 DOI: 10.17116/jnevro20191191234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study the development of depressive disorders in women, the victims of domestic violence, who committed aggressive acts. MATERIAL AND METHODS Patients (n=12) were divided into two groups depending on acute depressive reaction in response to violence from husbands, which resulted in criminal acts. The first group included 4 women who killed their children and the second group included 8 women who killed their husbands. A psychopathological method was used in the study. RESULTS AND CONCLUSION Women of both groups shared the same features of the development of depression: the transition from a neurotic stage to a psychotic stage (with aggression) and then to the prolonged depression. Every stage had its own features, in particular during the criminal act, which are described in the article.
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Affiliation(s)
- N K Haritonova
- Serbsky National Medical Research Centre for Psychiatry and Narcology Ministry of Health of RF, Moscow, Russia
| | - M A Kachaeva
- Serbsky National Medical Research Centre for Psychiatry and Narcology Ministry of Health of RF, Moscow, Russia
| | - B A Kazakovtsev
- Serbsky National Medical Research Centre for Psychiatry and Narcology Ministry of Health of RF, Moscow, Russia
| | - V I Vasianina
- Serbsky National Medical Research Centre for Psychiatry and Narcology Ministry of Health of RF, Moscow, Russia
| | - O A Shishkina
- Serbsky National Medical Research Centre for Psychiatry and Narcology Ministry of Health of RF, Moscow, Russia
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Mahendran R, Puthussery S, Amalan M. Prevalence of antenatal depression in South Asia: a systematic review and meta-analysis. J Epidemiol Community Health 2019; 73:768-777. [PMID: 31010821 DOI: 10.1136/jech-2018-211819] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To estimate the prevalence of antenatal depression in South Asia and to examine variations by country and study characteristics to inform policy, practice and future research. METHODS We conducted a comprehensive search of 13 databases including international databases and databases covering scientific literature from South Asian countries in addition to Google Scholar and grey sources from 1 January 2007 to 31 May 2018. Studies reporting prevalence estimates of antenatal depression using a validated diagnostic/screening tool were identified, screened, selected and appraised. Primary outcome was proportion (%) of pregnant women identified as having antenatal depression. RESULTS Thirty-three studies involving 13 087 pregnant women were included in the meta-analysis. Twelve studies were rated as high quality and 21 studies were of moderate quality. Overall pooled prevalence of antenatal depression was 24.3 % (95% Confidence Interval (CI) 19.03 to 30.47). Studies showed a high degree of heterogeneity (I2=97.66%) and evidence of publication bias (p=0.668). Prevalence rates for India (17.74%, 95% CI 11.19 to 26.96) and Sri Lanka (12.95%, 95% CI 8.29 to 19.68) were lower compared with the overall prevalence, whereas prevalence rates for Pakistan (32.2%, 95% CI 23.11 to 42.87) and Nepal (50%, 95% CI 35.64 to 64.36) were higher. CONCLUSIONS While robust prevalence studies are sparse in most South Asian countries, available data suggest one in four pregnant women is likely to experience antenatal depression in the region. Findings highlight the need for recognition of the issue in health policy and practice and for resource allocation for capacity building at regional and national levels for prevention, diagnosis and treatment.
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Affiliation(s)
- Rahini Mahendran
- Smile Train Project, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Shuby Puthussery
- Maternal and Child Health Research Centre, University of Bedfordshire, Luton, UK
| | - Mahendran Amalan
- Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
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Chorwe-Sungani G, Chipps J. Performance of the 3-item screener, the Edinburgh Postnatal Depression Scale, the Hopkins Symptoms Checklist-15 and the Self-Reporting Questionnaire and Pregnancy Risk Questionnaire, in screening of depression in antenatal clinics in the Blantyre district of Malawi. Malawi Med J 2019; 30:184-190. [PMID: 30627354 PMCID: PMC6307058 DOI: 10.4314/mmj.v30i3.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Screening instruments for antenatal depression vary in performance. This study aimed at assessing the performance of a range of screening instruments in detecting depressive symptoms in antenatal clinics in Blantyre district, Malawi. Methods A cross-sectional study was conducted to screen for depression among women attending 8 selected antenatal clinics in Blantyre district using 3-item screener, Edinburgh Postnatal Depression Scale (EPDS), Hopkins Symptoms Checklist-15 (HSCL-15), Self-Reporting Questionnaire (SRQ) and Pregnancy Risk Questionnaire (PRQ). The instruments were administered to a random sample of 480 pregnant women. Data were analysed using SPSS 22.0 testing for performance differences in proportions of screen positives and how screen positive results might differ by particular variables. Results The prevalence estimates yielded by screening instruments ranged from 12.9% (SRQ) to 42.1% (3-item screener). There were no significant differences in prevalence estimates for EPDS, HSCL-15, PRQ and SRQ. There were performance differences in the proportions of screen positives with significant systematic differences between proportions of screen positives of PRQ and SRQ (p<.001), EPDS and HSCL-15 (p=.001), HSCL and PRQ (p<.001), and EPDS and SRQ (p<.001). Screen positive results on HSCL-15, PRQ, 3-item screener and EPDS were found to differ by variables such as “not being supported by partner” which resulted in respondents having ≥3 times chances to screen positive on these four instruments. The screen positive results on SRQ were found not to differ by age, education, employment status, marital status, setting, gestation and number of pregnancies. Conclusions There were minimal variations in the performance of the EPDS, SRQ and HSCL-15 as standard public health screening instruments. However, systematic differences between proportions of screen positives exist and screen positive results from these instruments differed by demographics. It is important to validate screening instruments against a gold standard to ensure relevant clinical outcomes for pregnant women with depression.
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Affiliation(s)
- Genesis Chorwe-Sungani
- University of Malawi, Kamuzu College of Nursing.,University of the Western Cape, School of Nursing
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De Oliveira CVR, Rasheed M, Yousafzai AK. Chronic Maternal Depressive Symptoms Are Associated With Reduced Socio-Emotional Development in Children at 2 Years of Age: Analysis of Data From an Intervention Cohort in Rural Pakistan. Front Psychiatry 2019; 10:859. [PMID: 31824356 PMCID: PMC6880608 DOI: 10.3389/fpsyt.2019.00859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 11/01/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Maternal depression affects a high proportion of women during the antenatal and postnatal period in low- and middle-income countries. While maternal depression is recognized as a significant risk for poor early child development that warrants interventions, the effects of chronic maternal depression on children's development are less understood. Objective: To determine the association of chronicity of maternal depressive symptoms and early child development in a rural population in southern Pakistan. Materials and Methods: This study employs data from the "Pakistan Early Child Development Scale-Up Trial," a randomized controlled study that evaluated the integration of responsive stimulation and nutrition interventions in a community health service. In the present analysis, linear regression was used to test the effects of chronicity of high maternal depressive symptoms on children's early development (n = 1205 mother-infant dyads). Children's development was assessed using the Bayley Scales of Infant and Toddler Development at 24 months of age. Maternal depressive symptoms were assessed at baseline and every 6 months using the Self-Reporting Questionnaire. Results: No significant associations were observed between chronic maternal depressive symptoms and child cognitive, language, or motor development after adjusting for parental characteristics, the caregiving environment and socioeconomic variables. A negative significant association between chronicity of high maternal depressive symptoms and child socio-emotional development (β coefficient -2.57, 95% CI: -5.14; -0.04) was observed after adjusting for the selected variables. Conclusions: The results suggest that interventions designed to promote early child development should also integrate repeat screening for depression and longer-term psychosocial support for mothers.
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Affiliation(s)
- Clariana V R De Oliveira
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Muneera Rasheed
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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