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Folliard KJ, Crozier K, Kamble MMW. A very, very lonely, unmagical time. The lived experience of perinatal anxiety: A longitudinal interpretative phenomenological analysis. Midwifery 2024; 136:104070. [PMID: 38901128 DOI: 10.1016/j.midw.2024.104070] [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: 04/18/2024] [Revised: 06/01/2024] [Accepted: 06/16/2024] [Indexed: 06/22/2024]
Abstract
PROBLEM Minimal longitudinal qualitative evidence examining lived experience of anxiety over the perinatal continuum limits holistic understanding of the course of antenatal and postnatal anxiety. BACKGROUND Perinatal anxiety has deleterious effects on the mother and infant and is more commonly experienced yet less well investigated than perinatal depression. AIM AND METHOD To explore women's experiences living with perinatal anxiety to increase understanding of the condition; inform support given by midwives and other health professionals and provide practice, education, and research recommendations. Five women were interviewed at three timepoints, producing 15 datasets. Data was analysed using longitudinal interpretative phenomenological analysis. FINDINGS Nine Group Experiential Themes emerged: the anxious mother, transformation, sets of ears and the anxious pregnancy (antenatal); baby as external focus, returning to oneself and the emotional unknown (early postnatal); and moving on, and shifting sands (late postnatal). Three Longitudinal Experiential Concepts explicated lived experience over time: maternal eyes, transforming existence, and emotional kaleidoscope. The lived experience of perinatal anxiety was revealed as socially constructed, with relationships with self, others, and the world key. The collision between anxiety and motherhood as social constructs provides perinatal anxiety with its unique characteristics. CONCLUSION Midwives and other healthcare professionals should understand the significance of perinatal anxiety, enabling disclosure of stigmatising and uncomfortable feelings without judgement. Research examining whether perinatal specific screening tools should be used by midwives and exploring the relationship between perinatal anxiety and depression is recommended. Education for clinicians on the significance of perinatal anxiety is essential.
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Affiliation(s)
- Kelda J Folliard
- Norfolk and Norwich University Hospital, Maternity Department, Colney Lane, Norwich, NR4 7UY, UK; University of East Anglia, School of Health Sciences, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Kenda Crozier
- University of East Anglia, School of Health Sciences, Norwich Research Park, Norwich, NR4 7TJ, UK
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Jimènez-Barragan M, Falguera-Puig G, Curto-Garcia JJ, Monistrol O, Coll-Navarro E, Tarragó-Grima M, Ezquerro-Rodriguez O, Ruiz AC, Codina-Capella L, Urquizu X, Pino Gutierrez AD. Prevalence of anxiety and depression and their associated risk factors throughout pregnancy and postpartum: a prospective cross-sectional descriptive multicentred study. BMC Pregnancy Childbirth 2024; 24:500. [PMID: 39054429 PMCID: PMC11270936 DOI: 10.1186/s12884-024-06695-6] [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: 08/29/2023] [Accepted: 07/12/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE To assess the prevalence of anxiety and depression and their associated risk factors throughout the pregnancy and postpartum process using a new screening for the early detection of mental health problems. DESIGN A prospective cross-sectional descriptive multicentred study. Participants were consecutively enrolled at ≥ 12 weeks' gestation and followed at three different time points: at 12-14 weeks of pregnancy, at 29-30 weeks of pregnancy, and 4-6 weeks postpartum. All women completed a mental screening at week 12-14 of pregnancy consisting of two questions from the Generalised Anxiety Disorder Scale (GAD-2) and the two Whooley questions. If this screening was positive, the woman completed the Edinburgh Postnatal Depression Scale (EPDS). SETTING Seven primary care centres coordinated by a Gynaecology and Obstetrics Department in the city of Terrassa (Barcelona) in northern Spain. PARTICIPANTS Pregnant women (N = 335, age 18-45 years), in their first trimester of pregnancy, and receiving prenatal care in the public health system between July 2018 and July 2020. FINDINGS The most relevant factors associated with positive screening for antenatal depression or anxiety during pregnancy, that appear after the first trimester of pregnancy, are systematically repeated throughout the pregnancy, and are maintained in the postpartum period were: a history of previous depression, previous anxiety, abuse, and marital problems. In weeks 12-14 early risk factors for positive depression and anxiety screening and positive EPDS were: age, smoking, educational level, employment status, previous psychological/psychiatric history and treatment, suicide in the family environment, voluntary termination of pregnancy and current planned pregnancy, living with a partner and partner's income. In weeks 29-30 risk factors were: being a skilled worker, a history of previous depression or anxiety, and marital problems. In weeks 4-6 postpartum, risk factors were: age, a history of previous depression or anxiety or psychological/psychiatric treatment, type of treatment, having been mistreated, and marital problems. CONCLUSIONS Early screening for anxiety and depression in pregnancy may enable the creation of more effective healthcare pathways, by acting long before mental health problems in pregnant women worsen or by preventing their onset. Assessment of anxiety and depression symptoms before and after childbirth and emotional support needs to be incorporated into routine practice.
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Affiliation(s)
- Marta Jimènez-Barragan
- Universitat de Barcelona, Fundació Assistencial Mútua Terrassa, (Terrassa), Research Group on Sexual and Reproductive Healthcare (GRASSIR), (2021-sgr-01489), Barcelona, 08221, Spain.
- ASSIR Fundació Assistencial Mútua Terrassa, Universitat de Barcelona, Plaça Dr. Robert 5, Barcelona, 08221, Spain.
| | - Gemma Falguera-Puig
- Atenció a la Salut Sexual i Reproductiva Metropolitana Nord, Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
- Research Group on Sexual and Reproductive Healthcare (GRASSIR), (2021-sgr-01489), Barcelona, 08007, Spain
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | | | - Olga Monistrol
- Faculty of Nursing and Physiotherapy, University of Lleida, Iguada, Spain
| | | | - Mercè Tarragó-Grima
- Midwife, Sexual and Reproductive Health Clinic (ASSIR) CAP Rambla Terrassa, Mollet, Spain
| | | | - Anna Carmona Ruiz
- Department of Obstetrics and Gynaecology, Fundació Sanitària Mollet, Mollet, Spain
| | - Laura Codina-Capella
- Department of Obstetrics and Gynaecology, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
| | - Xavier Urquizu
- Department of Obstetrics and Gynaecology, Fundació Sanitària Mollet, Mollet, Spain
| | - Amparo Del Pino Gutierrez
- Departament de Salut Pública, Facultat de Medicina i Ciències de la Salut, Salut Mental i Materno-infantil, Universitat de Barcelona, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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Thela L, Paruk S, Bhengu B, Chiliza B. Psychiatric emergencies during pregnancy and puerperium in low - And middle-income countries. Best Pract Res Clin Obstet Gynaecol 2024; 94:102478. [PMID: 38401484 DOI: 10.1016/j.bpobgyn.2024.102478] [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: 10/01/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
Pregnancy and puerperium are critical points in women's health, and various psychiatric emergencies may worsen or manifest (for the first time) during this period. In the presence of a psychiatric emergency, the pregnancy and puerperium outcomes may be compromised. In addition to the mother being at risk, the health of the fetus and the newborn may also be compromised if the psychiatric emergency is not managed appropriately. Early detection and collaborative approaches between mental health practitioners and obstetricians are of utmost importance in women who are at risk and those living with psychiatric illnesses during pregnancy and puerperium. Practitioners should also ensure that women with impaired capacity due to psychiatric disease are treated in a non-judgmental and respectful manner, even if their autonomies have been overridden.
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Affiliation(s)
- Lindokuhle Thela
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa.
| | - Saeeda Paruk
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
| | - Busisiwe Bhengu
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
| | - Bonginkosi Chiliza
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
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El Hadathy D, Malaeb D, Hallit S, Fekih-Romdhane F, Barakat H. The relationship between maternal-infant bonding and postpartum depression/anxiety: moderating effect of childhood psychological abuse and validation of the Mother-to-Infant Bonding scale (MIBS-8) in Arabic. BMC Psychiatry 2024; 24:293. [PMID: 38632592 PMCID: PMC11025253 DOI: 10.1186/s12888-024-05745-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The emotional bond that a mother senses to her infant is essential to their social, emotional, and cognitive development. Understanding the level of mother-infant bonding plays an imperative role in the excellence of care. However, in Lebanon, there is a paucity of information about mother-infant bonding in the postpartum period. Given that Lebanese pregnant women constitute an important part of the population to look at, the objectives of the study were to (1) validate the Arabic version of the mother-infant bonding scale and (2) the relation between mother-infant bond and postpartum depression/anxiety; (3) the moderating effect of child abuse in the association between mother-infant bond and postpartum depression/anxiety. METHODS This cross-sectional study was conducted from September 2022 until June 2023, enrolling 438 women 4-6 weeks after delivery (mean age: 31.23 ± 5.24 years). To examine the factor structure of the mother-infant bond scale, we used an Exploratory-Confirmatory (EFA-CFA) strategy. To check if the model was adequate, several fit indices were calculated: the normed model chi-square (χ2/df), the Steiger-Lind root mean square error of approximation (RMSEA), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI). RESULTS EFA was conducted on the first subsample. Three items were removed. The five items remaining loaded on one factor, which explained 73.03% of the common variance (ω = .91 / α = .90). After adding a correlation between residuals for items 2-7 and 5-8, fit indices of the CFA results were acceptable: χ2/df = 6.97/3 = 2.32, RMSEA = .068 (90% CI .001, .135), SRMR = .017, CFI = .996, TLI = .988. The interaction maternal-infant bonding by child psychological abuse was significantly associated with depression and anxiety respectively. At low, moderate and high levels of child psychological abuse, higher maternal-infant bonding scores (greater difficulty in bonding) were significantly associated with higher depression and higher anxiety respectively. CONCLUSION This study provides, for the first time, a specific Arabic scale to assess mother-infant bonding reliably and validly. Furthermore, our study has suggested the existence of factors that have additive effects in potentiating the risk for depression and anxiety among Lebanese postpartum women, namely a history of psychological child abuse. Therefore, laborious awareness programs and healthcare services need to be implemented in order to prevent maternal mental health disorders from being unrecognized and left untreated.
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Affiliation(s)
- Diane El Hadathy
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Habib Barakat
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Department of Obstetrics and Gynecology, Notre Dame des Secours University Hospital Center, Postal Code 3, Byblos, Lebanon
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Dol J, Campbell-Yeo M, Leahy-Warren P, Hambly LaPointe C, Dennis CL. Bibliometric analysis of published articles on perinatal anxiety from 1920 to 2020. J Affect Disord 2024; 351:314-322. [PMID: 38290588 DOI: 10.1016/j.jad.2024.01.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Trends and gaps in perinatal anxiety research remain unknown. The objective of this bibliometric review was to analyze the characteristics and trends in published research on perinatal anxiety to inform future research. METHODS All published literature in Web of Science on perinatal anxiety from January 1, 1920 to December 31, 2020 were screened by two reviewers. VOSViewer was utilized to visualize linkages between publications. Bibliometric data were extracted from abstracts. RESULTS The search strategy identified 4561 publications. After screening, 2203 publications related to perinatal anxiety were used for the visualization analysis. For the bibliometric data, 1534 publications had perinatal anxiety as a primary focus. There were 7910 different authors, over half named only once (55.5 %), from 63 countries. 495 journals were identified, with over half (56.0 %) publishing only one article. Most articles were published between 2011 and 2020 (75.9 %). In terms of perinatal timing, over half (54.2 %) published on antenatal anxiety. Only 6.0 % of studies reported on perinatal anxiety in fathers and 56.5 % also reported on perinatal depression. LIMITATIONS Web of Science was solely used, and manual screening of each publication was required. CONCLUSION This bibliometric analysis found: (1) perinatal anxiety is a growing field of research, with publications increasing over time; (2) there is variation in authors and journals; (3) over half of the publications focus on antenatal anxiety; (4) paternal anxiety is understudied; and (5) only 6 % of publications came from low and lower-middle income countries. Gaps related to maternal postnatal anxiety and paternal perinatal anxiety exist.
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Affiliation(s)
- Justine Dol
- IWK Health, Halifax, Nova Scotia, Canada; Dalhousie University, Nova Scotia, Canada.
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Nova Scotia, Canada
| | | | | | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada; Lunenfeld-Tannenbaum Research Institute, Sinai Health, Ontario, Canada
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Yang Y, Huang XX, Huo RX, Lin JY. Impact of Sjögren's syndrome on maternal and fetal outcomes following pregnancy: a systematic review and meta-analysis of studies published between years 2007-2022. Arch Gynecol Obstet 2024; 309:1135-1149. [PMID: 37921880 DOI: 10.1007/s00404-023-07259-3] [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: 03/04/2023] [Accepted: 10/06/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVE To show the impact of Sjögren's syndrome (SS) on maternal and fetal outcomes following pregnancy. METHODS We performed a literature search based on PubMed, Web of science, Wan fang, China National Knowledge Infrastructure and ProQuest databases from 1 January 2007 to 6 November 2022. Grading of Recommendations, Assessment, Development, and Evaluations approach was used to assess the certainty of the evidence. Systematic reviews and meta-analyses were performed using RevMan 5.3 software. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird. Trial sequential analyses were performed by TSA 0.9. RESULTS Nine studies with 2341 patients and 2472 pregnancies with SS were included in our analysis. This current analysis showed pregnancy hypertension and preeclampsia/eclampsia to be significantly higher in pregnant women with SS compared to pregnant women without SS (OR: 1.65, 95% CI: 1.04-2.63; P = 0.03), (OR: 2.06, 95% CI: 1.16-3.65; P = 0.01) respectively. Cesarean section, thromboembolic disease, premature rupture of membranes, and spontaneous abortion were also significantly higher in the SS women with OR: 2.07, 95% CI: 1.48-2.88; P < 0.0001, OR: 9.45, 95% CI: 1.99-44.87; P = 0.005, OR: 1.36, 95% CI: 1.13-1.64; P = 0.001, OR: 9.30, 95% CI: 4.13-20.93; P < 0.00001, respectively. Significantly higher premature births were observed with infants who were born from SS mothers (OR: 2.19, 95% CI: 1.54-3.12; P < 0.0001). Infants defined as 'small for gestational age/intrauterine growth restriction' and 'weighing < 2500 g' were also significantly higher in patients suffering from SS (OR: 2.26, 95% CI: 1.38-3.70; P = 0.001), (OR: 3.84, 95% CI: 1.39-10.61; P = 0.009) respectively. In addition, live birth significantly favored infants who were born from mothers without SS (OR: 21.53, 95% CI: 8.36-55.44; P < 0.00001). Subgroup analysis by sample size revealed that pregnancy hypertension risk has significantly increased in small cohort (OR: 2.74, 95%CI: 1.45-5.18), and a slight increase was found in population-based studies (OR: 1.14, 95%CI: 0.91-1.43). In both small cohorts and population-based researches, cesarean section was significantly higher in SS (OR: 2.13, 95% CI: 1.29, 3.52; OR: 1.85, 95% CI: 1.29-2.64, respectively). The number of infants with intrauterine growth restriction did not grow in the population-based researches (OR: 2.07, 95%CI: 0.92-4.66) although there has been an increase in small reports (OR: 2.53, 95%CI: 1.16-5.51). Subgroup analysis was conducted on the basis of study location (not Asian vs. Asian countries) indicated that cesarean section was significantly higher in SS in both countries (OR: 1.69, 95% CI: 1.31-2.18; OR: 3.37, 95% CI: 2.39-4.77, respectively). CONCLUSION This meta-analysis has shown SS to have a high impact on maternal and fetal outcomes following pregnancy.
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Affiliation(s)
- Yang Yang
- Department of Rheumatology and Immunology, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530016, China
| | - Xin-Xiang Huang
- Department of Rheumatology and Immunology, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530016, China
| | - Rong-Xiu Huo
- Department of Rheumatology and Immunology, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530016, China
| | - Jin-Ying Lin
- Department of Rheumatology and Immunology, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530016, China.
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Mollons M, Levasseur-Puhach S, Kaur J, Doyle J, Giesbrecht G, Lebel CA, Woods L, Tomfohr-Madsen L, Roos L. Mixed-methods study exploring health service access and social support linkage to the mental well-being of Canadian Indigenous pregnant persons during the COVID-19 pandemic. BMJ Open 2024; 14:e078388. [PMID: 38553054 PMCID: PMC11005712 DOI: 10.1136/bmjopen-2023-078388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES This study aimed to explore how the unprecedented stressors associated with the COVID-19 pandemic may have contributed to heightened levels of depression and anxiety among pregnant Indigenous persons, and identify protective individual-level factors. DESIGN The current study used a mixed-methods design including standardised questionnaires and open-ended response questions. Using hierarchical regression models, we examined the extent to which COVID-19-related factors of service disruption (ie, changes to prenatal care, changes to birth plans and social support) were associated with mental well-being. Further, through qualitative analyses of open-ended questions, we examined the coping strategies used by pregnant Indigenous persons in response to the pandemic. SETTING Participants responded to an online questionnaire consisting of standardised measures from 2020 to 2021. PARTICIPANTS The study included 336 self-identifying Indigenous pregnant persons in Canada. RESULTS Descriptive results revealed elevated rates of clinically relevant depression (52.7%) and anxiety (62.5%) symptoms among this population. 76.8% of participants reported prenatal care service disruptions, including appointment cancellations. Thematic analyses identified coping themes of staying informed, social and/or cultural connections and activities, and internal mental well-being strategies. Disruptions to services and decreased quality of prenatal care negatively impacted mental well-being of Indigenous pregnant persons during the COVID-19 pandemic. CONCLUSIONS Given the potential for mental well-being challenges to persist and long-term effects of perinatal distress, it is important to examine the quality of care that pregnant individuals receive. Service providers should advance policies and practices that promote relationship quality and health system engagement as key factors linked to well-being during the perinatal period for Indigenous persons.
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Affiliation(s)
- Meghan Mollons
- Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Jasleen Kaur
- Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Jennifer Doyle
- Educational and Counselling Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerald Giesbrecht
- Alberta Children's Hospital Research Institute, Calgary, Province of Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Province of Alberta, Canada
| | - Catherine A Lebel
- Alberta Children's Hospital Research Institute, Calgary, Province of Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Province of Alberta, Canada
| | | | - Lianne Tomfohr-Madsen
- Educational and Counselling Psychology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie Roos
- Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba Children's Hospital Research Institute, Winnipeg, Manitoba, Canada
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Miller ML, Jiang LJ, O'Hara MW. Experiential avoidance as a mediator of risk factors for higher order internalizing psychopathology in the perinatal period. J Clin Psychol 2024; 80:625-645. [PMID: 38265296 DOI: 10.1002/jclp.23644] [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: 04/09/2023] [Revised: 11/09/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES Perinatal psychopathology can be damaging. This study examined the strength of the associations between risk factors and all perinatal mood and anxiety disorder symptoms while assessing the mediating effect of experiential avoidance. METHOD Participants (N = 246) completed assessments during pregnancy (28-32 weeks) and the postpartum (6-8 weeks). Structural equation modeling (SEM) was used to examine associations between risk factors and latent factors: distress (composed of depression, generalized anxiety, irritability, and panic symptoms); fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive); and bipolar (mania and obsessive-compulsive). RESULTS During pregnancy, past psychiatric history, anxiety sensitivity, maladaptive coping, and age were significant risk factors. In the postpartum, negative maternal attitudes and past psychiatric history were only risk factors for symptoms that composed distress. Experiential avoidance mediated the relation between maladaptive coping and symptoms that composed fear. CONCLUSION It is important to assess for psychological risk factors starting in pregnancy. This study identified critical risk factors that are associated with the underlying commonality among perinatal mood and anxiety symptoms. Some of the risk factors as well as the mediator are malleable (negative maternal attitudes, experiential avoidance), creating new possibilities for prevention and treatment of perinatal mood and anxiety disorder symptoms.
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Affiliation(s)
- Michelle L Miller
- University of Iowa, Iowa City, Iowa, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lily J Jiang
- Indiana University-Bloomington, Bloomington, Indiana, USA
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Turchioe MR, Hermann A, Benda NC. Recentering responsible and explainable artificial intelligence research on patients: implications in perinatal psychiatry. Front Psychiatry 2024; 14:1321265. [PMID: 38304402 PMCID: PMC10832054 DOI: 10.3389/fpsyt.2023.1321265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024] Open
Abstract
In the setting of underdiagnosed and undertreated perinatal depression (PD), Artificial intelligence (AI) solutions are poised to help predict and treat PD. In the near future, perinatal patients may interact with AI during clinical decision-making, in their patient portals, or through AI-powered chatbots delivering psychotherapy. The increase in potential AI applications has led to discussions regarding responsible AI and explainable AI (XAI). Current discussions of RAI, however, are limited in their consideration of the patient as an active participant with AI. Therefore, we propose a patient-centered, rather than a patient-adjacent, approach to RAI and XAI, that identifies autonomy, beneficence, justice, trust, privacy, and transparency as core concepts to uphold for health professionals and patients. We present empirical evidence that these principles are strongly valued by patients. We further suggest possible design solutions that uphold these principles and acknowledge the pressing need for further research about practical applications to uphold these principles.
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Affiliation(s)
| | - Alison Hermann
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States
| | - Natalie C. Benda
- School of Nursing, Columbia University School of Nursing, New York, NY, United States
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10
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Matvienko-Sikar K, Butler E, Keeffe LO, Dijk WV, Hayes CB, Huizink AC, Kearney PM, Costelloe SJ, Curtin S, Foley K, McCarthy FP, Mahony SO, Khashan A, Murray DM. Prenatal maternal cortisol, stress and anxiety, and childhood obesity at 5 years: a nested case-control study. J Reprod Infant Psychol 2023:1-15. [PMID: 38018852 DOI: 10.1080/02646838.2023.2288298] [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: 09/22/2023] [Accepted: 11/21/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Paediatric obesity is a global public health issue. Prenatal maternal mental health is potentially implicated in the development of childhood obesity. This study examined associations between prenatal maternal cortisol, self-reported stress, anxiety and depression in the second trimester, and childhood overweight and obesity at 5 years of age. METHODS A nested case-control study was conducted using data from the Irish prospective longitudinal birth cohort SCOPE BASELINE. Cases were children with overweight or obesity, operationalised as having a BMI z-score above +2 standard deviations. Controls were children with a BMI z-score between -0.5 and 0.5 standard deviations at 5 years of age. Two to one matching by sex was conducted. Thirty-eight cases and 83 sex-matched controls were included. Maternal serum cortisol concentration and self-reported stress, anxiety and depression were measured at 15 ± 1 and 20 ± 1 weeks gestation. Conditional logistic regression analyses were conducted to examine associations between prenatal maternal cortisol and self-reported stress, anxiety and depression, and childhood overweight and obesity. RESULTS Despite some evidence for associations between anxiety and depression, and child BMI z-scores in univariate analyses, adjusted models indicated no associations between prenatal maternal stress (OR: 1.02, 95% CI: 0.94-1.12), anxiety (OR: 1.03, 95% CI: 0.97-1.09), depression (OR: 1.04, 95% CI: 0.91-1.19), or cortisol concentration (OR: 0.99, 95% CI: 0.99-1.00) and child BMI z-score. CONCLUSION Our findings do not provide support for associations between foetal exposure during the second trimester of pregnancy and maternal cortisol, stress and anxiety, and childhood overweight or obesity at 5 years of age.
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Affiliation(s)
| | - Emma Butler
- School of Population Health, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Linda O' Keeffe
- School of Public Health, University College Cork, Cork, Ireland
| | - Willeke V Dijk
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- VU Medical Center, Amsterdam, Netherlands
| | - Catherine B Hayes
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Anja C Huizink
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Sean J Costelloe
- Department of Clinical Biochemistry, Cork University Hospital, Cork, Ireland
| | - Sinead Curtin
- Department of Clinical Biochemistry, Cork University Hospital, Cork, Ireland
| | - Kelly Foley
- Department of Clinical Biochemistry, Cork University Hospital, Cork, Ireland
| | - Fergus P McCarthy
- Department of Obstetrics and Gynaecology, University College Cork, Cork Ireland
- INFANT Maternal and Child Health Research Centre, Cork, Ireland
| | - Siobhain O Mahony
- Department of Anatomy, University College Cork, Cork, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Ali Khashan
- School of Public Health, University College Cork, Cork, Ireland
- INFANT Maternal and Child Health Research Centre, Cork, Ireland
| | - Deirdre M Murray
- INFANT Maternal and Child Health Research Centre, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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11
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Zimmermann M, Peacock-Chambers E, Merton C, Pasciak K, Thompson A, Mackie T, Clare CA, Lemon SC, Byatt N. Equitable reach: Patient and professional recommendations for interventions to prevent perinatal depression and anxiety. Gen Hosp Psychiatry 2023; 85:95-103. [PMID: 37862962 PMCID: PMC11056209 DOI: 10.1016/j.genhosppsych.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Perinatal depression and anxiety are the most common complications in the perinatal period and disproportionately affect those experiencing economic marginalization. Fewer than 15% of individuals at risk for perinatal depression are referred for preventative counseling. The goal of this study was to elicit patient and perinatal care professionals' perspectives on how to increase the reach of interventions to prevent perinatal depression and anxiety among economically marginalized individuals. METHODS We conducted qualitative interviews with perinatal individuals with lived experience of perinatal depression and/or anxiety who were experiencing economic marginalization (n = 12) and perinatal care professionals and paraprofessionals (e.g., obstetrician/gynecologists, midwives, doulas; n = 12) serving this population. Three study team members engaged a "a coding consensus, co-occurrence, and comparison," approach to code interviews. RESULTS Perinatal individuals and professionals identified prevention intervention delivery approaches and content to facilitate equitable reach for individuals who are economically marginalized. Factors influential included availability of mental health counselors, facilitation of prevention interventions by a trusted professional, digital health options, and options for mental health intervention delivery approaches. Content that was perceived as increasing equitable intervention reach included emphasizing stigma reduction, using cultural humility and inclusive materials, and content personalization. CONCLUSIONS Leveraging varied options for mental health intervention delivery approaches and content could reach perinatal individuals experiencing economic marginalization and address resource considerations associated with preventative interventions.
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Affiliation(s)
- Martha Zimmermann
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America.
| | - Elizabeth Peacock-Chambers
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Catherine Merton
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Katarzyna Pasciak
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Azure Thompson
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Thomas Mackie
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Camille A Clare
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Stephenie C Lemon
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Nancy Byatt
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
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12
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Fletcher R, Regan C, May C, White S, St George J. Equipping fathers to support distressed mothers: What do mothers want fathers to know and do? Health Promot J Austr 2023; 34:683-690. [PMID: 37327354 DOI: 10.1002/hpja.758] [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: 02/14/2023] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 06/18/2023] Open
Abstract
ISSUE ADDRESSED Up to one in five new mothers experience depression or anxiety, and their partners are often the first line of social and practical support. However, many fathers are unprepared for their role as support person. The SMS4dads program (www.sms4dads.com) provides text-based support to new fathers but lacks specific messages addressing maternal mental distress. METHODS A mixed methods process engaged mothers with lived experience of perinatal mental distress to identify message content for co-designing texts in SMS4dads. Participants completed surveys derived from research literature and parenting websites using the theoretical framework of support domains: emotional or affectionate support, informational support, tangible support and positive social interaction. Mothers also indicated the most appropriate timing of support: at the point of identifying the distress (emerging), with ongoing symptoms (persistent) or during recovery (easing). Free text comments from mothers were linked to survey topics to provide examples of wording suitable for text messages to fathers. RESULTS Fifty-five mothers with lived experience completed the surveys. All support items were more often endorsed as helpful rather than not helpful by mothers. Emotional support was thought helpful in the early stages, tangible support was valued with ongoing symptoms and social interaction appreciated as symptoms eased. CONCLUSIONS Mothers experiencing perinatal depression and anxiety require a range of supportive actions by their partners, including household tasks and baby-care, encouragement, listening and managing relationships with family and friends. SO WHAT?: Information provided by distressed mothers can provide guidance to professionals when designing information for fathers/partners. Digital delivery of this co-designed information to fathers across urban and rural areas may enhance the competence of fathers working to support mothers experiencing mental distress in the perinatal period.
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Affiliation(s)
- Richard Fletcher
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Casey Regan
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Chris May
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Scott White
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Jennifer St George
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
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13
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Mahoney A, Shiner CT, Grierson AB, Sharrock MJ, Loughnan SA, Harrison V, Millard M. Online cognitive behaviour therapy for maternal antenatal and postnatal anxiety and depression in routine care. J Affect Disord 2023; 338:121-128. [PMID: 37295653 DOI: 10.1016/j.jad.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/15/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Perinatal depression and anxiety are associated with significant adverse effects for the mother and child. Online cognitive behavioural therapy (iCBT) can provide scalable access to psychological interventions to improve perinatal depression and anxiety, however, few studies have examined the effectiveness of these interventions in routine care. This study investigated the uptake and treatment outcomes of women living in the Australian community who enrolled in a pregnancy or postnatal iCBT program for their symptoms of depression and anxiety. METHODS 1502 women commenced iCBT (529 pregnancy and 973 postnatal) and completed measures of anxiety and depression symptom severity, and psychological distress pre- and post-treatment. RESULTS 35.0 % of women in the pregnancy program and 41.6 % in the postnatal program completed all 3 lessons, with lower pre-treatment depression symptom severity significantly associated with increased likelihood of perinatal program completion. Both iCBT programs were associated with medium pre- to post-treatment effect size reductions in generalised anxiety symptom severity (gs = 0.63 and 0.71), depression symptom severity (gs = 0.58 and 0.64), and psychological distress (gs = 0.52 and 0.60). LIMITATIONS Lack of control group and long-term follow-up, as well as detailed information on nature of the sample (e.g., health status, relationship status). Additionally, the sample was limited to Australian residents. CONCLUSION iCBT for perinatal anxiety and depression was associated with significant symptom improvement. Current findings support the use of iCBT in perinatal populations and its integration within routine healthcare provision.
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Affiliation(s)
- Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Christine T Shiner
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia; School of Clinical Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Ashlee B Grierson
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
| | - Maria J Sharrock
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
| | - Siobhan A Loughnan
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Queensland, Australia.
| | - Virginia Harrison
- School of Psychology and Counselling, The Open University, Milton Keynes MK7 6AA, United Kingdom.
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales 2052, Australia.
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14
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Leyland AF, Boekhorst MGBM, Offermans JE, Emerson LM, Hulsbosch LP, Potharst ES. The protective value of trait mindfulness for mothers' anxiety during the perinatal period. Acta Psychol (Amst) 2023; 240:104034. [PMID: 37716215 DOI: 10.1016/j.actpsy.2023.104034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/26/2023] [Accepted: 09/12/2023] [Indexed: 09/18/2023] Open
Abstract
OBJECTIVES Anxiety is highly prevalent in the perinatal period and can have negative consequences for the mother and the child. Extensive research has been done on risk factors for anxiety during the perinatal period, but less is known about protective factors. The current study aims to determine the relative contribution of trait mindfulness as a protective factor for anxiety. METHODS A longitudinal study design was used, with four measurement points: 12, 22, and 32 weeks of pregnancy (T0, T1, and T2, respectively), and 6 weeks postpartum (T3). General anxiety was measured at T1, T2, and T3, pregnancy-specific distress was measured at T1 and T2, mindfulness facets (acting with awareness, non-reacting, and non-judging) and partner involvement were measured at T1, and other known risk factors for anxiety were measured at T0. Multilevel regression models were used for statistical analyses. RESULTS Mindfulness facets measured at T1 were negatively associated with anxiety at T1, T2, and T3, and pregnancy-specific distress at T1 and T2. Of the mindfulness facets, non-judging was shown to have the largest protective effect against anxiety and pregnancy-specific distress. Also compared to partner-involvement and known risk factors, non-judging showed the largest effect on anxiety and pregnancy-specific distress. CONCLUSIONS For pregnant women who are at risk for developing or experiencing high levels of anxiety, it may be beneficial to participate in a mindfulness training with special attention for the attitudinal aspects of mindfulness.
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Affiliation(s)
- Anna F Leyland
- Department of Sociological Studies, University of Sheffield, Elmfield Building, Northumberland Road, Sheffield S10 2TU, UK.
| | - Myrthe G B M Boekhorst
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, the Netherlands.
| | - Julia E Offermans
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, the Netherlands; UvA minds, Academic Treatment Center for Parents and Children, Banstraat 29, 1071 JW Amsterdam, the Netherlands.
| | - Lisa-Marie Emerson
- School of Health Sciences, University of Canterbury, Rehua 305, Christchurch, New Zealand.
| | - Lianne P Hulsbosch
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, the Netherlands.
| | - Eva S Potharst
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, the Netherlands; UvA minds, Academic Treatment Center for Parents and Children, Banstraat 29, 1071 JW Amsterdam, the Netherlands.
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15
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Zimmermann M, Julce C, Sarkar P, McNicholas E, Xu L, Carr C, Boudreaux ED, Lemon SC, Byatt N. Can psychological interventions prevent or reduce risk for perinatal anxiety disorders? A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 84:203-214. [PMID: 37619299 PMCID: PMC10569160 DOI: 10.1016/j.genhosppsych.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Little is known about the extent to which interventions can prevent perinatal anxiety disorders. We conducted a systematic review and meta-analysis to examine whether interventions can decrease the onset and symptoms of perinatal anxiety among individuals without an anxiety disorder diagnosis. METHOD We conducted a comprehensive literature search across five databases related to key concepts: (1) anxiety disorders/anxiety symptom severity (2) perinatal (3) interventions (4) prevention. We included studies that examined a perinatal population without an anxiety disorder diagnosis, included a comparator group, and assessed perinatal anxiety. We included interventions focused on perinatal anxiety as well as interventions to prevent perinatal depression or influence related outcomes (e.g., physical activity). RESULTS Thirty-six studies were included. No study assessing the incidence of perinatal anxiety disorder (n = 4) found a significant effect of an intervention. Among studies assessing anxiety symptom severity and included in the quantitative analysis (n = 30), a meta-analysis suggested a small standardized mean difference of -0.31 (95% CI [-0.46, -0.16], p < .001) for anxiety at post intervention, favoring the intervention group. Both mindfulness (n = 6), and cognitive behavioral therapy approaches (n = 10) were effective. CONCLUSIONS Interventions developed for perinatal anxiety were more effective than interventions to prevent perinatal depression. Psychological interventions show promise for reducing perinatal anxiety symptom severity, though interventions specifically targeting anxiety are needed.
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Affiliation(s)
- Martha Zimmermann
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America.
| | - Clevanne Julce
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Pooja Sarkar
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Eileen McNicholas
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Lulu Xu
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Catherine Carr
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Edwin D Boudreaux
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Stephenie C Lemon
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
| | - Nancy Byatt
- UMass Chan Medical School, 222 Maple Avenue - Chang Building, Shrewsbury, MA 01545, United States of America
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16
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Endres K, Haigler K, Sbrilli M, Jasani S, Laurent H. Social determinants of perinatal mental health during the COVID-19 pandemic. Gen Hosp Psychiatry 2023; 84:39-43. [PMID: 37336179 PMCID: PMC10204342 DOI: 10.1016/j.genhosppsych.2023.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/21/2023] [Accepted: 05/19/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE We sought to clarify relevant social-structural determinants of perinatal mental health-material and social resources, as well as pandemic employment-related stressors, in White and BIPOC child-bearers-toward building comprehensive risk screening and prevention/intervention models that can alleviate health disparities. Each of these determinants was hypothesized to contribute to perinatal symptoms in ways that disproportionately benefit White child-bearers. METHOD A community sample of Illinois child-bearers (n = 409 pregnant, 122 new parents) completed online questionnaires from May 2020-June 2021. Relations between composite measures of child-bearers' material resources, social resources, and pandemic employment-related stressors and mental health symptoms were tested in multiple regression models. Main effects of social determinant composites and moderated effects by race/ethnic identification were tested. RESULTS All social determinants displayed significant unique associations with mental health in the sample, with social resources carrying the greatest weight. Although no moderated effects of composite resource measures were found, the relation between pandemic employment-related reduced resources and symptoms proved stronger in BIPOC compared to White child-bearers. CONCLUSIONS Both stable social-structural determinants and acute crisis-related shifts contribute to perinatal mental health, with higher levels and/or impacts of resources helping to explain racial/ethnic disparities. These findings can inform more comprehensive screening and prevention protocols and policy recommendations that improve perinatal health outcomes.
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Affiliation(s)
- Kodi Endres
- Penn State College of Medicine, Hershey, PA, USA
| | - Katherine Haigler
- Pennsylvania State University, Dept. of Human Development and Family Studies, University Park, PA, USA
| | - Marissa Sbrilli
- University of Illinois, Dept. of Psychology, Champaign, IL, USA
| | - Sona Jasani
- Yale School of Medicine Dept. of Obstetrics, Gynecology and Reproductive Sciences, Newhaven, CT, USA
| | - Heidemarie Laurent
- Pennsylvania State University, Dept. of Human Development and Family Studies, University Park, PA, USA.
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17
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Arikan G, Kumru A. A person-based approach to emotion socialization in toddlerhood: Individual differences in maternal emotion regulation, mental-health and parental sense of competence. Sci Rep 2023; 13:13606. [PMID: 37604851 PMCID: PMC10442338 DOI: 10.1038/s41598-023-40850-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 08/17/2023] [Indexed: 08/23/2023] Open
Abstract
Mothers adopt various emotion socialization strategies and sometimes exhibit contradictory responses. Thus, it is essential to understand how mothers differentiate in their use of emotion socialization strategies, and whether a set of emotion socialization responses is associated with individual differences in emotion regulation, mental health, and parental sense of competence during toddlerhood. Therefore, we used a person-centred approach to identify mothers' emotion socialization responses and then compared mothers based on the aforementioned characteristics. The mothers (N = 680) with toddlers (M = 23.56 months) responded to the Coping with Toddlers' Negative Emotions Scale, the Emotion Regulation Questionnaire, the Brief Symptom Inventory, and the Parental Sense of Competence Scale. The 3-profile-solution revealed: Unspecified (moderate scores in all emotion socialization strategies), supportive (high scores in supportive emotion socialization strategies) and mixture profiles (high in all emotion socialization strategies). The supportive and mixture profiles scored highly in cognitive reappraisal. Unspecified and mixture profiles did not vary in expressive suppression and mental health symptoms, but they scored lower than supportive profile mothers. In the parental sense of competence, the supportive profile scored higher than the mixture profile. The results showed mothers mainly using supportive emotion socialization strategies can demonstrate adequate emotion regulation and benefit from psychological well-being that potentially boosts parenting competence.
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Affiliation(s)
- Gizem Arikan
- Department of Psychology, Ozyegin University, 34794, Istanbul, Turkey.
| | - Asiye Kumru
- Department of Psychology, Ozyegin University, 34794, Istanbul, Turkey
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18
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Shariatpanahi M, Faramarzi M, Barat S, Farghadani A, Shirafkan H. Prevalence and risk factors of prenatal anxiety disorders: A cross-sectional study. Health Sci Rep 2023; 6:e1491. [PMID: 37614287 PMCID: PMC10442528 DOI: 10.1002/hsr2.1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/13/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023] Open
Abstract
Background and Aims Studies regarding the risk factors of prenatal anxiety disorders are inconclusive and sometimes contradictory. The current study aimed to define the prevalence and risk factors for anxiety disorders in women during pregnancy. Methods This is a cross-sectional and hospital-based survey of two public hospitals (Ayatollah Rohani and Yahyanejad) of inpatients/outpatients, obstetric wards/clinics, and four private outpatient obstetric clinics in the city of Babol. Convenience sampling was utilized to recruit 432 pregnant women. A trained clinical psychologist conducted the Structured Clinical Interview for DSM-5 (SCID-5) to diagnose anxiety disorders. In addition, the Brief Symptom Inventory 18 (BSI-18) was completed by the participants to assess the severity of psychological distress. Results Of 432 pregnant women, 132 (30.5%) were diagnosed with anxiety disorders. Anxiety disorders included 61 cases of pregnancy adjustment disorder (47.7%), 52 cases of generalized anxiety disorder (40.6%), and 15 cases of specific phobia (to delivery) (11.7%). The logistic regression results showed that the age, pregnancy, education, parity, and high-risk pregnancy variables predicted 28% of the variance of anxiety disorders. Furthermore, as the age (β = 0.94, p = 0.003) and gestational age (β = 0.9, p < 0.001) increased, the probability of anxiety disorders in pregnancy decreased. Moreover, university education (β = 1.65, p = 0.049) and high-risk pregnancy (β = 1.72, p = 0.02) were recognized as risk factors for developing anxiety disorders during pregnancy. Conclusion The high incidence of anxiety disorders in pregnant women suggests that obstetricians should pay more attention to identifying and treating anxiety disorders in all pregnant women, especially in high-risk pregnancies.
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Affiliation(s)
- Mojgan Shariatpanahi
- Department of Psychology, Saveh BranchIslamic Azad University, Science and Research BranchSavehIran
| | - Mahbobeh Faramarzi
- Department of General Courses, Social Determinants of Health Research Center, Health Research InstituteBabol University of Medical SciencesBabolIran
| | - Shahnaz Barat
- Department of Obstetrics and Gynecology, Infertility and Health Reproductive Research Center, Health Research InstituteBabol University of Medical SciencesBabolIran
| | - Azadeh Farghadani
- Department of Psychology, Saveh BranchIslamic Azad UniversitySavehIran
| | - Hoda Shirafkan
- Department of Statistic and Epidemiology, Social Determinants of Health Research Center, Health Research InstituteBabol University of Medical SciencesBabolIran
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Fish-Williamson A, Hahn-Holbrook J. Nutritional factors and cross-national postpartum depression prevalence: an updated meta-analysis and meta-regression of 412 studies from 46 countries. Front Psychiatry 2023; 14:1193490. [PMID: 37398595 PMCID: PMC10311512 DOI: 10.3389/fpsyt.2023.1193490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/02/2023] [Indexed: 07/04/2023] Open
Abstract
Background Postpartum depression (PPD) is the most common complication associated with childbirth and can lead to adverse outcomes for both mothers and their children. A previous meta-analysis found that PPD prevalence varies widely across countries. One potential underexplored contributor to this cross-national variation in PPD is diet, which contributes to mental health and varies significantly around the world. Here, we sought to update the global and national estimates of PPD prevalence using systematic review and meta-analysis. Further, we examined whether cross-national variation in PPD prevalence is associated with cross-national variation in diet using meta-regression. Methods To estimate national rates of PPD prevalence, we conducted an updated systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale between 2016-2021 and combined our findings with a previous meta-analysis of articles published between 1985-2015. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To examine dietary predictors, we extracted data on sugar-sweetened beverage, fruit, vegetable, total fiber, yogurt, and seafood consumption from the Global Dietary Database. Random effects meta-regression was used to test whether between-country and within-country variation in dietary factors predicted variation in PPD prevalence, controlling for economic and methodological variables. Results 412 studies of 792,055 women from 46 countries were identified. The global pooled prevalence of PPD was 19.18% (95% confidence interval: 18.02 to 20.34%), ranging from 3% in Singapore to 44% in South Africa. Countries that consumed more sugar-sweetened beverages (SSBs) had higher rates of PPD (Coef. = 0.325, p = 0.044, CI:0.010-0.680); Moreover, in years when higher rates of sugar-sweetened beverages were consumed in a country, there were correspondingly higher rates of PPD in that country (Coef. = 0.129, p = 0.026, CI: 0.016-0.242). Conclusion The global prevalence of PPD is greater than previous calculations, and drastically varies by country. Sugar-sweetened beverage consumption explained some of the national variation in PPD prevalence.
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20
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Yan P, Xu J. The Effects of Perceived Social Support on Postpartum Anxiety: A Moderated Mediation Model. Matern Child Health J 2023:10.1007/s10995-023-03712-6. [PMID: 37273134 DOI: 10.1007/s10995-023-03712-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Previous literature showed that perceived social support, self-esteem and optimism all played critical roles in the developing of postpartum anxiety. However, the mechanisms of influence were still unclear. This study aimed to explore the underlying mechanism of the relationship among perceived social support, self-esteem, optimism and postpartum anxiety. METHOD 756 women within one year after childbirth were surveyed using the Perceived Social Support Scale, Self-Assessment of Anxiety Scale, Self-Esteem Scale and Life Orientation Test Questionnaire. Pearson correlation analyses were performed to determine the direction and size of the all variables. The mediation model and the moderated mediation model were performed using the PROCESS macro. RESULTS Postpartum anxiety negatively correlated with perceived social support, self-esteem and optimism. A significant positive relationship existed among perceived social support, self-esteem and optimism. Self-esteem played a mediating role in the association between perceived social support and postpartum anxiety, with a mediating effect value of - 0.23. Optimism moderated the mediating process by which perceived social support affected postpartum anxiety via self-esteem. At the three levels of optimism (mean minus 1 SD, mean and mean plus 1 SD), the mediating effect values of self-esteem in the relationship between perceived social support and postpartum anxiety tended to diminish. CONCLUSION Self-esteem partially mediated the relationship between perceived social support and postnatal anxiety, and this mediating process was moderated by optimism.
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Affiliation(s)
- Panpan Yan
- School of Psychology, Weifang Medical University, Weifang, China
| | - Jihong Xu
- National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China.
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21
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Kohlhoff J, Harris SA, Lawson KD, Eapen V. ForWhen Australian perinatal and infant mental health navigation programme: evaluation protocol. BMJ Open 2023; 13:e070067. [PMID: 37277223 DOI: 10.1136/bmjopen-2022-070067] [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] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Many parents and carers experience mental health challenges during pregnancy and early postpartum years, and there are cumulative shortfalls in the identification, follow-up, and treatment of those experiencing perinatal and infant mental health (PIMH) challenges. ForWhen is a new national navigation programme in Australia that aims to improve outcomes for families by supporting parents and carers to access PIMH services that best meet their needs. This paper presents the protocol of an evaluation of the ForWhen programme, to be conducted over the first 3 years of its implementation. The specific objectives of the evaluation include examining the characteristics of navigation service delivery, its implementation and clinical impact, and identifying potential moderators of change. METHODS AND ANALYSIS Utilising a mixed-methods design, this evaluation will incorporate three phases that reflect the stages of the programme life-cycle: (1) programme description, (2) implementation evaluation and (3) outcomes evaluation. The evaluation will use a mix of quantitative and qualitative data including deidentified routinely collected service data, participant observations, semistructured interviews, surveys and questionnaires, and a resource audit. DISCUSSION Evaluation findings will be used to inform the development of a refined clinical navigation model, identify barriers and facilitators to successful navigation programme implementation, examine the impact of the ForWhen programme on client clinical outcomes and health service utilisation, understand how the programme is/can be best embedded in the evolving service system, and assess the cost-effectiveness and sustainability of a national navigation programme in improving health outcomes for PIMH in Australia. ETHICS AND DISSEMINATION This research was approved by South Western Sydney Local Health District Human Research Ethics Committee (2021/ETH11611). This study was registered on the Australian New Zealand Clinical Trials Registry (ACTRN12622001443785). Results will be disseminated at conferences, in scientific journals, and in a final evaluation report.
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Affiliation(s)
- Jane Kohlhoff
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
- Karitane Research Department, Karitane, Sydney, New South Wales, Australia
| | - Sophia A Harris
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kenny D Lawson
- Western Sydney University, Sydney, New South Wales, Australia
| | - Valsamma Eapen
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia
- Academic Unit of Infant, Child & Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District, Sydney, New South Wales, Australia
- Ingham Institute, Sydney, New South Wales, Australia
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22
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Clinkscales N, Golds L, Berlouis K, MacBeth A. The effectiveness of psychological interventions for anxiety in the perinatal period: A systematic review and meta-analysis. Psychol Psychother 2023; 96:296-327. [PMID: 36504355 DOI: 10.1111/papt.12441] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Anxiety disorders are relatively common during pregnancy and the postnatal period. Despite their potential acceptability to users, psychological interventions research for this population is still in its infancy. The meta-analysis aimed to comprehensively evaluate the evidence of the effectiveness of psychological interventions for reducing perinatal anxiety. METHOD The review followed PRISMA guidelines. A total of 26 studies published between 2004 and 2022 fulfilled inclusion criteria of which 22 were included in the meta-analysis. RESULTS Results indicated that psychological interventions were more effective than control conditions in reducing symptoms of perinatal anxiety (equivalent to a medium post treatment effect size). Effect sizes were robust for cognitive, behavioural and mindfulness-based interventions. Targeting anxiety also appeared to impact on depression symptoms. There was substantial evidence of methodological heterogeneity. CONCLUSIONS This review demonstrates that psychological interventions are effective in reducing symptoms of both anxiety and comorbid anxiety and depression in both the antenatal and postnatal periods. Further research on longer-term effects, infant outcomes, treatment approach and modality are required.
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Affiliation(s)
- Natalie Clinkscales
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, Scotland, UK
- Maternity and Neonatal Psychological Interventions Team, NHSGGC, Glasgow, Scotland, UK
| | - Lisa Golds
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - Katherine Berlouis
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, Scotland, UK
- National Cleft Surgical Service for Scotland, Glasgow, Scotland, UK
| | - Angus MacBeth
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, Scotland, UK
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23
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Inness BE, Furtado M, Barrett E, Stallwood E, Streiner DL, McCabe RE, Green SM. Psychometric properties of the PSWQ in a sample of pregnant and postpartum women. J Reprod Infant Psychol 2023:1-16. [PMID: 37139571 DOI: 10.1080/02646838.2023.2209101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Generalized anxiety disorder (GAD)-characterised by excessive and uncontrollable worry-is the most frequently diagnosed anxiety disorder during pregnancy and the postpartum period. Identification of GAD often relies on assessment of its cardinal feature, pathological worry. The Penn State Worry Questionnaire (PSWQ) is the most robust measure of pathological worry to date but has not been extensively evaluated for use during pregnancy and the postpartum period. This study evaluated the internal consistency, construct validity, and diagnostic accuracy of the PSWQ in a sample of pregnant and postpartum women with and without a principal GAD diagnosis. METHODS One hundred forty-two pregnant and 209 postpartum women participated in this study. Sixty-nine pregnant and 129 postpartum participants met criteria for a principal diagnosis of GAD. RESULTS The PSWQ demonstrated good internal consistency and converged with measures assessing similar constructs. Pregnant participants with principal GAD scored significantly higher on the PSWQ than those with no psychopathology and postpartum participants with principal GAD scored significantly higher than those with principal mood disorders, other anxiety and related disorders, and no psychopathology. A cut-off score of 55 and 61 or greater was determined for detecting probable GAD during pregnancy and the postpartum period, respectively. Screening accuracy of the PSWQ was also demonstrated. CONCLUSIONS This study underscores the robustness of the PSWQ as a measure of pathological worry and probable GAD and supports its use in the detection and monitoring of clinically significant worry symptoms during pregnancy and postpartum period.
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Affiliation(s)
- Briar E Inness
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Furtado
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Emily Barrett
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Emma Stallwood
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Sheryl M Green
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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24
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Langille C, Andreou P, Piccinini-Vallis H. The Prevalence of Pregnancy-Specific Perinatal Anxiety in Nova Scotia. Matern Child Health J 2023:10.1007/s10995-023-03639-y. [PMID: 37005936 PMCID: PMC10067513 DOI: 10.1007/s10995-023-03639-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVES Pregnancy-Specific Perinatal Anxiety (PSPA) is an understudied mental health condition of pregnancy that may affect maternal-fetal health outcomes. The purpose of this study was to determine the prevalence of PSPA among pregnant women in the province of Nova Scotia, Canada, as well as the factors associated with it. METHODS A sample of 90 pregnant women provided data on PSPA symptomology and demographic co-variables via a self-report online survey. The prevalence of PSPA in the sample was calculated and bivariate statistics and binomial logistic regression were conducted to assess the relationship between the presence of PSPA and the independent variables. RESULTS The prevalence of PSPA in our sample was 17.8%. Smoking during pregnancy and a pre-pregnancy diagnosis of anxiety were significantly associated with meeting the criteria for PSPA (p = 0.008 and p = 0.013, respectively) and strongly predicted the presence of PSPA (odds ratio 8.54 and 3.44, respectively). CONCLUSIONS FOR PRACTICE A significant proportion of participants in our sample experienced symptoms consistent with a diagnosis of PSPA. This underscores the importance of further research on PSPA as a unique phenomenon in pregnant women, and the impact it may have on fetal and maternal health outcomes. A greater clinical emphasis should be placed on screening for and treating mental health conditions of pregnancy, including PSPA.
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Affiliation(s)
| | - Pantelis Andreou
- Community Health and Epidemiology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
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25
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Pope J, Redsell S, Houghton C, Matvienko-Sikar K. Healthcare professionals' experiences and perceptions of providing support for mental health during the period from pregnancy to two years postpartum. Midwifery 2023; 118:103581. [PMID: 36608486 DOI: 10.1016/j.midw.2022.103581] [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: 09/23/2022] [Revised: 12/01/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Mental health issues in the perinatal period are common, and can have negative consequences for maternal and child health. Healthcare professionals (HCPs) who provide women with perinatal care are well-placed to detect mental health issues and provide support. This study therefore examines HCPs' experiences and perceptions of providing mental health support during the perinatal period, including during the COVID-19 pandemic. DESIGN An exploratory realist qualitative study was conducted. SETTING Republic of Ireland PARTICIPANTS: A purposive sampling strategy was employed to recruit HCPs (e.g., general practitioners, midwives, public health nurses, practice nurses, doulas, and breastfeeding counsellors), via professional bodies in Ireland. An invitation to participate was also circulated via Twitter. A total of 18 HCPs participated in semi-structured interviews conducted between 18/8/2020 and 24/5/2021. MEASUREMENTS AND FINDINGS Semi-structured interviews were conducted according to a topic guide designed by a multidisciplinary team. Data were analysed using thematic analysis. Four themes were developed: 'Supporting women in healthcare settings,' 'Skills and capacity to provide adequate care,' 'Structural barriers to care provision,' and 'The impact of the COVID-19 pandemic on stress support.' KEY CONCLUSIONS HCPs reported providing emotional support and advocacy, but highlighted challenges, including limited capacity to address women's concerns, clinical culture and hierarchy, insufficient organisational investment, and social inequities in support access. Some HCPs felt these barriers could lead to additional psychological harm. HCPs also reported that the pandemic had introduced novel stressors and changed the nature of the mental health support they provided. IMPLICATIONS FOR PRACTICE Interventions incorporating education and physical resources for HCPs, increased investment in specialist perinatal mental health services, increased investment in holistic supports, and changes to address cultural challenges in care environments, may facilitate - or enhance - support for women.
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Affiliation(s)
- Johanna Pope
- School of Public Health, University College Cork, Western Road, Mardyke, Cork, Ireland; School of Nursing and Midwifery, Aras Moyola, University of Galway, Upper Newcastle, Gaillimh, Ireland.
| | - Sarah Redsell
- School of Health Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Catherine Houghton
- School of Nursing and Midwifery, Aras Moyola, University of Galway, Upper Newcastle, Gaillimh, Ireland
| | - Karen Matvienko-Sikar
- School of Public Health, University College Cork, Western Road, Mardyke, Cork, Ireland
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26
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Lax ES, Novak SA, Webster GD. Maternal Functioning and Psychological Distress During the COVID-19 Pandemic. J Womens Health (Larchmt) 2023; 32:138-149. [PMID: 36178475 DOI: 10.1089/jwh.2021.0588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Our objective was to understand maternal functioning and psychological distress among mothers of young children in the United States during April/May 2020, early in the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: Participants were 862 moms of children aged 0-3 years old who completed an online survey. We examined maternal functioning (maternal competency and self-care subscales from the Barkin Index of Maternal Functioning) and psychological distress (depression, anxiety, and stress subscales of the DASS-21), and then examined interaction effects of COVID-19 impact and socioeconomic status (SES; represented by income and education). Results: Mothers' reports of higher maternal functioning correlated with lower psychological distress and both sets of factors varied substantially by SES and COVID-19 Impact. Higher COVID-19 Impact was associated with lower functioning and greater distress. Higher income and education were associated with better maternal self-care, but not maternal competency. Although we expected high SES to buffer mothers from a higher impact of COVID-19, we found that mothers with high SES reported a lower level of maternal competence and more stress than low-SES mothers. Interactions between COVID-19 impact and SES predicting maternal functioning and psychological distress revealed that when COVID-19 impact was low, high SES was associated with high functioning scores and less distress. Conclusions: This work challenges the assumptions that a stressful event will be uniformly experienced by mothers of young children as well as the stress-buffering role of higher SES. This study highlights the importance of considering SES when characterizing maternal functioning and psychological distress during times of high stress. Further research is needed to examine the processes contributing to these discrepancies.
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Affiliation(s)
- Elizabeth S Lax
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Sarah A Novak
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | - Gregory D Webster
- Department of Psychology, University of Florida, Gainesville, Florida, USA
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27
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Postpartum Depression and Anxiety among Lebanese Women: Correlates and Scales Psychometric Properties. Healthcare (Basel) 2023; 11:healthcare11020201. [PMID: 36673569 PMCID: PMC9859353 DOI: 10.3390/healthcare11020201] [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: 12/04/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
Background: We found that it was important to fill a gap in the literature and check the psychometric properties of the Edinburgh Postnatal Depression Scale (EPDS) and Perinatal Anxiety Screening Scale (PASS) in the Arabic language and delineate factors associated with postnatal depression (PPD) and anxiety (PPA) among Lebanese women 4−6 weeks after delivery. Methods: This cross-sectional study carried out between July 2018 and March 2019 enrolled 295 participants who came for a postnatal checkup at four clinics. Results: The EPDS and PASS scales’ items converged over two- and four-factor solutions, explaining 62.51% and 53.33% of the variance, respectively (KMO EPDS = 0.816, αCronbach EPDS = 0.826; KMO PASS = 0.878, αCronbach PASS = 0.920; Bartlett’s test of sphericity p < 0.001). Higher postpartum anxiety (Beta = 0.256), higher postpartum insomnia (Beta = 0.079), having hypotension during pregnancy (Beta = 2.760), and having a second (Beta = 1.663) or a third baby or more (Beta = 2.470) compared with the first one were significantly associated with higher postpartum depression. Higher postpartum depression (Beta = 1.33) was significantly associated with higher postpartum anxiety, whereas having a baby through a planned pregnancy (Beta = −4.365) and having a baby who ate regularly (Beta = −3.639) were significantly associated with lower postpartum anxiety. Conclusion: Depression and anxiety prevalence rates in the Lebanese population were higher compared with other countries, which may be due in part to the differences in regional, social and environmental culture.
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28
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Val A, Míguez MC. Prevalence of Antenatal Anxiety in European Women: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1098. [PMID: 36673854 PMCID: PMC9858852 DOI: 10.3390/ijerph20021098] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
The presence of anxiety during pregnancy is associated with adverse consequences for both mothers and their babies. The aim of this study was to review the prevalence of anxiety in European pregnant women in order to find out which countries have published the most studies in respect to the presence of anxiety during pregnancy, which countries are the most and least prevalent in terms of anxiety within pregnant women, and which are the most common tools used to assess anxiety during this stage. As such, a literature review was conducted regarding the studies that were published in the last twenty years in the PsycInfo, Medline, and SCOPUS databases. Thirty-eight studies were selected for the purposes of this review. The prevalence of anxiety in pregnancy and generalized anxiety disorder (GAD) varies considerably between studies. The European countries that have carried out the most research on this issue are Spain, Italy, and the United Kingdom. The most widely used assessment instrument is the State Trait Anxiety Inventory (STAI). The lowest prevalence rate of anxiety, using the STAI-E, was found in Poland, 7.7%, and the highest was found in Italy, 36.5%. The prevalence of GAD ranges from 0.3% to 10.8%. This indicates that anxiety in pregnant women is a very relevant mental health problem. It is therefore important to detect and intervene early in order to promote the well-being of both mothers and children.
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Affiliation(s)
| | - M. Carmen Míguez
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain
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29
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Effects of maternal depression on maternal responsiveness and infants' expressive language abilities. PLoS One 2023; 18:e0277762. [PMID: 36630343 PMCID: PMC9833548 DOI: 10.1371/journal.pone.0277762] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 11/02/2022] [Indexed: 01/12/2023] Open
Abstract
High levels of maternal responsiveness are associated with healthy cognitive and emotional development in infants. However, depression and anxiety can negatively impact individual mothers' responsiveness levels and infants' expressive language abilities. Australian mother-infant dyads (N = 48) participated in a longitudinal study examining the effect of maternal responsiveness (when infants were 9- and 12-months), and maternal depression and anxiety symptoms on infant vocabulary size at 18-months. Global maternal responsiveness ratings were stronger predictors of infants' vocabulary size than levels of depression and anxiety symptoms. However, depression levels moderated the effect of maternal responsiveness on vocabulary size. These results highlight the importance of screening for maternal responsiveness-in addition to depression-to identify infants who may be at developmental risk. Also, mothers with elevated depression need support to first reduce their symptoms so that improvements in their responsiveness have the potential to be protective for their infant's language acquisition.
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30
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Amiri P, Bahaadinbeigy K, Asadi F, Rahmati S, Mazhari S. Validation of the Persian version of the Perinatal Anxiety Screening Scale (PASS) among antenatal and postnatal women. BMC Pregnancy Childbirth 2022; 22:883. [PMID: 36447132 PMCID: PMC9706838 DOI: 10.1186/s12884-022-05217-6] [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: 08/27/2022] [Accepted: 11/14/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Anxiety disorder is more common in women than men. To some extent, it can be attributed to childbirth and factors related to pregnancy in women. Therefore, it is necessary for mothers to use valid and reliable scale to assess perinatal anxiety, such as the perinatal anxiety screening scale (PASS). The purpose of this study was to investigate the validity and reliability of the PASS in Persian language. METHODS The PASS was translated into Persian (PASS-IR). Generally, 224 women antenatal and 125 postnatal answered the questions of PASS, EPDS-10, BAI and DASS-21 questionnaires. The data was collected in the health centers of Kerman by random sampling method. Finally, content validity, factor analysis, internal consistency and test-retest reliability were evaluated. RESULTS The mean age of the participants was 32.89 years (range between 18 and 45 and SD = 6.23). More than half of the participating were at risk of severe anxiety (53.5%). Content Validity Index (CVI) and Content Validity Ratio (CVR) were 0.80 and 0.87. PASS-IR subscales include social anxiety and specific fears, general anxiety and adjustment, acute anxiety and trauma, and perfectionism and control. PASS-IR was significantly correlated with EPDS-10 (rho = 0.42), BAI (rho = 0.53), DASS-21 with three concepts of depression, anxiety and stress (rho = 0.51, rho = 0.49 and rho = 0.49), and adverse life events (rho = 0.30). CONCLUSION The results of this study show that PASS-IR has good validity and reliability. Therefore, it can be used to screen for anxiety disorder among Iranian women in the perinatal stage.
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Affiliation(s)
- Parastoo Amiri
- grid.412105.30000 0001 2092 9755Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- grid.412105.30000 0001 2092 9755Medical Informatics Research Center, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Asadi
- grid.412105.30000 0001 2092 9755Health Information Technology, School of Management and Medical Information, Kerman University of Medical Sciences, Kerman, Iran
| | - Shoboo Rahmati
- grid.412105.30000 0001 2092 9755Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahrzad Mazhari
- grid.412105.30000 0001 2092 9755Neuroscience Research Center, Institute of Neuropharmachology, Kerman University of Medical Sciences, Kerman, Iran
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31
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A preliminary investigation into testing a transdiagnostic cognitive model of fear of childbirth (FOC): a multiple indicators multiple causes (MIMIC) model. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-04010-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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32
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Smith CG, Jones EJH, Wass SV, Jacobs D, Fitzpatrick C, Charman T. The effect of perinatal interventions on parent anxiety, infant socio‐emotional development and parent‐infant relationship outcomes: A systematic review. JCPP ADVANCES 2022. [DOI: 10.1002/jcv2.12116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Celia G. Smith
- Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
| | | | | | | | | | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
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Vogazianos P, Motrico E, Domínguez-Salas S, Christoforou A, Hadjigeorgiou E. Validation of the generalized anxiety disorder screener (GAD-7) in Cypriot pregnant and postpartum women. BMC Pregnancy Childbirth 2022; 22:841. [DOI: 10.1186/s12884-022-05127-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Anxiety is increasingly acknowledged as a common mental health issue during the perinatal period. Its prevalence as well as the associated adverse effects constitute screening imperative. This study evaluates the psychometric properties and underlying factor structures of a Greek version of GAD-7 among pregnant and postpartum women (up to 6 months) in Cyprus.
Methods
This study was conducted from June to December 2020. A total of 457 Cypriot women in the perinatal period (222 pregnant and 235 postpartum) were surveyed. The assessment included anxiety (GAD-7) and depression (EPDS), and psychosocial factors related with anxiety. The internal consistency and factor structure of GAD-7 were evaluated using reliability coefficients, Cronbach’s Alpha and McDonald's Omega, and factor analysis, both Exploratory as well as Confirmatory.
Results
GAD-7 demonstrated good internal consistency (α = 0.907; Ω = 0.909). Horn's parallel analysis indicated a single factor as the most appropriate. CFA using the standard ML method indicated a good model fit, χ2 = 21.207, p = 0.096; CFI = 0.999; SRMR = 0.027. More studies are needed to determinate the cut-off point and the maximisation of the scale’s sensitivity and specificity in pregnant and postpartum Greek Cypriot women.
Conclusions
GAD-7 is a valid and reliable measure and healthcare professionals should utilize GAD-7 as a standard instrument for the screening of anxiety symptoms in pregnant and postpartum Greek Cypriot women.
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Jeličić L, Veselinović A, Ćirović M, Jakovljević V, Raičević S, Subotić M. Maternal Distress during Pregnancy and the Postpartum Period: Underlying Mechanisms and Child's Developmental Outcomes-A Narrative Review. Int J Mol Sci 2022; 23:ijms232213932. [PMID: 36430406 PMCID: PMC9692872 DOI: 10.3390/ijms232213932] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
Maternal mental health may be considered a determining factor influencing fetal and child development. An essential factor with potentially negative consequences for a child's psychophysiological development is the presence of maternal distress during pregnancy and the postpartum period. The review is organized and presented to explore and describe the effects of anxiety, stress, and depression in pregnancy and the postpartum period on adverse child developmental outcomes. The neurobiology of maternal distress and the transmission mechanisms at the molecular level to the fetus and child are noted. In addition, the paper discusses the findings of longitudinal studies in which early child development is monitored concerning the presence of maternal distress in pregnancy and the postpartum period. This topic gained importance in the COVID-19 pandemic context, during which a higher frequency of maternal psychological disorders was observed. The need for further interdisciplinary research on the relationship between maternal mental health and fetal/child development was highlighted, especially on the biological mechanisms underlying the transmission of maternal distress to the (unborn) child, to achieve positive developmental outcomes and improve maternal and child well-being.
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Affiliation(s)
- Ljiljana Jeličić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-11-3208-519; Fax: +381-11-2624-168
| | - Aleksandra Veselinović
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia
| | - Milica Ćirović
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia
- Department of Speech, Language and Hearing Sciences, Institute for Experimental Phonetics and Speech Pathology, 11000 Belgrade, Serbia
| | - Vladimir Jakovljević
- Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Department of Human Pathology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Saša Raičević
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Montenegro, 81000 Podgorica, Montenegro
- Clinic of Gynecology and Obstetrics, Clinical Center of Montenegro, 81000 Podgorica, Montenegro
| | - Miško Subotić
- Cognitive Neuroscience Department, Research and Development Institute “Life Activities Advancement Institute”, 11000 Belgrade, Serbia
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35
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Evans C, Kreppner J, Lawrence PJ. The association between maternal perinatal mental health and perfectionism: A systematic review and meta-analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1052-1074. [PMID: 35762187 PMCID: PMC9796248 DOI: 10.1111/bjc.12378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Perfectionism is an important feature of adult psychopathology. In the absence of a prior review of the role of perfectionism in perinatal psychopathology, we aimed to ascertain whether perfectionism was associated with symptoms of maternal perinatal depression and anxiety. METHOD We followed PRISMA guidance (PROSPERO: 42019143369), estimated weighted effect sizes and tested possible moderators: timing (pre or post- natal), scales used to measure constructs, infant gender, temperament and age; and rated study quality. RESULTS Fourteen studies met eligibility criteria. Perfectionism as a whole, and the perfectionistic concerns dimension, were moderately correlated with common maternal perinatal mental health difficulties r = .32 (95% Confidence Interval = 0.23 to 0.42). In sub-group analyses, perfectionistic concerns were associated with depression (r = .35, 95% CI = 0.26-0.43). We found no evidence of significant moderation of associations. LIMITATIONS Included studies had methodological and conceptual limitations. All studies examined depression and two examined anxieties; all examined perfectionistic concerns and four examined perfectionist strivings. CONCLUSIONS Perfectionism, namely perfectionistic concerns, is potentially associated with common maternal perinatal mental health problems. While further research is warranted, identification of perfectionism in the perinatal period may help focus resources for intervention, reducing the prevalence of perinatal mental health difficulties.
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Affiliation(s)
- Clare Evans
- Sussex Partnership NHS Foundation TrustWest SussexUK
| | - Jana Kreppner
- Centre for Innovation in Mental HealthSchool of PsychologyUniversity of SouthamptonSouthamptonUK
| | - Peter J. Lawrence
- Centre for Innovation in Mental HealthSchool of PsychologyUniversity of SouthamptonSouthamptonUK
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Di Paolo AL, King S, McLean MA, Lequertier B, Elgbeili G, Kildea S, Dahlen HG. Prenatal stress from the COVID-19 pandemic predicts maternal postpartum anxiety as moderated by psychological factors: The Australian BITTOC Study. J Affect Disord 2022; 314:68-77. [PMID: 35760187 PMCID: PMC9232265 DOI: 10.1016/j.jad.2022.06.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/01/2022] [Accepted: 06/20/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND While there have been reports of increased perinatal anxiety during the COVID-19 pandemic (Stepowicz et al., 2020), there has been a lack of research on the relative importance of objective hardship and subjective distress. In this study, we explored the extent to which resilience, tolerance of uncertainty, and cognitive appraisal of the pandemic's consequences moderate the effect of prenatal objective hardship and subjective distress due to the pandemic on 2-month postpartum anxiety. METHODS Data were collected as part of the Birth in the Time of COVID (BITTOC) study. We measured objective hardship and subjective distress, mental health, and potential psychological moderators in 419 pregnant women residing in Australia, and at two months postpartum. Hierarchical multiple regressions were used. RESULTS Objective hardship and subjective distress independently predicted postpartum anxiety. All three psychological factors moderated the effect of objective hardship on anxiety. For women with low/neutral resilience, or low/moderate tolerance of uncertainty, or a negative cognitive appraisal, greater objective hardship predicted higher postpartum anxiety. Conversely, for women with high resilience, or high tolerance of uncertainty, or neutral/positive cognitive appraisal, there was no association. Only a neutral/positive cognitive appraisal significantly buffered the effect of subjective distress on anxiety. LIMITATIONS Participants self-selected themselves into the study. The generalizability of our results could be restricted to women of higher socio-economic status. CONCLUSIONS These findings help us better understand options for intervention and assessment of vulnerable women during times of stress, along with the mechanisms by which COVID-related stress during pregnancy contributes to postpartum anxiety.
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Affiliation(s)
- Amber-Lee Di Paolo
- Douglas Institute Research Centre, 6875 Boulevard LaSalle, Verdun, QC H4H 1R3, Canada
| | - Suzanne King
- Douglas Institute Research Centre, 6875 Boulevard LaSalle, Verdun, QC H4H 1R3, Canada; Department of Psychiatry, McGill University, 1033 Avenue des Pins, Montreal, QC H3A 1A1, Canada.
| | - Mia A McLean
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Belinda Lequertier
- Molly Wardaguga Research Centre, School of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Guillaume Elgbeili
- Douglas Institute Research Centre, 6875 Boulevard LaSalle, Verdun, QC H4H 1R3, Canada
| | - Sue Kildea
- Molly Wardaguga Research Centre, School of Nursing and Midwifery, Charles Darwin University, Brisbane, QLD, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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Pérez JC, Aldoney D, García MI, Olhaberry M, Fernández O, Alamo N, Franco P, Pérez F, Fisher J, Rowe H, Coo S. Online intervention to prevent postnatal depression and anxiety in Chilean new mothers: Protocol for a feasibility trial. Health Informatics J 2022; 28:14604582221135440. [DOI: 10.1177/14604582221135440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Symptoms of postpartum depression and anxiety in new mothers are prevalent and negatively impact maternal emotional wellbeing and infant development. Barriers to accessing treatment prevent women from receiving mental health care, a situation that has worsened due to the COVID-19 pandemic. mHealth interventions hold the potential to support women during the transition to parenthood despite these barriers and to promote the use of preventive interventions. This study uses a mixed methods design to assess the feasibility and preliminary effectiveness of a psychoeducational, guided mHealth intervention to prevent postpartum mental health difficulties in women who receive care in primary health centers in Chile. The study will contribute to evidence-based research on the effectiveness of mHealth interventions for new mothers from an understudied cultural background. The findings will also enable the development of a larger randomized controlled trial to assess the effectiveness of the intervention, which, if effective, could significantly contribute to the emotional wellbeing of women and their families.
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Affiliation(s)
- J. Carola Pérez
- Millennium Institute for Research on Depression and Personality (MIDAP), Santiago, Chile; Facultad de Psicología. Universidad del Desarrollo (UDD), Santiago, Chile
| | - Daniela Aldoney
- Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile
| | - María I García
- Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile
| | - Marcia Olhaberry
- Millennium Institute for Research on Depression and Personality (MIDAP), Santiago, Chile; School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Olga Fernández
- Millennium Institute for Research on Depression and Personality (MIDAP), Santiago, Chile; Universidad de Chile, Santiago, Chile
| | - Nicolle Alamo
- Millennium Institute for Research on Depression and Personality (MIDAP), Santiago, Chile; School of Social Work, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pamela Franco
- Millennium Institute for Research on Depression and Personality (MIDAP), Santiago, Chile; School of Psychology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Pérez
- Millennium Institute for Research on Depression and Personality (MIDAP), Santiago, Chile; Universidad Alberto Hurtado, Santiago, Chile
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Heather Rowe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Soledad Coo
- Facultad de Psicología, Universidad del Desarrollo (UDD), Santiago, Chile
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Abstract
Objectives The present study investigated the effectiveness of an 8-week mindfulness mobile phone app on women’s depression, anxiety, stress and mindful attention/awareness in the postnatal period. Methods The study enrolled 99 mothers of a child under 1 year old, and randomly assigned them to intervention (n = 49, mean age = 31.11, SD = 4.30, years) and control (n = 50, mean age = 31.35, SD = 5.29, years) groups. Multiple regression examined intervention effects on depression, anxiety, stress and mindful attention/awareness measured post-intervention and at 4-week follow-up, controlling for the baseline and post-intervention measurement of the specific outcome, respectively. Results The intervention group showed significant decreases in depression, anxiety and stress levels and an increase of mindful attention/awareness post-intervention compared to the control group, with medium to large effect sizes after controlling for effects of corresponding variables at baseline. The intervention group showed further decrease in depression and stress levels and an increase in mindful attention/awareness at 4 weeks post-intervention compared to the control group, with small to medium effect sizes, after controlling for effects of corresponding variables at post-intervention. Conclusions The outcomes of the study suggest that delivery of mindfulness via smartphones could be a viable and affordable resource for reducing postnatal depression, anxiety and stress.
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Affiliation(s)
- Katie A Bear
- School of Psychology, University of Waikato, Hillcrest, Private Bag 3105, 3240 Hamilton, New Zealand
| | - Carol C Barber
- School of Psychology, University of Waikato, Hillcrest, Private Bag 3105, 3240 Hamilton, New Zealand
| | - Oleg N Medvedev
- School of Psychology, University of Waikato, Hillcrest, Private Bag 3105, 3240 Hamilton, New Zealand
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Sommer M, Knappe S, Garthus-Niegel S, Weidner K, Martini J. Die Bedeutung peripartaler mütterlicher Angst- und depressiver Störungen für die frühkindliche Entwicklung. KINDHEIT UND ENTWICKLUNG 2022. [DOI: 10.1026/0942-5403/a000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Aktuelle Studien zeigen spezifische Zusammenhänge von peripartalen psychischen Störungen und kindlichen Entwicklungsauffälligkeiten. Fragestellung: Haben Kinder von Müttern mit einer peripartalen Angst- oder depressiven Störung ein erhöhtes Risiko für (visuo–)motorische, sprachliche und kognitive Entwicklungsauffälligkeiten? Methode: In der prospektiven MARI-Studie ( N = 306) wurden peripartale psychische Störungen mit dem CIDI-V in jedem Schwangerschaftstrimester sowie 2, 4 und 16 Monate nach der Geburt erhoben. Die kindliche Entwicklung wurde mit dem Neuropsychologischen Entwicklungs-Screening im Alter von 4 ( N = 263) und 16 Monaten ( N = 241) erfasst. Ergebnisse: Maternale depressive Störungen vor der Schwangerschaft waren negativ mit der visuellen Entwicklung (4 Monate; OR = 3.3) und der Haltungs- und Bewegungssteuerung (16 Monate; OR = 4.4) des Kindes assoziiert. Diskussion: Entwicklungsauffälligkeiten könnten u. a. durch ein verändertes Interaktionsverhalten (z. B. weniger Blickkontakt/Ermutigung) betroffener Mütter begründet sein.
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Affiliation(s)
- Maria Sommer
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Medizinische Fakultät an der Technischen Universität Dresden, Deutschland
| | - Susanne Knappe
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Deutschland
- Professur für Gesundheitswissenschaften, Evangelische Hochschule Dresden, Deutschland
| | - Susan Garthus-Niegel
- Institute for Systems Medicine und Fakultät Medizin, Medical School Hamburg MSH, Hamburg, Deutschland
- Institut und Poliklinik für Arbeits- und Sozialmedizin, Technische Universität Dresden, Deutschland
- Abteilung für kindliche Gesundheit und Entwicklung, Norwegisches Institut für Public Health, Oslo, Norwegen
| | - Kerstin Weidner
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Universitätsklinikum Carl Gustav Carus, Medizinische Fakultät an der Technischen Universität Dresden, Deutschland
| | - Julia Martini
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Medizinische Fakultät an der Technischen Universität Dresden, Deutschland
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Deutschland
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Pierce SK, Reynolds KA, Hardman MP, Furer P. How do prenatal people describe their experiences with anxiety? a qualitative analysis of blog content. BMC Pregnancy Childbirth 2022; 22:398. [PMID: 35538436 PMCID: PMC9092700 DOI: 10.1186/s12884-022-04697-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/18/2022] [Indexed: 01/07/2023] Open
Abstract
Background Despite elevated prevalence rates of prenatal (antenatal) anxiety across studies (13–21%), and prenatal people’s use of the Internet to search for pregnancy-related information and support, research investigating prenatal people’s experiences with online mental health communication, such as blogs, is lacking. This study examined blog entries focused on anxiety in pregnancy to better understand prenatal people’s Internet discourse concerning their experiences with anxiety. Methods A Google search using the keywords “anxiety,” “pregnant,” and “blog” resulted in N = 18 blogs that met inclusion criteria (public blog written in English describing a personal experience with prenatal anxiety in 250 words or more). Blog content was analyzed using a thematic analytic approach based on grounded theory principles. Results Three main themes capturing prenatal people’s experiences with anxiety as written in public blog content were developed from qualitative analyses: 1) etiology (subthemes: before pregnancy, during the current pregnancy, related to a previous pregnancy), 2) triggers (subthemes: uncertainty, perceived lack of control, and guilt and shame for not having a normal pregnancy), and 3) symptoms (subthemes: intertwined emotional, cognitive and physical symptoms, in addition to behavioural symptoms). Conclusions Our findings demonstrate a need for perinatal professionals to address anxiety symptoms and triggers in pregnancy. One way to address this may be by providing credible information regarding prenatal mental and physical health to pregnant people through online mediums, such as blogs. Bloggers often discussed experiencing a combination of emotional, cognitive, physical, and behavioural symptoms, which suggests that medical and mental health professionals should work collaboratively to provide care for prenatal people experiencing anxiety. Furthermore, Cognitive Behavioural Therapy (CBT) addresses these types of symptoms, which suggests that interventions developed or adapted to meet this populations’ needs could employ this therapeutic approach. Future research should explore the reasons why prenatal people experiencing anxiety engage with blogs, the characteristics of bloggers and readers, the impact of the blogging experience on both the blogger and their audience, and the information quality of blog content. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04697-w.
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Affiliation(s)
- Shayna K Pierce
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, MB, R3T 2N2, Canada
| | - Kristin A Reynolds
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, MB, R3T 2N2, Canada.
| | - Madison P Hardman
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, MB, R3T 2N2, Canada
| | - Patricia Furer
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
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The prevalence of borderline personality features and borderline personality disorder during the perinatal period: a systematic review and meta-analysis. Arch Womens Ment Health 2022; 25:277-289. [PMID: 35217928 DOI: 10.1007/s00737-022-01218-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/20/2022] [Indexed: 11/02/2022]
Abstract
Borderline personality disorder (BPD) is a psychiatric disorder marked by severe affective instability and poor interpersonal functioning. Existing literature has highlighted that individuals with BPD are at greater risk for a wide range of adverse physiological and psychosocial outcomes in the perinatal period compared to perinatal individuals without BPD. However, to date, no systematic review has addressed the prevalence of BPD and borderline personality features (BPF) in pregnant and postpartum individuals. A systematic review and meta-analysis was conducted by searching three databases (PubMed, PsycINFO, and Embase) on April 6th, 2021. Research articles and conference abstracts that evaluated BPF or BPD in pregnant, postpartum, or mixed perinatal populations were included. Sixteen publications were included in the systematic review (n = 14 research articles, n = 2 conference abstracts), seven of which were included in the meta-analysis. Among non-clinical samples, prevalence rates of BPF during pregnancy ranged from 6.9 to 26.7%, while rates of BPD across the perinatal period ranged from 0.7 to 1.7%. Among clinical samples, rates of BPF and BPD across the perinatal period spanned 9.7-34% and 2.0-35.2%, respectively. Results from the meta-analysis revealed that the pooled prevalence rate of BPD in clinical samples during the perinatal period is 14.0% (95% CI [7.0, 22.0]). Among clinical perinatal samples, there is a high prevalence of borderline personality pathology. This review highlights the need for appropriate validated screening methods to identify and treat BPD in the perinatal population.
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Daundasekara SS, Schuler B, Hernandez DC. Independent and combined associations of intimate partner violence and food insecurity on maternal depression and generalized anxiety disorder. J Anxiety Disord 2022; 87:102540. [PMID: 35192977 DOI: 10.1016/j.janxdis.2022.102540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
While research has investigated intimate partner violence (IPV) and food insecurity (FI) as independent experiences on mental health, research is lacking on the possible longitudinal associations of combined experiences of IPV and FI on maternal depression and generalized anxiety disorder (GAD). Using data from the Fragile Families and Child Wellbeing study (n = 1440), the current study examined the independent and combined associations of IPV and FI mothers experienced 3-5 years after their child's birth on depression and GAD at Year 15. Five mutually exclusive dichotomous variables were created based on IPV and FI experiences during Year 3 and Year 5. Depression and GAD were measured at Year 15 using the Composite International Diagnostic Interview-Short Form. According to the covariate-adjusted logistic regression models, exposure to IPV and FI, both concurrently and independently predicted greater depression at Year 15. Mothers in all IPV and FI categories had greater odds of having GAD at Year 15 compared to those with no exposure. Compared to the independent effect of IPV and FI, the combined effect of IPV and FI was highly associated with maternal GAD, but not depression. Using a trauma-informed approach to counseling in combination with food assistance programs might be an effective strategy in preventing mental health symptoms.
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Affiliation(s)
- Sajeevika Saumali Daundasekara
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Avenue, Houston, TX 77030, USA.
| | - Brittany Schuler
- School of Social Work, Temple University, Ritter Annex 549, 1301 Cecil B. Moore Ave., Philadelphia, PA 19122, USA.
| | - Daphne C Hernandez
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Avenue, Houston, TX 77030, USA.
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Liu CH, Hyun S, Mittal L, Erdei C. Psychological risks to mother-infant bonding during the COVID-19 pandemic. Pediatr Res 2022; 91:853-861. [PMID: 34645943 PMCID: PMC9008072 DOI: 10.1038/s41390-021-01751-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/09/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of this study was to examine the association between mental health symptoms, along with psychological experiences and coronavirus disease 2019 (COVID-19) related concerns, and self-reported maternal-infant bonding experiences of postpartum women. METHODS Using data collected from May 19 to August 17, 2020, this cross-sectional online study assessed 429 women to better understand the impact of the COVID-19 pandemic on women during the postpartum period. Enrolled respondents were asked to participate in a 30-45-min online survey about COVID-19-related experiences, pregnancy, stress, and well-being. RESULTS Postpartum women's depressive symptoms were related to lower quality maternal-infant bonding, but the anxiety symptoms were not associated with bonding. Maternal self-efficacy, but not social support, was associated with mothers' higher quality of maternal-infant bonding. COVID-19-related grief was significantly associated with lower quality bonding. On the other hand, COVID-19-related health worries were associated with higher quality of maternal-infant bonding. CONCLUSIONS We describe potential psychological risk factors to maternal-infant bonding among postpartum women during the pandemic period. To best support the medical and psychological well-being of the mothers and infants, enhanced interdisciplinary partnerships among perinatal healthcare professionals involved in primary and/or specialty care is needed. IMPACT Unique COVID-19-related health and grief concerns exist, with implications for maternal-infant bonding. Depression but not anxiety is associated with lower maternal-infant bonding. Caregiving confidence, but not social support, is associated with higher maternal-infant bonding. It is critical to screen for postpartum depression and COVID-19-related grief during maternal follow-up and pediatric visits. Study findings inform and prioritize pediatric interventions toward enhancing maternal-infant bonding during the COVID-19 era.
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Affiliation(s)
- Cindy H. Liu
- Department of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA,Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA,Corresponding Author: Cindy H. Liu, PhD, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA, Tel: 617-525-4131, Fax: 617-582-6026,
| | - Sunah Hyun
- Department of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Leena Mittal
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Carmina Erdei
- Department of Newborn Medicine, Brigham and Women’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
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Evans K, Rennick-Egglestone S, Cox S, Kuipers Y, Spiby H. Remotely Delivered Interventions to Support Women With Symptoms of Anxiety in Pregnancy: Mixed Methods Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e28093. [PMID: 35166688 PMCID: PMC8889484 DOI: 10.2196/28093] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/03/2021] [Accepted: 11/19/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Symptoms of anxiety are common in pregnancy, with severe symptoms associated with negative outcomes for women and babies. Low-level psychological therapy is recommended for women with mild to moderate anxiety, with the aim of preventing an escalation of symptoms and providing coping strategies. Remotely delivered interventions have been suggested to improve access to treatment and support and provide a cost-effective, flexible, and timely solution. OBJECTIVE This study identifies and evaluates remotely delivered, digital, or web-based interventions to support women with symptoms of anxiety during pregnancy. METHODS This mixed methods systematic review followed a convergent segregated approach to synthesize qualitative and quantitative data. The ACM Digital Library, Allied and Complementary Medicine Database, Applied Social Sciences Index and Abstracts, Centre for Reviews and Dissemination database, the Cochrane Central Register of Controlled Trials, the Cochrane Library, CINAHL, Embase, Health Technology Assessment Library, IEEE Xplore, Joanna Briggs Institute, Maternity and Infant Care, MEDLINE, PsycINFO, and the Social Science Citation Index were searched in October 2020. Quantitative or qualitative primary research that included pregnant women and evaluated remotely delivered interventions reporting measures of anxiety, fear, stress, distress, women's views, and opinions were included. RESULTS Overall, 3 qualitative studies and 14 quantitative studies were included. Populations included a general antenatal population and pregnant women having anxiety and depression, fear of childbirth, insomnia, and preterm labor. Interventions included cognitive behavioral therapy, problem solving, mindfulness, and educational designs. Most interventions were delivered via web-based platforms, and 62% (8/13) included direct contact from trained therapists or coaches. A meta-analysis of the quantitative data found internet-based cognitive behavioral therapy and facilitated interventions showed a beneficial effect in relation to the reduction of anxiety scores (standardized mean difference -0.49, 95% CI -0.75 to -0.22; standardized mean difference -0.48, 95% CI -0.75 to -0.22). Due to limitations in the amount of available data and study quality, the findings should be interpreted with caution. Synthesized findings found some evidence to suggest that interventions are more effective when women maintain regular participation which may be enhanced by providing regular contact with therapists or peer support, appropriate targeting of interventions involving components of relaxation and cognitive-based skills, and providing sufficient sessions to develop new skills without being too time consuming. CONCLUSIONS There is limited evidence to suggest that women who are pregnant may benefit from remotely delivered interventions. Components of interventions that may improve the effectiveness and acceptability of remotely delivered interventions included providing web-based contact with a therapist, health care professional, or peer community. Women may be more motivated to complete interventions that are perceived as relevant or tailored to their needs. Remote interventions may also provide women with greater anonymity to help them feel more confident in disclosing their symptoms.
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Affiliation(s)
- Kerry Evans
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Serena Cox
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Yvonne Kuipers
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
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Bowman LC, McCormick SA, Kane-Grade F, Xie W, Enlow MB, Nelson CA. Infants' neural responses to emotional faces are related to maternal anxiety. J Child Psychol Psychiatry 2022; 63:152-164. [PMID: 33993507 PMCID: PMC9644832 DOI: 10.1111/jcpp.13429] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Postnatal maternal anxiety is common (estimates as high as 40% prevalence) and is associated with altered mother-infant interactions (e.g., reduced maternal emotional expression and engagement). Neural circuitry supporting infants' face and emotion processing develops in their first year. Thus, early exposure to maternal anxiety may impact infants' developing understanding of emotional displays. We examine whether maternal anxiety is associated with individual differences in typically developing infants' neural responses to emotional faces. METHODS One hundred and forty two mother-infant dyads were assessed when infants were 5, 7, or 12 months old. Infants' electroencephalographic (EEG) data were recorded while passively viewing female happy, fearful, and angry faces. Three event-related potential (ERP) components, each linked to face and emotion processing, were evaluated: NC, N290, and P400. Infant ERP amplitude was related to concurrent maternal-report anxiety assessed with the Spielberger State-Trait Anxiety Inventory (Trait form). RESULTS Greater maternal anxiety predicted more negative NC amplitude for happy and fearful faces in left and mid-central scalp regions, beyond covarying influences of maternal depression symptoms, infant negative emotionality, and infant age. CONCLUSIONS Postnatal maternal anxiety is related to infants' neural processing of emotional expressions. Infants of mothers endorsing high trait anxiety may need additional attentional resources to process happy and fearful faces (expressions less likely experienced in mother-infant interactions). Future research should investigate mechanisms underlying this association, given possibilities include experiential, genetic, and prenatal factors.
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Affiliation(s)
- Lindsay C. Bowman
- Center for Mind and Brain and Department of Psychology, University of California Davis, Davis, CA,Correspondence to: Lindsay C. Bowman, Center for Mind and Brain at UC Davis, 267 Cousteau Place, Davis, CA, USA, 95616
| | - Sarah A. McCormick
- Department of Psychology and Brain Sciences, University of Massachusetts, Amherst, MA
| | - Finola Kane-Grade
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA
| | - Wanze Xie
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Michelle Bosquet Enlow
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Charles A. Nelson
- Laboratories of Cognitive Neuroscience, Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA,Harvard Graduate School of Education, Cambridge, MA
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Morton A, Adams C. Health visiting in England: The impact of the COVID-19 pandemic. Public Health Nurs 2022; 39:820-830. [PMID: 35099079 DOI: 10.1111/phn.13053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/17/2021] [Accepted: 01/15/2022] [Indexed: 01/15/2023]
Abstract
This focused review of evidence considers the impact of the pandemic in 2020 on families with children under 5 years in England, and the health visiting (HV) service that supports them. . Data were drawn from national surveys of health visitors (HVs) and parents, a freedom of information request of employers, published research, and national data. Framework analysis and triangulation, using the Key Elements of an effective HV service, were used to categorize the key findings. The findings from the review indicate that the impacts of the pandemic were wide-ranging and disproportionately affected the most disadvantaged families, increasing demand for HV support. HVs' ability to respond was compromised due to national policy decisions to partially stop the service and variations in local implementation including the redeployment of HVs, pre-existing workforce capacity issues, and the effectiveness of innovations to identify and support vulnerable families. The pandemic exacerbated factors that can lead to poorer outcomes for families. Key learning from the pandemic response, including the need to prioritize the HV service, must be acted upon to reduce ongoing impacts now and ensure that the service is equipped for future emergencies.
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Ribeiro MM, Andrade A, Nunes I. Physical exercise in pregnancy: benefits, risks and prescription. J Perinat Med 2022; 50:4-17. [PMID: 34478617 DOI: 10.1515/jpm-2021-0315] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this article is to provide a comprehensive literature review, gathering the strongest evidence about the risks and benefits and the prescription of physical exercise during pregnancy. CONTENT Regular physical exercise during pregnancy is associated with numerous benefits. In general women are not adequately advised on this matter. Along with their concerns regarding the potential associated risks, it contributes to the abandonment or refusal to start exercising during pregnancy. A systematic review was conducted in MEDLINE including articles considered to have the highest level of scientific evidence. Fifty-seven articles, including 32 meta-analysis, 9 systematic reviews and 16 randomized controlled trials were included in the final literature review. SUMMARY Exercise can help preventing relevant pregnancy related disorders, such as gestational diabetes, excessive gestational weight gain, hypertensive disorders, urinary incontinence, fetal macrosomia, lumbopelvic pain, anxiety and prenatal depression. Exercise is not related with an increased risk of maternal or perinatal adverse outcomes. Compliance with current guidelines is sufficient to achieve the main benefits, and exercise type and intensity should be based on woman's previous fitness level. OUTLOOK Exercise in pregnancy is safe for both mother and fetus, contributing to prevent pregnancy related disorders. Exercise type and intensity should be adapted to woman's previous fitness level, medical history and characteristics of the ongoing pregnancy.
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Affiliation(s)
| | - Ana Andrade
- Department of Women and Reproductive Medicine, Centro Hospitalar Universitário do Porto EPE Centro Materno-Infantil do Norte Dr Albino Aroso, Porto, Portugal
| | - Inês Nunes
- Department of Women and Reproductive Medicine, Centro Hospitalar Universitário do Porto EPE Centro Materno-Infantil do Norte Dr Albino Aroso, Porto, Portugal
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Lautarescu A, Victor S, Lau-Zhu A, Counsell SJ, Edwards AD, Craig MC. The factor structure of the Edinburgh Postnatal Depression Scale among perinatal high-risk and community samples in London. Arch Womens Ment Health 2022; 25:157-169. [PMID: 34244862 PMCID: PMC8784492 DOI: 10.1007/s00737-021-01153-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
Timely and accurate detection of perinatal mental health problems is essential for the wellbeing of both mother and child. Growing evidence has suggested that the Edinburgh Postnatal Depression Scale (EPDS) is not a unidimensional measure of perinatal depression, but can be used to screen for anxiety disorders. We aimed to assess the factor structure of the EPDS in 3 different groups of women: n = 266 pregnant women at high-risk of depression ("Perinatal Stress Study"), n = 471 pregnant women from a community sample, and n = 637 early postnatal women from a community sample ("developing Human Connectome Project"). Exploratory factor analysis (40% of each sample) and confirmatory factor analysis (60% of each sample) were performed. The relationship between EPDS scores and history of mental health concerns was investigated. Results suggested that a 3-factor model (depression, anxiety, and anhedonia) is the most appropriate across groups. The anxiety subscale (EPDS-3A) emerged consistently and was related to maternal history of anxiety disorders in the prenatal sample (W = 6861, p < 0.001). EPDS total score was related to history of mental health problems in both the prenatal (W = 12,185, p < 0.001) and postnatal samples (W = 30,044, p < 0.001). In both high-risk and community samples in the perinatal period, the EPDS appears to consist of depression, anxiety, and anhedonia subscales. A better understanding of the multifactorial structure of the EPDS can inform diagnosis and management of women in the prenatal and postnatal period. Further research is required to validate the EPDS-3A as a screening tool for anxiety.
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Affiliation(s)
- Alexandra Lautarescu
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, Westminster Bridge Road, London, SE1 7EH, UK. .,Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Suresh Victor
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, London, SE1 7EH UK
| | - Alex Lau-Zhu
- Oxford Institute of Clinical Psychology Training and Research, Medical Sciences Division, University of Oxford, Oxford, UK ,Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - Serena J. Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, London, SE1 7EH UK
| | - A. David Edwards
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, London, SE1 7EH UK
| | - Michael C. Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,National Female Hormone Clinic, South London and Maudsley National Health Service Foundation Trust, London, UK
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Eitenmüller P, Köhler S, Hirsch O, Christiansen H. The Impact of Prepartum Depression and Birth Experience on Postpartum Mother-Infant Bonding: A Longitudinal Path Analysis. Front Psychiatry 2022; 13:815822. [PMID: 35706472 PMCID: PMC9189288 DOI: 10.3389/fpsyt.2022.815822] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Negative effects of impaired postpartum mother-infant-bonding on mental health of mothers, their newborn children and subsequent child development are well documented. Previous research demonstrated an association between a negative birth experience and postpartum mental health affecting postpartum mother-infant bonding. This study investigates the extent to which prepartum depression and birth experience influence the postpartum mental health of mothers and their bonding toward their newborns, and whether these influences differ according to parity and self-reported prior mental health problems. METHOD Three hundred and fifty-four women (18-43 years; M = 30.13, SD = 5.10) filled in the Edinburgh Postnatal Depression Scale (EPDS), the Maternal-Fetal Attachment Scale (MFAS), Salmon's Item List (SIL) assessing the birth experience, and the Postpartum Bonding Questionnaire (PBQ) at pre- and postpartum; they were also asked about birth complications and parity status. RESULTS Primipara reported significantly more birth complications (p = 0.048), with path analysis confirming this result (p < 0.001). Birth complications were associated with a more negative rating of the overall birth experience (p < 0.001). Mothers with self-reported prior mental health problems had higher prepartum depression scores (p < 0.001) but did not differ in other variables from mothers without prior self-reported mental health problems. Differences in depression scores between mothers with self-reported prior mental health problems and those without vanished at postpartum assessment (p > 0.05). Path-analysis highlighted the key role of postpartum depression, which was the only significant predictor of postpartum impairment in maternal-child bonding (p < 0.001). Birth experience and prepartum depression scores exerted an indirect effect on postpartum maternal-child bonding, mediated by postpartum depression. DISCUSSION The present study demonstrates the relevance of prepartum mental health of expectant mothers, especially of those who self-report prior mental health problems. The results support that reducing mental health problems of pregnant mothers might contribute to a more positive birth experience and potentially reduce postpartum depressive symptoms. As postpartum depression is associated with impaired parent-child bonding, such targeted interventions could promote child development. Group differences between primiparous and multiparous mothers suggest that the birth experience may be an influential factor for postpartum mental health.
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Affiliation(s)
- Pia Eitenmüller
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Siegmund Köhler
- Department of Obstetrics and Gynecology, University of Giessen-Marburg, Marburg, Germany
| | - Oliver Hirsch
- Department of Psychology, FOM University of Applied Sciences, Siegen, Germany
| | - Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
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Reynolds KA, Pankratz L, Cameron EE, Roos LE, Giesbrecht GF, Lebel C, Tomfohr-Madsen LM. Pregnancy during the COVID-19 pandemic: a qualitative examination of ways of coping. Arch Womens Ment Health 2022; 25:1137-1148. [PMID: 36443483 PMCID: PMC9707189 DOI: 10.1007/s00737-022-01277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic and related public health restrictions have impacted the mental health and coping strategies of many population groups, including people who are pregnant. Our study sought to explore the ways that pregnant people described coping with stressors associated with the pandemic. N = 5879 pregnant individuals completed the pan-Canadian Pregnancy During the COVID-19 Pandemic Survey between April and December 2020. We used descriptive statistics to quantify sociodemographic characteristics and thematic analysis (Braun & Clarke, 2006, 2019) to analyze n = 3316 open-ended text responses to the question "Can you tell us what things you are doing to cope with the COVID-19 pandemic?" The average age of participants was 32 years (SD = 4.4), with the majority identifying as White (83.6%), female (99.7%), married (61.5%), having completed post-secondary education (90.0%), and working full-time (75.4%). We categorized participant responses into two overarching thematic dimensions: (1) ways of coping and (2) coping challenges. Ways of coping included the following main themes: (1) taking care of oneself, (2) connecting socially, (3) engaging in pandemic-specific coping strategies, (4) keeping busy, (5) taking care of others, (6) creating a sense of normalcy, (7) changing perspectives, and (8) practicing spirituality. Coping challenges included the following: (1) the perception of coping poorly, (2) loss of coping methods, (3) managing frontline or essential work, and (4) worries about the future. Findings highlight important implications for targeted prenatal supports delivered remotely, including opportunities for social support, prenatal care, and mental health strategies.
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Affiliation(s)
- Kristin A. Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba Canada ,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba Canada
| | - Lily Pankratz
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba Canada
| | - Emily E. Cameron
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba Canada
| | - Leslie E. Roos
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba Canada
| | - Gerald F. Giesbrecht
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta Canada
| | - Catherine Lebel
- Department of Radiology, University of Calgary, Calgary, Alberta Canada
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