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Græsholt-Knudsen T, Rask CU, Lucas S, Bech BH. Exploratory assessment of parental physical disease categories as predictors of documented physical child abuse. Eur J Pediatr 2024; 183:663-675. [PMID: 37955746 PMCID: PMC10912441 DOI: 10.1007/s00431-023-05317-1] [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: 04/17/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023]
Abstract
Improved prediction of physical child abuse could aid in developing preventive measures. Parental physical disease has been tested previously as a predictor of documented physical child abuse but in broad categories and with differing results. No prior studies have tested clinically recognizable categories of parental disease in a high-powered dataset. Using Danish registries, data on children and their parents from the years 1997-2018 were used to explore several parental physical disease categories' associations with documented physical child abuse. For each disease category, survival analysis using pseudovalues was applied. When a parent of a child was diagnosed or received medication that qualified for a category, this family and five comparison families not in this disease category were included, creating separate cohorts for each category of disease. Multiple analyses used samples drawn from 2,705,770 children. Estimates were produced for 32 categories of physical diseases. Using Bonferroni-corrected confidence intervals (CIc), ischemic heart disease showed a relative risk (RR) of 1.44 (CIc 1.13-1.84); peripheral artery occlusive disease, RR 1.39 (CIc 1.01-1.90); stroke, RR 1.19 (1.01-1.41); chronic pulmonary disease, RR 1.33 (CIc 1.18-1.51); ulcer/chronic gastritis, RR 1.27 (CIc 1.08-1.49); painful condition, 1.17 (CIc 1.00-1.37); epilepsy, RR 1.24 (CIc 1.00-1.52); and unspecific somatic symptoms, RR 1.37 (CIc 1.21-1.55). Unspecific somatic symptoms were present in 71.87% of families at some point during the study period. CONCLUSION Most parental physical disease categories did not show statistically significant associations, but some showed predictive ability. Further research is needed to explore preventive potential. WHAT IS KNOWN • Few and broad categories of parental physical disease have been examined as risk factors for severe physical child abuse; no prior study has used several categories as predictors. WHAT IS NEW • Unspecific symptoms, ischemic heart disease, peripheral artery occlusive disease, stroke, chronic pulmonary disease, stomach ulcer/chronic gastritis, painful condition, and epilepsy all showed to be potential predictors, with unspecific symptoms being the most prevalent.
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Affiliation(s)
- Troels Græsholt-Knudsen
- Research Unit for Mental Public Health, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul Jensens Boulevard 175, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Olof Palmes Allé 43, 8200, Aarhus N, Denmark
| | - Steven Lucas
- Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
| | - Bodil Hammer Bech
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
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Behboudi-Gandevani S, Bidhendi-Yarandi R, Hossein Panahi M, Mardani A, Prinds C, Vaismoradi M, Glarcher M. Prevalence of preterm birth in Scandinavian countries: a systematic review and meta-analysis. J Int Med Res 2023; 51:3000605231203843. [PMID: 37843530 PMCID: PMC10683576 DOI: 10.1177/03000605231203843] [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: 11/04/2022] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES As welfare societies, Scandinavian countries share characteristics of equality related to healthcare access, gender, and social services. However, cultural and lifestyle variations create country-specific health differences. This meta-analysis assessed the prevalence of preterm birth (PTB) and its categories in Scandinavian countries. METHODS A systematic search in key databases of literature published between 1990 and 2021 identified studies of the prevalence of PTB and its categories. Following the use of the Freeman-Tukey double arcsine transformation, a meta-analysis of weighted data was performed using the random-effects model and meta-prop method. RESULTS We identified 109 observational studies that involved 86,420,188 live births. The overall pooled prevalence (PP) of PTB was 5.3% (PP = 5.3%, 95% confidence interval [CI] 5.1%, 5.5%). The highest prevalence was in Norway (PP = 6.2%, 95% CI 5.3%, 7.0%), followed by Sweden (PP = 5.3%, 95% CI 5.1%, 5.4%), Denmark (PP = 5.2%, 95% CI 4.9%, 5.3%), and Iceland (PP = 5.0%, 95% CI 4.4%, 5.7%). Finland had the lowest PTB rate (PP = 4.9%, 95% CI 4.7%, 5.1%). CONCLUSIONS The overall PP of PTB was 5.3%, with small variations among countries (4.9%-6.2%). The highest and lowest PPs of PTB were in Norway and Finland, respectively.
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Affiliation(s)
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics and Epidemiology, School of Social Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hossein Panahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Christina Prinds
- Department of Clinical Research, University South Denmark, Odense, Denmark; Department of Women’s Health, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
| | - Manela Glarcher
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
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3
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Reilly TJ, Roberts E, Sagnay De La Bastida VC, McGuire P, Dazzan P, Cullen AE. Systematic review of the association between adverse life events and the onset and relapse of postpartum psychosis. Front Psychiatry 2023; 14:1154557. [PMID: 37139317 PMCID: PMC10149966 DOI: 10.3389/fpsyt.2023.1154557] [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: 01/30/2023] [Accepted: 03/16/2023] [Indexed: 05/05/2023] Open
Abstract
Postpartum psychosis is defined as a psychotic episode occurring within 4 to 6 weeks of childbirth. While there is robust evidence that adverse life events are associated with the onset and relapse of psychosis outside the postpartum period, the extent to which these contribute to postpartum psychosis is less clear. This systematic review examined whether adverse life events are associated with an increased likelihood of developing postpartum psychosis or subsequent relapse in women diagnosed with postpartum psychosis. The following databases were searched from inception to June 2021: MEDLINE, EMBASE, PsycInfo. Study level data were extracted including setting, number of participants, type of adverse event, and differences between groups. A modified version of the Newcastle-Ottawa Quality Assessments Scale was used to assess risk of bias. In total, 1933 records were identified, of which 17 met the inclusion criteria, comprising nine case-control studies and eight cohort studies. Most studies (16/17) examined the association between adverse life events and the onset of postpartum psychosis, with only in which the outcome was relapse of psychosis. Overall, there were 63 different measures of adversity examined (most of which were examined in a single study only) and 87 associations between these measures and postpartum psychosis tested across the studies. In terms of statistically significant associations with onset/relapse of postpartum psychosis, 15 (17%) were positive (i.e., the adverse event increased the risk of onset/relapse), 4 (5%) were negative, and 68 (78%) were not statistically significant. Our review highlights the diversity of risk factors examined in this field, with few attempts at replication, hence limiting the ability to conclude that any single risk factor is robustly associated with the onset of postpartum psychosis. Further large-scale studies, that attempt to replicate earlier studies, are urgently needed to determine whether adverse life events play a role in the onset and exacerbation of postpartum psychosis. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=260592], identifier [CRD42021260592].
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Affiliation(s)
- Thomas J. Reilly
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Emma Roberts
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | | | - Philip McGuire
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Alexis E. Cullen
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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4
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Nguyen K, Mukona LT, Nalbandyan L, Yar N, St. Fleur G, Mukona L, Hernandez E, Lamberty N. Peripartum Complications as Risk Factors for Postpartum Psychosis: A Systemic Review. Cureus 2022; 14:e29224. [PMID: 36159350 PMCID: PMC9495292 DOI: 10.7759/cureus.29224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 11/08/2022] Open
Abstract
The aim of this research paper is to conduct a systematic review of periparturient complications as risk factors of postpartum psychosis. The investigation of risk factors for maternal psychosis following childbirth is complicated by the risk of confounding by a previous psychiatric history; therefore, this systematic review focuses on labor complications as risk factors among women without any previous psychiatric hospitalizations or diagnoses. Articles were collected and analyzed from the PubMed, MEDLINE, and Cochrane Review Library databases, as well as Clinicaltrials.gov, in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Article abstracts and article titles of the identified publications were screened independently by all seven authors, and studies were selected if they met the following inclusion criteria: patients were diagnosed with postpartum psychosis per the guidelines in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V), DSM-IV or World Health Organization’s ICD-10 Classification of Mental and Behavioral Disorders; patients presented with no prior psychiatric diagnoses, hospitalizations or history; and the study evaluated the association of periparturient complications to first-onset postpartum psychosis, excluding narrative reviews, systematic reviews, or meta-analyses. Fifteen case-control, cohort, and case report studies, with thousands of patients, were selected to investigate the correlation between perinatal complications and first-onset post-partum psychosis. Obstetric complications during childbirth significantly predisposed for postpartum psychosis in certain individual studies but did not reveal an association in others. More studies must be implemented to elaborate on this limited scope.
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Perry A, Gordon-Smith K, Jones L, Jones I. Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review. Brain Sci 2021; 11:brainsci11010047. [PMID: 33406713 PMCID: PMC7824357 DOI: 10.3390/brainsci11010047] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/18/2020] [Accepted: 12/27/2020] [Indexed: 11/16/2022] Open
Abstract
Postpartum psychoses are a severe form of postnatal mood disorders, affecting 1–2 in every 1000 deliveries. These episodes typically present as acute mania or depression with psychosis within the first few weeks of childbirth, which, as life-threatening psychiatric emergencies, can have a significant adverse impact on the mother, baby and wider family. The nosological status of postpartum psychosis remains contentious; however, evidence indicates most episodes to be manifestations of bipolar disorder and a vulnerability to a puerperal trigger. While childbirth appears to be a potent trigger of severe mood disorders, the precise mechanisms by which postpartum psychosis occurs are poorly understood. This review examines the current evidence with respect to potential aetiology and childbirth-related triggers of postpartum psychosis. Findings to date have implicated neurobiological factors, such as hormones, immunological dysregulation, circadian rhythm disruption and genetics, to be important in the pathogenesis of this disorder. Prediction models, informed by prospective cohort studies of high-risk women, are required to identify those at greatest risk of postpartum psychosis.
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Affiliation(s)
- Amy Perry
- Psychological Medicine, University of Worcester, Worcester WR2 6AJ, UK; (K.G.-S.); (L.J.)
- Correspondence:
| | - Katherine Gordon-Smith
- Psychological Medicine, University of Worcester, Worcester WR2 6AJ, UK; (K.G.-S.); (L.J.)
| | - Lisa Jones
- Psychological Medicine, University of Worcester, Worcester WR2 6AJ, UK; (K.G.-S.); (L.J.)
| | - Ian Jones
- National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff CF24 4HQ, UK;
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Warselius P, Cnattingius S, Li J, Wei D, Valdimarsdottir UA, Kosidou K, Reutfors J, Olsen J, Vestergaard M, Obel C, László KD. Maternal bereavement shortly before or during pregnancy and risk of postpartum psychotic illness: a population-based study from Denmark and Sweden. Clin Epidemiol 2019; 11:285-298. [PMID: 31118817 PMCID: PMC6500870 DOI: 10.2147/clep.s195741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/27/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose: Postpartum psychosis is a rare but severe complication following childbirth, with unknown etiology. This study investigated whether the death of a close family member — a source of severe stress — the year before or during pregnancy was associated with an increased risk of psychotic illness in the postpartum period among women without and with a history of psychiatric disorder. Methods: We studied live births in Denmark during 1978–2008 and births in Sweden during 1973–2006 (n=5,246,978). Information on death of women’s relatives and partners and sociodemographic, health-, and pregnancy-related factors was obtained through linkage with nationwide registries. Results: The death of a close relative the year before or during pregnancy was not associated with psychotic illness during the first 90 days postpartum among women without (adjusted HR 1.02, 95% CI 0.76–1.37) or with a history of psychiatric disorder (HR 0.96, 95% CI 0.74–1.25). Similarly, there was no association between bereavement and risk of postpartum psychosis according to the timing of the loss (the year before or during pregnancy), the relative’s cause of death (natural or unnatural), or the woman’s relationship to the deceased (parent/sibling or partner/older child). Conclusions: Death of a close relative, one of the most severe sources of stress, before or during pregnancy was not associated with postpartum psychosis. Therefore, these data do not support the hypothesis that severely stressful life events, such as bereavement around the time of pregnancy, are associated with postpartum psychosis.
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Affiliation(s)
- Pauline Warselius
- Department of Medicine Solna, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Sven Cnattingius
- Department of Medicine Solna, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Dang Wei
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Unnur Anna Valdimarsdottir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Kyriaki Kosidou
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County's Health Care District, Stockholm, Sweden
| | - Johan Reutfors
- Department of Medicine Solna, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.,Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA
| | - Mogens Vestergaard
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Research Unit and Section for General Practice, Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Carsten Obel
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Research Unit and Section for General Practice, Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Krisztina D László
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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7
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VanderKruik R, Barreix M, Chou D, Allen T, Say L, Cohen LS. The global prevalence of postpartum psychosis: a systematic review. BMC Psychiatry 2017; 17:272. [PMID: 28754094 PMCID: PMC5534064 DOI: 10.1186/s12888-017-1427-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/13/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Mental health is a significant contributor to global burden of disease and the consequences of perinatal psychiatric morbidity can be substantial. We aimed to obtain global estimates of puerperal psychosis prevalence based on population-based samples and to understand how postpartum psychosis is assessed and captured among included studies. METHODS In June 2014, we searched PubMed, CiNAHL, EMBASE, PsycINFO, Sociological Collections, and Global Index Medicus for publications since the year 1990. Criteria for inclusion in the systematic review were: use of primary data relevant to pre-defined mental health conditions, specified dates of data collection, limited to data from 1990 onwards, sample size >200 and a clear description of methodology. Data were extracted from published peer reviewed articles. RESULTS The search yielded 24,273 publications, of which six studies met the criteria. Five studies reported incidence of puerperal psychosis (ranging from 0.89 to 2.6 in 1000 women) and one reported prevalence of psychosis (5 in 1000). Due to the heterogeneity of methodologies used across studies in definitions and assessments used to identify cases, data was not pooled to calculate a global estimate of risk. CONCLUSIONS This review confirms the relatively low rate of puerperal psychosis; yet given the potential for serious consequences, this morbidity is significant from a global public health perspective. Further attention to consistent detection of puerperal psychosis can help provide appropriate treatment to prevent harmful consequences for both mother and baby.
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Affiliation(s)
- Rachel VanderKruik
- Department of Psychology and Neuroscience, University of Colorado, Boulder, 345 UCB Muenzinger, Office D314D, Boulder, CO 80309 USA
| | - Maria Barreix
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Doris Chou
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Tomas Allen
- Department of Strategy, Policy and Information (SPI), World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Lale Say
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Lee S. Cohen
- Center for Women’s Mental Health, Perinatal and Reproductive Psychiatry Clinical Research Program, Massachusetts General Hospital, Simches Research Building, 185 Cambridge St Suite 2200, Boston, MA 02114 USA
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8
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Upadhyaya SK, Sharma A, Raval CM. Postpartum psychosis: risk factors identification. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:274-7. [PMID: 25006563 PMCID: PMC4083529 DOI: 10.4103/1947-2714.134373] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A better understanding of risk factors associated with postpartum psychosis may contribute to the better management. AIMS This study was to identify the risk factors contributing to postpartum psychosis. MATERIALS AND METHODS In this cross-sectional, case control study 100 patients of postpartum psychosis (PP) were compared with the healthy controls. Risk factors explored were sociodemographic factors (age, education, occupation, income, and family type); positive family history; pregnancy and perinatal factors (number of antenatal check-up, parity, and complications during pregnancy, perinatal phase or in newborn); and presence of husband during peripartum period. Data were analyzed by graph pad instat software using chi square test and Fisher's exact test. RESULTS Total of 64% patients and 42% controls were less than 25 years of age (P = 0.001). Among the patients, 62% were primiparae compared with 46% in the controls (P = 0.02). Per capita family income was less than 5000 INR in 72% patients and 56% controls (P = 0.01). Maternal complications during perinatal period were observed in 38% patients and 22% controls (P = 0.01), while the complications in newborns were seen in 21% patients and 8% controls (P = 0.009). Husband was present in 58% patients and 76% controls. (P = 0.006). CONCLUSIONS The risk factors related to PP were younger age, lower per capita income, perinatal and neonatal complications, and absence of husband in peripartum phase.
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Affiliation(s)
- Suneet Kumar Upadhyaya
- Department of Psychiatry, Gujarat Medical Education and Research Society Medical College, Patan, Gujarat, India
| | - Archana Sharma
- Department of Obstetrics and Gynecology, Gujarat Medical Education and Research Society Medical College, Patan, Gujarat, India
| | - Chintan M Raval
- Department of Psychiatry, Gujarat Medical Education and Research Society Medical College, Patan, Gujarat, India
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9
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Engqvist I, Nilsson K. The Recovery Process of Postpartum Psychosis from Both the Woman's and Next of Kin's Perspective - An Interview Study in Sweden. Open Nurs J 2014; 8:8-16. [PMID: 24660040 PMCID: PMC3960751 DOI: 10.2174/1874434601408010008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 01/11/2014] [Accepted: 01/13/2014] [Indexed: 01/27/2023] Open
Abstract
Objectives: The most serious type of psychiatric disorder in connection with childbirth is postpartum
psychosis. With this disorder occasionally follows emotional rejection of the infant which has serious long term effect on
mother and child. The aim of this study was to explore the experiences of the recovery process of postpartum psychosis
from the women, from the partners of the women, and their next of kin. Methods: Interviews were conducted with seven women, who had previously suffered postpartum psychosis, and six of
their next of kin. The interviews were transcribed verbatim and analysed using content analysis. Results: Two categories emerged: the recovery process and the circumstances of the support provided. The women and
their next of kin spoke about the turning point in the illness, their own personal as well as their social recovery, the
importance of support not only from relatives and friends, but also from professionals, and the use of medication.
However, the key to recovery was an internal decision by the women themselves. Conclusion: Conclusion is that the recovery from this severe mental disorder requires hard work and the key to their
recovery was the decision made by the women. This disorder causes a mental darkness to descend, but at the start of the
recovery a dim light shines in the dark tunnel. The nursing staff must be made aware that good sleep is important for the
psychiatric treatment and that recovery may take a long time. The nurse needs to provide hope and encouragement, as
well as help the woman to recognise the strength that exists within her. To reduce the risk of a recurrence of the disorder,
the staff needs to offer follow up visits.
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Affiliation(s)
- I Engqvist
- School of Life Science, University of Skövde, Sweden ; Skaraborg Hospitals, Falköping, Sweden
| | - K Nilsson
- Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden
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10
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Carlsson IM, Ziegert K, Nissen E. Psychometric properties of the Swedish childbirth self-efficacy inventory (Swe-CBSEI). BMC Pregnancy Childbirth 2014; 14:1. [PMID: 24383788 PMCID: PMC3893383 DOI: 10.1186/1471-2393-14-1] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has reported that women who are admitted to delivery wards in early labour process before an active stage of labour has started run an increased risk of instrumental deliveries. Therefore, it is essential to focus on factors such as self-efficacy that can enhance a woman's own ability to cope with the first stage of labour. However, there was no Swedish instrument measuring childbirth self-efficacy available. Thus, the aim of the study was to translate the Childbirth Self-efficacy Inventory and to psychometrically test the Swedish version on first- time mothers within the Swedish culture. METHODS The method included a forward-backward translation with face and content validity. The psychometric properties were evaluated using a Principal Component Analysis and by using Cronbach's alpha coefficient and inter-item correlations. Descriptive statistics and non-parametric tests were used to describe and compare the scales. All data were collected from January 2011 to June 2012, from 406 pregnant women during the gestational week 35-42. RESULTS The Swedish version of the Childbirth Self-Efficacy Inventory indicated good reliability and the Principal Component Analysis showed a three-component structure. The Wilcoxon Signed-Ranks Test indicated that the women could differentiate between the concepts outcome expectancy and self-efficacy expectancy and between the two labour stages, active stage and the second stage of labour. CONCLUSIONS The Swedish version of Childbirth Self-efficacy Inventory is a reliable and valid instrument. The inventory can act as a tool to identify those women who need extra support and to evaluate the efforts of improving women's self-efficacy during pregnancy.
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Affiliation(s)
- Ing-Marie Carlsson
- Department of Women's and Children's health at Karolinska Institutet, SE-171 77 Stockholm, Sweden.
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11
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Blackmore ER, Rubinow DR, O’Connor TG, Liu X, Tang W, Craddock N, Jones I. Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis. Bipolar Disord 2013; 15:394-404. [PMID: 23651079 PMCID: PMC3740048 DOI: 10.1111/bdi.12071] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 01/12/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Women who experience postpartum psychosis (PP) seek guidance on further pregnancies and risk of illness; however, empirical data are limited. This study describes reproductive and mental health outcomes in women diagnosed with PP and examines clinical risk factors as predictors of further illness. METHODS A retrospective cohort design was used; 116 women who experienced episodes of mania or depression with psychotic features within six weeks of childbirth were recruited. All subjects underwent clinical diagnostic interviews and medical case notes were reviewed. RESULTS Only 33% of women had an antecedent history, of which 34% had bipolar disorder and 55% unipolar depression. Only 58% of those with PP in their first pregnancy had a subsequent pregnancy, and 18% of marriages ended following the PP episode. Clinical presentation at the time of initial episode did not influence the timing of the onset of symptoms, treatment, or recovery. Although 86% of patients received treatment within 30 days of onset, 26% of women reported ongoing symptoms at a year after delivery. The recurrence rate of PP was 54.4%; a longer duration of the index episode (p < 0.05) and longer latency between the index PP and next pregnancy predicted a subsequent PP. The rate of subsequent non-puerperal episodes was 69%, and all these episodes were bipolar. CONCLUSIONS Postpartum psychosis is difficult to predict in women with no antecedent history and is associated with a high rate of subsequent puerperal and non-puerperal illness. Risk of further illness needs to be conveyed in order to allow fully informed decisions to be made regarding future pregnancies.
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Affiliation(s)
- Emma Robertson Blackmore
- Departments of Psychiatry and Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - David R Rubinow
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas G O’Connor
- Departments of Psychiatry and Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Xiang Liu
- Departments of Psychiatry and Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Wan Tang
- Departments of Psychiatry and Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY
| | - Nick Craddock
- Department of Psychological Medicine, Cardiff University, Cardiff, UK
| | - Ian Jones
- Department of Psychological Medicine, Cardiff University, Cardiff, UK
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Hellerstedt WL, Phelan SM, Cnattingius S, Hultman CM, Harlow BL. Are prenatal, obstetric, and infant complications associated with postpartum psychosis among women with pre-conception psychiatric hospitalisations? BJOG 2012. [PMID: 23194279 DOI: 10.1111/1471-0528.12073] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine the associations of maternal and infant complications with postpartum hospitalisation for psychosis in women with a pre-conception history of psychiatric hospitalisation. DESIGN Population-based study. SETTING Swedish medical birth register. POPULATION Primiparous women who gave birth between 1 January 1987 and 31 December 2001, and who had a pre-conception history of psychiatric hospitalisation but who were not hospitalised during pregnancy (n = 1842). METHODS International Classification of Diseases (ICD) codes were used to identify prenatal, obstetric, postpartum maternal complications, and newborn health conditions. We used multivariable logistic regression to describe the associations between maternal and infant health conditions and the odds for postpartum hospitalisation for psychosis. MAIN OUTCOME MEASURE Psychiatric hospitalisation within 90 days of delivery. RESULTS Compared with women who did not have a postpartum psychiatric hospitalisation, hospitalised women were at 2.3 times higher odds (95% CI 1.0-4.9) of having non-psychiatric puerperium complications (e.g. infection, lactation problems or venous complications). No other maternal complications were associated with postpartum psychiatric hospitalisation. Although their infants were at no higher odds for health complications, the offspring of women who had a postpartum psychiatric hospitalisation were at 4.1 times higher odds (95% CI 1.3-12.6) of death within the first 365 days of life than those of women who were not hospitalised. CONCLUSIONS We found no prenatal indicators of postpartum risk for psychiatric hospitalisation among high-risk women, but they had higher odds of postpartum pregnancy-related medical problems and, rarely, offspring death.
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Affiliation(s)
- W L Hellerstedt
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA.
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Posmontier B. The Role of Midwives in Facilitating Recovery in Postpartum Psychosis. J Midwifery Womens Health 2011; 55:430-7. [DOI: 10.1016/j.jmwh.2010.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 02/16/2010] [Accepted: 02/16/2010] [Indexed: 11/26/2022]
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