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Su X, Sun L. Prevalence and associated factors of abortion among women with severe mental disorders. J Affect Disord 2024; 355:432-439. [PMID: 38548200 DOI: 10.1016/j.jad.2024.03.116] [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: 11/20/2023] [Revised: 02/23/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Abortion behaviors among individuals with mental disorders presented major obstacles to women's health. However, few studies reported the prevalence and associated factors of abortion among women with severe mental disorders in China. Consequently, this study aims to investigate the prevalence of abortion among female patients in rural communities and identify potential health risks. METHOD This was a cross-sectional study of 276 women aged 18 years and older with severe mental disorders in rural areas of Shandong Province, China. The pregnancy history, abortion history and socio-demographic characteristics of women were investigated by questionnaire. Logistic regression analysis was employed to examine the associated factors for different abortion behaviors. RESULT The study showed that 82.61 % (228/276) of patients had a pregnancy history. Among the patients with a pregnancy history, 43.42 % (99/228) reported having had at least one abortion, and 15.79 % (36/228) had more than one. In the other side, 31.58 % (72/228) of them experienced spontaneous abortion, while 12.72 % (29/228) experienced induced abortion. Age at first gestation (aOR 0.80, 95 % CI 0.70-0.90) and age at last gestation (aOR 1.17, 95 % CI 1.07-1.27) were both associated with abortion. Anxiety was related to spontaneous (aOR 1.08, 95 % CI 1.02-1.15) and repeat abortions (aOR 1.10, 95 % CI 1.01-1.19). In addition, religion (aOR 10.47, 95 % CI 2.81-39.01), number of children≥2 (aOR 0.18, 95 % CI 0.04-0.77), and family functioning (aOR 1.31, 95 % CI 1.06-1.63) were associated with induced abortion. CONCLUSION Women with severe mental disorders in rural regions have notably higher rates of abortion compared to the general female population, particularly for spontaneous abortions. Gestational age and anxiety of pregnant patients deserve attention and preventive measures to avoid the outcomes of abortion.
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Affiliation(s)
- Xiaoying Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; National Health Commission of China (NHC), Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan 250012, China
| | - Long Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; National Health Commission of China (NHC), Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan 250012, China.
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Aymerich C, Pedruzo B, Salazar de Pablo G, Madaria L, Goena J, Sanchez-Gistau V, Fusar-Poli P, McGuire P, González-Torres MÁ, Catalan A. Sexually transmitted infections, sexual life and risk behaviours of people living with schizophrenia: systematic review and meta-analysis. BJPsych Open 2024; 10:e110. [PMID: 38725352 PMCID: PMC11094452 DOI: 10.1192/bjo.2024.49] [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: 11/10/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs), along with sexual health and behaviour, have received little attention in schizophrenia patients. AIMS To systematically review and meta-analytically characterise the prevalence of STIs and sexual risk behaviours among schizophrenia patients. METHOD Web of Science, PubMed, BIOSIS, KCI-Korean Journal Database, MEDLINE, Russian Science Citation Index, SciELO and Cochrane Central Register were systematically searched from inception to 6 July 2023. Studies reporting on the prevalence or odds ratio of any STI or any outcome related to sexual risk behaviours among schizophrenia samples were included. PRISMA/MOOSE-compliant (CRD42023443602) random-effects meta-analyses were used for the selected outcomes. Q-statistics, I2 index, sensitivity analyses and meta-regressions were used. Study quality and publication bias were assessed. RESULTS Forty-eight studies (N = 2 459 456) reporting on STI prevalence (including 15 allowing for calculation of an odds ratio) and 33 studies (N = 4255) reporting on sexual risk behaviours were included. Schizophrenia samples showed a high prevalence of STIs and higher risks of HIV (odds ratio = 2.11; 95% CI 1.23-3.63), hepatitis C virus (HCV, odds ratio = 4.54; 95% CI 2.15-961) and hepatitis B virus (HBV; odds ratio = 2.42; 95% CI 1.95-3.01) infections than healthy controls. HIV prevalence was higher in Africa compared with other continents and in in-patient (rather than out-patient) settings. Finally, 37.7% (95% CI 31.5-44.4%) of patients were sexually active; 35.0% (95% CI 6.6-59.3%) reported consistent condom use, and 55.3% (95% CI 25.0-82.4%) maintained unprotected sexual relationships. CONCLUSIONS Schizophrenia patients have high prevalence of STIs, with several-fold increased risks of HIV, HBV and HCV infection compared with the general population. Sexual health must be considered as an integral component of care.
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Affiliation(s)
- Claudia Aymerich
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain; Biobizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain; and Neuroscience Department, University of the Basque Country, Leioa, Spain
| | - Borja Pedruzo
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Gonzalo Salazar de Pablo
- Child and Adolescent Mental Health Services, South London and the Maudsley NHS Foundation Trust, London, UK; Institute of Psychiatry and Mental Health. Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERSAM, Madrid, Spain; and Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Lander Madaria
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain; and Biobizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao, Spain
| | - Javier Goena
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain
| | - Vanessa Sanchez-Gistau
- Early Intervention in Psychosis Service, Hospital Universitari Institut Pere Mata, IISPV-CERCA, CIBERSAM, ISCIII, Universitat Rovira i Virgili, Reus, Spain
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; OASIS Service, South London and Maudsley National Health Service Foundation Trust, London, UK; and National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK; and NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Miguel Ángel González-Torres
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain; Biobizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao, Spain; CIBERSAM, Madrid, Spain; and Neuroscience Department, University of the Basque Country, Leioa, Spain
| | - Ana Catalan
- Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain; Biobizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao, Spain; CIBERSAM, Madrid, Spain; Neuroscience Department, University of the Basque Country, Leioa, Spain; Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; and Department of Psychiatry, University of Oxford, Oxford, UK
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Sun W, Wu X, Yang H, Yuan S, Chen J, Fang Y, Zhang X. Identifying causal associations between women's reproductive traits and risk of schizophrenia: a multivariate validated two-sample Mendelian randomization analysis. BMC Psychiatry 2024; 24:161. [PMID: 38395764 PMCID: PMC10893634 DOI: 10.1186/s12888-024-05614-5] [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: 08/31/2023] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND A significant association between women's reproductive traits and the risk of schizophrenia (SCZ) has been discovered, but the causalities remain unclear. We designed a two-sample univariate Mendelian randomization (MR) study using female-specific SNPs collected from a large-scale genome-wide association study as a genetic tool to explore the causal effect of female reproductive traits on the risk of SCZ, and conducted a multivariate MR study to re-validate the above findings. METHODS From extensive genome-wide association studies (GWAS) of people with European ancestry (n = 176,881 to 418,758 individuals), summary-level data on five female reproductive variables were extracted. Summary-level information on SCZ was taken from a GWAS meta-analysis involving 320,404 people with European ancestry. The inverse variance weighting estimations for both univariable MR (UVMR) and multivariable MR (MVMR) were presented as the primary results. MR-Egger, weighted median, simple mode, and weighted mode regression methods for UVMR, and MVMR-Egger, MVMR-Lasso, and MVMR-median methods for MVMR were used for sensitivity analyses. RESULTS The UVMR produced compelling proof for a connection between genetically predicted later age at first sexual intercourse (AFS) (OR, 0.632; 95% CI, 0.512-0.777; P < 0.01) and decreased SCZ risk. Pleiotropy analysis of the AFS-SCZ association confirmed the robustness of the MR results (P > 0.05). Consistent, substantial causal effects of AFS (OR, 0.592; 95%CI, 0.407-0.862; P < 0.01) on the risk of SCZ were demonstrated after adjusting for body mass index, years of schooling, and smoking initiation using MVMR. CONCLUSIONS Our findings provide convincing evidence that early AFS is a risk factor for SCZ. SCZ risk may be decreased by raising awareness of reproductive healthcare for women.
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Affiliation(s)
- Wenxi Sun
- Suzhou Guangji Hospital, Suzhou, Jiangsu Province; Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Xiaohui Wu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Haidong Yang
- Department of Psychiatry, The Fourth People's Hospital of Lianyungang, The Affiliated KangDa College of Nanjing Medical University, Lianyungang, 222003, People's Republic of China
| | - Shiting Yuan
- Suzhou Guangji Hospital, Suzhou, Jiangsu Province; Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China
| | - Jun Chen
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yiru Fang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
- Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, Suzhou, Jiangsu Province; Affiliated Guangji Hospital of Soochow University, Suzhou, 215137, Jiangsu Province, China.
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Liu J, Dong Y, Wang X, Sun H, Huang J, Tang Z, Sun H. Association of spontaneous abortion with bipolar disorder and major depression based on inverse probability treatment weighting of multigroup propensity scores: Evidence from the UK Biobank. J Affect Disord 2024; 347:453-462. [PMID: 38065472 DOI: 10.1016/j.jad.2023.12.003] [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: 08/30/2023] [Revised: 11/20/2023] [Accepted: 12/02/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Few studies have explored the association between the number of SAs and bipolar disorder and major depression (BDMD). This study aims to investigate the association between SA and BDMD, and the possible dose-response relationship between them. METHODS We conducted a cross-sectional study of 13,200 female UK Biobank participants. Participants were classified into BDMD and no-BDMD groups based on their BDMD status. The number of SAs was grouped into non-SA, occasional SA (OSA), and recurrent SA (RSA). Baseline characteristics of the three groups were balanced using inverse probability treatment weighting (IPTW) based on propensity scores. The three-knots restricted cubic spline regression model was utilized to assess the dose-response relationship between the number of SAs and BDMD. RESULTS The IPTW-adjusted multivariate logistic regression revealed that SA was an independent risk factor for BDMD, with adjusted OR of 1.12 (95 % CI: 1.07-1.19) and 1.32 (95 % CI: 1.25-1.40) in the OSA and RSA groups, respectively. The strength of this association amplified as the number of SAs (P for trend <0.001). There was a nonlinear relationship between the number of SAs and the risk of BDMD, with an approximately inverted L-shaped curve. LIMITATIONS The information of the SA and BDMD status relied on self-reported by volunteers, and the study sample was mostly of European descent. CONCLUSIONS Women who reported experiencing multiple SAs are more likely to have BDMD. Therefore, it is imperative to provide psychological care and interventions for women in the postpartum period.
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Affiliation(s)
- Jingfang Liu
- Department of Gynecology and Obstetrics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215123, PR China
| | - Yongfei Dong
- Department of Biostatistics, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu 215123, PR China
| | - Xichao Wang
- Department of Biostatistics, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu 215123, PR China
| | - Hao Sun
- Department of Biostatistics, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu 215123, PR China
| | - Jie Huang
- Department of Biostatistics, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu 215123, PR China
| | - Zaixiang Tang
- Department of Biostatistics, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu 215123, PR China.
| | - Hongpeng Sun
- Department of Biostatistics, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, Jiangsu 215123, PR China.
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Galvin LJ, Nel YM. Contraceptive use in women with mental illness in Soweto, South Africa. S Afr J Psychiatr 2024; 30:2153. [PMID: 38322177 PMCID: PMC10839196 DOI: 10.4102/sajpsychiatry.v30i0.2153] [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: 07/23/2023] [Accepted: 11/28/2023] [Indexed: 02/08/2024] Open
Abstract
Background The psychosocial and medical implications of unplanned pregnancy in women with mental illness (MI) are vast. International guidelines make clear recommendations about family planning for women with MI, particularly those exposed to known human teratogens; however, there is limited research related to contraceptive usage among women with MI. Aim The aim of this study was to investigate the prevalence of consistent contraceptive use and family planning education (FPE) among a population of women of childbearing age with MI. Setting This quantitative cross-sectional study was conducted at Chris Hani Baragwanath psychiatric unit in Soweto, South Africa. Methods A convenience sample comprising 190 eligible women of childbearing age with MI was employed for the study. The women were invited to participate by means of a structured questionnaire which was administered by the researcher. Clinical information was obtained from the patients' medical records. Results Consistent contraceptive usage occurred in 44.7% of participants. Family planning education was low (26.8%). Relationship status was associated with using contraception consistently (p = 0.0229). Teratogen exposure was not associated with either contraceptive use or FPE. Family planning education was not associated with contraceptive use. Conclusion Women with MI may have increased risk for unplanned pregnancy if they are not in a relationship because of perceived lack of need for contraception. Contribution Family planning education must be prioritised in women with MI, especially among women prescribed teratogenic medication, highlighting the risks associated with unplanned pregnancy.
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Affiliation(s)
- Lisa J Galvin
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Perinatal HIV Research Unit, Wits Health Consortium, University of the Witwatersrand, Johannesburg, South Africa
| | - Yvette M Nel
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Vijayalakshmi S, Rajagopal K, Govindan R, Ganjekar S, Prathyusha PV, Chacko LK. Sexual and reproductive health problems among women with mental illness attending tertiary care psychiatric outpatient clinic in India: A cross-sectional study. J Neurosci Rural Pract 2023; 14:644-649. [PMID: 38059232 PMCID: PMC10696317 DOI: 10.25259/jnrp_62_2023] [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: 02/06/2023] [Accepted: 06/29/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Sexual and reproductive health (SRH) is a vital concern among women with mental illness (WMI) due to the increased risk for unplanned pregnancy, sexually transmitted infections (STIs), and poor obstetric outcomes. Objective of the study was to explore the current use of family planning (FP) methods, symptoms of STIs and sexual dysfunction among WMI. Materials and Methods This descriptive study involved 404 WMI of reproductive age (18-49 years) attending tertiary care psychiatric outpatient clinics in India. During face-to-face interviews, centers for disease control and prevention (CDC)-reproductive health assessment toolkit-FP questionnaire, STI questionnaire and Female sexual function index (FSFI) were used to collect the data. Results Of 404 WMI, 261(64.6%) were users, and 137 (33.9%) were non-users of FP methods. About 6(1.5%) WMI did not respond FP methods question. Female sterilization was the highest among the users, 244(93%). Among non-users, 100 (73%) were unaware of choosing the effective method of FP. Most of the WMI, 377(93.3%), were unaware of STIs. The symptoms of STI reported include unusual genital discharge 62(15.3%) and genital ulcers/ sores 58(14.4 %). Most of them, 76(63.3%), were not on any treatment. The most common reason for not taking treatment was feeling ashamed 70(92.1%). Female sexual dysfunction was reported in 176(43.6%). Most of the WMI had difficulties in the arousal domain 288(71.3%), followed by low desire 233(57.7%) and dissatisfaction 186(46%). Conclusion Most WMI underwent sterilization. Non-users of FP methods were not aware of choosing the effective method. Awareness about STIs was poor, and feeling ashamed was the primary reason for not availing of medical help. Nearly half of the WMI reported sexual dysfunction, among which arousal difficulties, low desire and dissatisfaction were common. Health professionals need to increase awareness about FP methods and symptoms of STIs among WMIs. Women require appropriate counselling regarding SRH and treatment for sexual dysfunction.
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Affiliation(s)
- Sundaram Vijayalakshmi
- College of Nursing, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kaipangala Rajagopal
- Department of Obstetrics and Gynaecology, Kanachur Institute of Medical Science, Mangaluru, Karnataka, India
| | - Radhakrishnan Govindan
- Department of Nursing, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - P. V. Prathyusha
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Leena Kunnath Chacko
- Department of Community Health Nursing, Yenepoya Nursing College, Yenepoya Deemed to be University, Mangaluru, Karnataka, India
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Yang Y, Granlund M, Tao F, Tao S, Zou L, Wu X, Hong J, Enskär K. Patterns of smartphone usage associated with depressive symptoms in nursing students. Front Psychiatry 2023; 14:1136126. [PMID: 37599870 PMCID: PMC10434770 DOI: 10.3389/fpsyt.2023.1136126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/28/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Rather than focusing on the activities that the smartphone has been used for, the existing literature frequently focuses on the association between problematic use of smartphone independent of the content of use (self-reported) and depressive symptoms in youth. This study aims to explore patterns of smartphone usage and the association with depressive symptoms in nursing students. Methods This cross-sectional study of nursing freshmen (n = 1, 716) was conducted between October and November 2018. Participants were recruited from three Chinese public medical universities using stratified cluster sampling. Self-rated frequency of 12 different smartphone activities over the preceding week was evaluated. Depressive symptoms were assessed by using the Patient Health Questionnaire-9 (PHQ-9). Results Of the 1,716 students recruited, 1,424 (83.0%) were girls, and the mean [SD] age was 18.90 [1.39] years. Using principal component analysis (PCA), two typical usage patterns were indicated. The "entertainment pattern" factor included a high frequency of streaming images or videos, searching for information, chatting online, online shopping, downloading, reading online, checking social media sites, taking pictures or videos, and playing games. The "communication pattern" had a high frequency of emailing, texting, and calling. Using logistic regression models, the association between smartphone usage patterns and depressive symptoms was tested. The "communication pattern" was significantly associated with a 53% increase in the odds of moderate and above depressive symptoms (AOR = 1.529; 95% CI = 1.286-1.818; p < 0.001), controlling for a set of socio-demographic and smartphone use covariates. Discussion This study provides insights into how the patterns of smartphone usage are associated with the severity of depressive symptoms in nursing students. It indicates that it may primarily be how we use our smartphones rather than how much we use them that poses a risk for depression.
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Affiliation(s)
- Yajuan Yang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Mats Granlund
- CHILD, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
| | - Shuman Tao
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
| | - Liwei Zou
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
| | - Xiaoyan Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
- MOE Key Laboratory of Population Health Across Life Cycle, Hefei, China
| | - Jingfang Hong
- School of Nursing, Anhui Medical University, Hefei, China
| | - Karin Enskär
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Shared genetic basis between reproductive behaviors and anxiety-related disorders. Mol Psychiatry 2022; 27:4103-4112. [PMID: 35750798 DOI: 10.1038/s41380-022-01667-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/17/2022] [Accepted: 06/08/2022] [Indexed: 02/07/2023]
Abstract
Reproductive behaviors are associated with risks for psychiatric disorders. Reproductive phenotypes are moderately heritable and have genetic overlaps with risks for psychiatric disorders. However, the genetic and causal relationships between anxiety-related disorders or specific anxiety disorders and reproductive phenotypes remain unknown. We utilized large-scale genome-wide association study (GWAS) results (n = 9537-542,901) for five reproductive phenotypes [age at menarche, age at first sexual intercourse (AFS), age at first birth (AFB), number of children ever born (NEB), and age at menopause] and five anxiety-related disorders [panic disorder, anxiety disorders from the ANGST and the UK biobank (UKBB), posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD)]. To assess genetic correlations and causal associations, linkage disequilibrium score regression and Mendelian randomization analyses, respectively, were performed. We found that AFS and AFB were negatively correlated with anxiety disorders ANGST (AFS: rg ± SE = -0.28 ± 0.08, p = 6.00 × 10-4; AFB: -0.45 ± 0.11, p = 3.26 × 10-5), anxiety disorders UKBB (AFS: -0.18 ± 0.03, p = 9.64 × 10-9; AFB; -0.25 ± 0.03, p = 2.90 × 10-13) and PTSD (AFS: -0.42 ± 0.12, p = 4.00 × 10-4; AFB: -0.44 ± 0.12, p = 2.00 × 10-4) and positively correlated with OCD (AFS: 0.25 ± 0.05, p = 2.46 × 10-6; AFB: 0.25 ± 0.05, p = 3.92 × 10-7). Conversely, NEB was negatively correlated with OCD (-0.28 ± 0.08, p = 6.00 × 10-4). We revealed bidirectional effects between earlier AFS and AFB and anxiety disorders (odds ratios: ORearlier AFS→Anxiety = 1.64, p = 2.27 × 10-8; ORearlier AFB→Anxiety = 1.15, p = 2.28 × 10-3; ORAnxiety→earlier AFS = 1.02, p = 6.62 × 10-8; ORAnxiety→earlier AFB = 1.08, p = 1.60 × 10-4). In contrast, we observed unidirectional effects of later AFS and AFB on OCD (ORlater AFS→OCD = 2.18, p = 2.16 × 10-6; ORlater AFB→OCD = 1.22, p = 0.016). We suggest that those who have earlier sexual debut and childbirth are prone to risk for anxiety disorders and vice versa, while those who have later sexual debut and childbirth are genetically prone to risk for OCD. Our findings further support revising the diagnostic criteria (DSM-5) such that OCD is independent from anxiety disorders.
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Sibanyoni AU, Joubert M, Naidu K. Are female bipolar patients of reproductive age aware of the teratogenic risk of sodium valproate? A qualitative study. S Afr J Psychiatr 2022; 28:1719. [PMID: 35169512 PMCID: PMC8831931 DOI: 10.4102/sajpsychiatry.v28i0.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/06/2021] [Indexed: 11/03/2022] Open
Abstract
Background Sodium valproate is considered the most teratogenic of all anticonvulsant drugs. Internationally, new regulations require women to sign risk assessment forms if initiated on it. Aim This study aimed to explore patients’ awareness of the teratogenic risk of sodium valproate. Setting Weskoppies Psychiatric Hospital, Tshwane, Gauteng. Methods We conducted a qualitative study comprising 23 semi-structured interviews with female bipolar patients of reproductive age at a tertiary psychiatric hospital in South Africa. Results Patient psychoeducation and self-education is improving as many patients were aware of the risk of teratogenicity of sodium valproate either by being educated or by searching online after developing an interest. Our study identified the need for female patients to be educated about contraceptive use when starting on sodium valproate to avoid pregnancy. Conclusion Our study shows that patients are becoming more aware of the teratogenic risk of sodium valproate. This suggests that consultations focusing on the issues of conception and the use of sodium valproate in women of childbearing potential has improved.
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Affiliation(s)
- Amanda U. Sibanyoni
- Department of Psychiatry, Faculty of Medicine, University of Pretoria, Pretoria, South Africa
| | - Marinda Joubert
- Department of Psychiatry, Faculty of Medicine, University of Pretoria, Pretoria, South Africa
| | - Kalaivani Naidu
- Department of Psychiatry, Faculty of Medicine, University of Pretoria, Pretoria, South Africa
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Zerihun T, Sorsdahl K, Hanlon C. Family planning for women with severe mental illness in rural Ethiopia: a qualitative study. Reprod Health 2021; 18:191. [PMID: 34583725 PMCID: PMC8480012 DOI: 10.1186/s12978-021-01245-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/17/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Family planning is a crucial issue for all women of reproductive age, but in women with severe mental illness (SMI), there may be particular challenges and concerns. As primary care-based mental health services are expanding in low- and middle-income countries (LMICs), there is an opportunity to improve family planning services for women with SMI. However, research exploring unmet family planning needs of women with SMI in such settings is scarce. Therefore, the present study explored the family planning experiences and preferences of women with SMI who reside in a predominantly rural area of Ethiopia. METHODS A qualitative study was conducted. Women with SMI who were participating in the ongoing population-based cohort study in Butajira were selected purposively based on their responses to a quantitative survey of current family planning utilisation. In-depth interviews were conducted with 16 women with SMI who were of reproductive age. Audio files were transcribed in Amharic, translated into English and analysed thematically. RESULTS Participants reported pervasive effects of SMI upon the intimate relationships and sexual lives of women. Although women with SMI felt that family planning was important, they had limited knowledge of family planning generally, and a lack of understanding of the specific family planning needs relevant to having SMI. None of the women with SMI in the present study had received any recommendations to use family planning services while accessing mental health care services. The participants identified ways in which primary care-based mental health services could better meet their family planning needs. CONCLUSIONS This study provided in-depth perspectives from women with SMI about the broader context of their family planning experience, needs, barriers and how integrated primary care services could better meet their needs. Empowerment of women with SMI to access information and services needs to be an important focus of future efforts to improve the reproductive experiences of this vulnerable group.
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Affiliation(s)
- Tigist Zerihun
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Katherine Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Zengin Eroglu M, Lus MG. Impulsivity, Unplanned Pregnancies, and Contraception Among Women with Bipolar Disorder. Neuropsychiatr Dis Treat 2020; 16:407-414. [PMID: 32103960 PMCID: PMC7012326 DOI: 10.2147/ndt.s238887] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 01/16/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Impulsivity is one of the principal symptoms of bipolar and related disorders (BD). Unsafe sex and unplanned pregnancies are serious problems in clinical practice. The aim of this study was to investigate impulsivity levels, contraception methods, and levels of planned pregnancies among women with bipolar and related disorders (WBD). METHODS Fifty-eight euthymic women with BD (bipolar disorder type I, II, or other) were matched by education levels with a control group of 59 healthy women. Data about their demographic, clinical-Barratt Impulsiveness Scale (BIS-11), Hamilton Depression Rating Scale, and Young Mania Rating Scale scores-and reproductive health features were obtained and compared between the groups. RESULTS No difference was found regarding BIS-11 (total, nonplanning, motor, and attentional subscales) scores between the WBD and control groups. The overall rate of contraception use was higher in WBD (96.6%), but they generally preferred "traditional" methods (i.e., withdrawal and calendar). The total rate of unplanned pregnancies in WBD was 49.52%. Rate of unplanned pregnancies in WBD was significantly different from women without bipolar disorder (49.52% vs 15.04%). DISCUSSION Levels of impulsivity in euthymic WBD under treatment were similar to those of healthy women in the control sample. WBD paid attention to contraception although they usually used traditional methods. The findings indicate that most WBD use contraception, yet the contraception is potentially ineffective especially if WBD have more unplanned pregnancies. The provision of an effective contraception method in WBD is suggested for all clinicians, in order to prevent sexually transmitted diseases and unplanned pregnancies, and thus protect the health of both mother and fetus.
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Affiliation(s)
- Meliha Zengin Eroglu
- Haydarpasa Numune Training and Research Hospital, Department of Psychiatry, Uskudar-Istanbul 34668, Turkey
| | - Melek Gözde Lus
- Department of Child and Adolescent Psychiatry, Haydarpasa Numune Training and Research Hospital, Uskudar-Istanbul 34668, Turkey
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Brown HK, Dennis CL, Kurdyak P, Vigod SN. A population-based study of the frequency and predictors of induced abortion among women with schizophrenia. Br J Psychiatry 2019; 215:736-743. [PMID: 30567612 DOI: 10.1192/bjp.2018.262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Induced abortion is an indicator of access to, and quality of reproductive healthcare, but rates are relatively unknown in women with schizophrenia. AIMS We examined whether women with schizophrenia experience increased induced abortion compared with those without schizophrenia, and identified factors associated with induced abortion risk. METHOD In a population-based, repeated cross-sectional study (2011-2013), we compared women with and without schizophrenia in Ontario, Canada on rates of induced abortions per 1000 women and per 1000 live births. We then followed a longitudinal cohort of women with schizophrenia aged 15-44 years (n = 11 149) from 2011, using modified Poisson regression to identify risk factors for induced abortion. RESULTS Women with schizophrenia had higher abortion rates than those without schizophrenia in all years (15.5-17.5 v. 12.8-13.6 per 1000 women; largest rate ratio, 1.33; 95% CI 1.16-1.54). They also had higher abortion ratios (592-736 v. 321-341 per 1000 live births; largest rate ratio, 2.25; 95% CI 1.96-2.59). Younger age (<25 years; adjusted relative risk (aRR), 1.84; 95% CI 1.39-2.44), multiparity (aRR 2.17, 95% CI 1.66-2.83), comorbid non-psychotic mental illness (aRR 2.15, 95% CI 1.34-3.46) and substance misuse disorders (aRR 1.85, 95% CI 1.47-2.34) were associated with increased abortion risk. CONCLUSIONS These results demonstrate vulnerability related to reproductive healthcare for women with schizophrenia. Evidence-based interventions to support optimal sexual health, particularly in young women, those with psychiatric and addiction comorbidity, and women who have already had a child, are warranted.
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Affiliation(s)
- Hilary K Brown
- Assistant Professor, Interdisciplinary Centre for Health and Society, University of Toronto Scarborough and Dalla Lana School of Public Health, University of Toronto and Department of Psychiatry, University of Toronto; and Adjunct Scientist, Women's College Research Institute, Women's College Hospital and Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Cindy-Lee Dennis
- Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; and Scientist, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Ontario, Canada
| | - Paul Kurdyak
- Professor, Department of Psychiatry, University of Toronto; Scientist, Institute for Clinical Evaluative Sciences; and Psychiatrist and Director of Health Outcomes and Performance Evaluation (HOPE), Centre for Addiction and Mental Health, Ontario, Canada
| | - Simone N Vigod
- Associate Professor, Department of Psychiatry, University of Toronto; and Scientist, Women's College Research Institute, Women's College Hospital and Institute for Clinical Evaluative Sciences, Ontario, Canada
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Bipolar Disorder Is Associated With an Increased Risk of Sexually Transmitted Infections: A Nationwide Population-based Cohort Study. Sex Transm Dis 2019; 45:735-740. [PMID: 29771866 DOI: 10.1097/olq.0000000000000863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Previous studies have suggested that sexually transmitted infections (STI) tend to increase in patients with bipolar disorder during a manic or hypomanic episode. However, in the long-term course of this disease, it is unclear whether patients with bipolar disorder have a higher risk of incident STI. METHODS Using the National Health Insurance Research Database of Taiwan, 3721 patients with bipolar disorder and 14,884 controls without bipolar disorder matched by gender and age were enrolled between 2000 and 2010 and followed up until the end of 2013. Participants who developed any STI (human immunodeficiency virus [HIV], syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis) during the follow-up period were identified. Cox regression analysis was performed to examine the risk of STI between patients with bipolar disorder and comparative controls. RESULTS Patients with bipolar disorder were prone to develop STI (hazard ratio [HR], 1.67, 95% confidence interval [95% CI], 1.27-2.18) especially for HIV (HR, 3.59; 95% CI, 1.16-11.08) and syphilis (HR, 2.26; 95% CI, 1.06-4.85). In addition, this study found that the incidence of STI was higher among women than men (HR, 1.83; 95% CI, 1.41-2.39). CONCLUSIONS This study shows that bipolar disorder is associated with an increased risk of developing STI, which has direct implications for the development of targeted prevention interventions or regular sexual health screening in mental health clinics to reduce the disproportionate burden of HIV and other STI in patients with bipolar disorder.
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Ni G, Amare AT, Zhou X, Mills N, Gratten J, Lee SH. The genetic relationship between female reproductive traits and six psychiatric disorders. Sci Rep 2019; 9:12041. [PMID: 31427629 PMCID: PMC6700195 DOI: 10.1038/s41598-019-48403-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/31/2019] [Indexed: 12/31/2022] Open
Abstract
Female reproductive behaviours have important implications for evolutionary fitness and health of offspring. Here we used the second release of UK Biobank data (N = 220,685) to evaluate the association between five female reproductive traits and polygenic risk scores (PRS) projected from genome-wide association study summary statistics of six psychiatric disorders (N = 429,178). We found that the PRS of attention-deficit/hyperactivity disorder (ADHD) were strongly associated with age at first birth (AFB) (genetic correlation of -0.68 ± 0.03), age at first sexual intercourse (AFS) (-0.56 ± 0.03), number of live births (NLB) (0.36 ± 0.04) and age at menopause (-0.27 ± 0.04). There were also robustly significant associations between the PRS of eating disorder (ED) and AFB (0.35 ± 0.06), ED and AFS (0.19 ± 0.06), major depressive disorder (MDD) and AFB (-0.27 ± 0.07), MDD and AFS (-0.27 ± 0.03) and schizophrenia and AFS (-0.10 ± 0.03). These associations were mostly explained by pleiotropic effects and there was little evidence of causal relationships. Our findings can potentially help improve reproductive health in women, hence better child outcomes. Our findings also lend partial support to the evolutionary hypothesis that causal mutations underlying psychiatric disorders have positive effects on reproductive success.
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Affiliation(s)
- Guiyan Ni
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, 4072, Australia
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, Adelaide, SA, 5000, Australia
- School of Environmental and Rural Science, University of New England, Armidale, NSW, 2351, Australia
| | - Azmeraw T Amare
- South Australian Academic Health Science and Translation centre, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Xuan Zhou
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, Adelaide, SA, 5000, Australia
| | - Natalie Mills
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Jacob Gratten
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, 4072, Australia
- Mater Research Institute, University of Queensland, Brisbane, Queensland, 4072, Australia
| | - S Hong Lee
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, Adelaide, SA, 5000, Australia.
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Ceylan B, Kocoglu-Tanyer D. An Examination of Turkish Nurses' Attitudes, Awareness and Practices Regarding Reproductive Health Needs of Individuals With Schizophrenia. Issues Ment Health Nurs 2019; 40:413-420. [PMID: 30605351 DOI: 10.1080/01612840.2018.1509404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aim: This study was conducted to evaluate Turkish nurses' attitudes, awareness and practices regarding reproductive health needs of individuals with schizophrenia. Method: The sample of this descriptive study consisted of 96 psychiatric nurses and 90 nurses and midwives working in family health centers who agreed to participate. The data were presented as numbers and percentages, and chi-square analyses were used to compare the groups. Findings: Although the majority of nurses stated that family planning education should be given to individuals with schizophrenia, to both genders and to both single and married patients, the proportion of those who give family planning education is only 23.5%. Of the nurses, 58.8% recommend tubal ligation as a method of family planning for individuals with schizophrenia, 39.6% of nurses think that involuntary abortion or sterilization for individuals with schizophrenia is necessary even if they do not support it culturally, and 20.3% of nurses provide sexual health counseling to individuals with schizophrenia. It appears that nurses, as members of society, do not approve of marriage or parenting by individuals with schizophrenia. Result: This study found that both nurses working in primary care and psychiatric clinics had negative attitudes towards the reproductive health of individuals with schizophrenia.
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Affiliation(s)
- Burcu Ceylan
- a Mental Health Nursing, Health Science Faculty , Necmettin Erbakan University , Konya , Turkey
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Yecies E, Judge-Golden C, Callegari L, Borrero S. Contraceptive Care in the Veterans Health Administration. Semin Reprod Med 2019; 37:24-31. [PMID: 31185515 PMCID: PMC7047650 DOI: 10.1055/s-0039-1692201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In recent years, the number of women Veterans obtaining care in the Veterans Affairs (VA) Healthcare System has grown, expanding the need for provision of contraceptive care. Women Veterans are a diverse group of women with complex sociodemographic and medical backgrounds, and meeting their needs presents a unique challenge for VA. Efforts including the establishment of comprehensive women's health clinics and training practitioners in women's health have greatly improved healthcare services for women Veterans over the last few decades. Recent data from a large cross-sectional survey study suggest that contraceptive use in VA is similar to the general population and that rates of unintended pregnancy, while still significant, are not higher than that in the general population. Subgroup analyses of this survey data, however, suggest that ongoing efforts are needed to improve outcomes in vulnerable subpopulations of women Veterans, particularly ethnic/racial minorities and Veterans with complex medical backgrounds. Policy changes such as the elimination of copayments for contraceptive prescriptions and the dispensing of more months of contraceptive supply are evidence-based starting points for improvements, in addition to leveraging VA's integrated system and research infrastructure to improve patient-centered counseling and contraceptive access.
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Affiliation(s)
- Emmanuelle Yecies
- Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- VA Pittsburgh Healthcare System, Pittsburgh, PA
| | | | - Lisa Callegari
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Drive Care, VA Health Services Research and Development, Seattle, WA
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA
- Department of Health Services, University of Washington School of Public Health, Seattle, WA
| | - Sonya Borrero
- Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- VA Pittsburgh Healthcare System, Pittsburgh, PA
- Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, PA
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Posada Correa AM, Andrade Carrillo RA, Suarez Vega DC, Gómez Cano S, Agudelo Arango LG, Tabares Builes LF, Agudelo García ÁM, Uribe Villa E, Aguirre-Acevedo DC, López-Jaramillo C. Sexual and Reproductive Health in Patients with Schizophrenia and Bipolar Disorder. ACTA ACUST UNITED AC 2018; 49:15-22. [PMID: 32081203 DOI: 10.1016/j.rcp.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/05/2018] [Accepted: 04/13/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION People with schizophrenia and bipolar disorder (BD) have a high risk of unwanted pregnancies and abortions, due to their condition of vulnerability or hypersexuality (common in BD). This is associated with difficulty in planning their actions and lack of sex education and counselling by medical personnel, and can lead to adverse obstetric outcomes and inability to care adequately for their children. OBJECTIVE To describe the characteristics in terms of sexual and reproductive health, and the use of contraception and counselling in psychiatric consultations, in a sample of patients with BD and schizophrenia in Medellin, Colombia. METHODS Observational cross-sectional study. We included the 160 participants from the clinical trial, "The effects of a multimodal intervention programme in patients with bipolar disorder and schizophrenia", who were recruited from the mood and psychosis disorders group clinic at Hospital Universitario de San Vicente Fundación in Medellin. They were contacted by phone by a third-year psychiatry resident, who applied a survey about the characteristics of their sex life, contraception and reproduction. RESULTS Almost all of the patients with schizophrenia were single, had no undergraduate studies and were unemployed. No significant differences were found regarding the age of starting sexual relations when comparing by diagnosis and gender. Almost all patients with schizophrenia and almost half of the patients with BD reported not having an active sexual life. Almost all of those who admitted to having an active sexual life claimed to always use contraception; in the BD group, only 48.8% of single women admitted to using contraception and a little over half of men stated that they used a condom when having sex. A quarter of the pregnancies were unplanned. Although the majority of the patients stated that they had never received information about family planning in the consultations with their psychiatrist, 57.4% of the patients with BD and 78.8% of those who had schizophrenia, considered themselves to be well informed on the subject. CONCLUSIONS Patients with mental illness have cognitive and behavioural alterations that affect their sexual and reproductive lives. Psychiatrists should therefore address this issue, to ensure education in areas such as contraception, family planning and sexually transmitted diseases and help safeguard the safety and quality of life of their patients.
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Affiliation(s)
- Ana María Posada Correa
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Sujey Gómez Cano
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Ángela María Agudelo García
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - Esteban Uribe Villa
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | | | - Carlos López-Jaramillo
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Psiquiatría GIPSI, Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
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Risk of sexual transmitted infection following bipolar disorder: a nationwide population-based cohort study. Oncotarget 2018; 9:17533-17542. [PMID: 29707127 PMCID: PMC5915135 DOI: 10.18632/oncotarget.24780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/25/2018] [Indexed: 11/25/2022] Open
Abstract
Background Bipolar disorder is a severe mental disorder associated with functional and cognitive impairment. Numerous studies have investigated associations between sexually transmitted infections (STIs) and psychiatric illnesses. However, the results of these studies are controversial. Objective We explored the association between bipolar disorder and the subsequent development of STIs, including human immunodeficiency virus infection; primary, secondary, and latent syphilis; genital warts; gonorrhea; chlamydial infection; and trichomoniasis. Results The bipolar cohort consisted of 1293 patients, and the comparison cohort consisted of 5172 matched control subjects without bipolar disorder. The incidence of subsequent STIs (hazard ratio (HR) = 2.23, 95% confidence interval (CI) 1.68-2.96) was higher among the patients with bipolar disorder than in the comparison cohort. Furthermore, female gender is a risk factor for acquisition of STIs (HR = 2.36, 95% CI 1.73-4.89) among patients with bipolar disorder. For individual STIs, the results indicated that the patients with bipolar disorder exhibited a markedly higher risk for subsequently contracting syphilis, genital warts, and trichomoniasis. Conclusions Bipolar disorder might increase the risk of subsequent newly diagnosed STIs, including syphilis, genital warts, and trichomoniasis. Clinicians should pay particular attention to STIs in patients with bipolar disorder. Patients with bipolar disorder, especially those with a history of high-risk sexual behaviors, should be routinely screened for STIs. Methods We identified patients who were diagnosed with bipolar disorder in the Taiwan National Health Insurance Research Database. A comparison cohort was constructed of patients without bipolar disorder who were matched with the bipolar cohort according to age and gender. The occurrence of subsequent new-onset STIs was evaluated in both cohorts.
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Ordan R, Shor R, Liebergall-Wischnitzer M, Noble L, Noble A. Nurses’ professional stigma and attitudes towards postpartum women with severe mental illness. J Clin Nurs 2018; 27:1543-1551. [DOI: 10.1111/jocn.14179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Revital Ordan
- School of Nursing; Faculty of Medicine; Henrietta Szold/Hadassah-Hebrew University; Jerusalem Israel
- Mental Health Division; Meuhedet Health Fund; Tel Aviv Israel
| | - Ron Shor
- Paul Baerwald School of Social Work and Social Welfare; Hebrew University of Jerusalem; Jerusalem Israel
| | | | - Lawrence Noble
- Icahn School of Medicine at Mt. Sinai; Jerusalem Israel
- Elmhurst Hospital; Elmhurst NY USA
| | - Anita Noble
- School of Nursing; Faculty of Medicine; Henrietta Szold/Hadassah-Hebrew University; Jerusalem Israel
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21
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Rusner M, Berg M, Begley C. Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes. BMC Pregnancy Childbirth 2016; 16:331. [PMID: 27793111 PMCID: PMC5084442 DOI: 10.1186/s12884-016-1127-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/22/2016] [Indexed: 01/08/2023] Open
Abstract
Background Bipolar Disorder (BD) is a mental disorder usually diagnosed between 18 and 30 years of age; this coincides with the period when many women experience pregnancy and childbirth. As specific problems have been reported in pregnancy and childbirth when the mother has BD, a systematic review was carried out to summarise the outcomes of pregnancy and childbirth, in mother and child, when the mother has BD diagnosed before pregnancy. Methods An a priori protocol was designed and a systematic search conducted in PubMed, CINAHL, Scopus, PsycINFO and Cochrane databases in March 2015. Studies of all designs were included if they involved women with a diagnosis of bipolar disorder prior to pregnancy, who were pregnant and/or followed up to one year postpartum. All stages of inclusion, quality assessment and data extraction were done by two people. All maternal or infant outcomes were examined, and narrative synthesis was used for most outcomes. Meta-analysis was used to achieve a combined prevalence for some outcomes and, where possible, case and control groups were combined and compared. Results The search identified 2809 papers. After screening and quality assessement (using the EPHPP and AMSTAR tools), nine papers were included. Adverse pregnancy outcomes such as gestational hypertension and antepartum haemorrhage occur more frequently in women with BD. They also have increased rates of induction of labour and caesarean section, and have an increased risk of mood disorders in the postnatal period. Women with BD are more likely to have babies that are severely small for gestational age (<2nd-3rd percentile), and it appears that those women not being treated with mood stabilisers in pregnancy might not have an increased risk of having a baby with congenital abnormalities. Discussion Due to heterogeneity of data, particularly the use of differing definitions of bipolar disorder, narrative synthesis was used for most outcomes, rather than a meta-analysis. Conclusions It is evident that adverse outcomes are more common in women with BD and their babies. Large cohort studies examining fetal abnormality outcomes for women with BD who are not on mood stabilisers in pregnancy are required, as are studies on maternal-infant interaction. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1127-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie Rusner
- Department of Research, Södra Älvsborgs Hospital, Brämhultsvägen 53, SE-501 82, Borås, Sweden. .,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Cecily Begley
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
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Bradbury-Jones C, Clark MT, Parry J, Taylor J. Development of a practice framework for improving nurses' responses to intimate partner violence. J Clin Nurs 2016; 26:2495-2502. [PMID: 27302748 DOI: 10.1111/jocn.13276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of this article is to discuss critically the theoretical concepts of awareness, recognition and empowerment as manifested in intimate partner violence and to show how these can be translated into a practice framework for improving nurses' response. BACKGROUND Intimate partner violence is a universal problem and is considered a significant public health issue. Nurses are in an ideal position to recognise and respond to intimate partner violence, but many lack confidence in this area of practice. In our previous empirical work, we identified three concepts through which nurses' responses to intimate partner violence can be understood: awareness, recognition and empowerment. In this article, we advance nursing knowledge by showing how these concepts can form a practice framework to improve nurses' responses to intimate partner violence. DESIGN A discussion paper and development of a practice framework to improve nurses' responses to intimate partner violence. DISCUSSION The framework comprises three principal needs of women and three related key requirements for nurses to meet these needs. Arising from these are a range of practice outcomes: enhanced understanding of intimate partner violence, increased confidence in recognising intimate partner violence, establishment of trusting relationships, increased likelihood of disclosure and optimised safety. CONCLUSIONS Nurses sometimes lack confidence in recognising and responding to intimate partner violence. Awareness, recognition and empowerment are important concepts that can form the basis of a framework to support them. When nurses feel empowered to respond to intimate partner violence, they can work together with women to optimise their safety. RELEVANCE TO CLINICAL PRACTICE Access to adequate and timely intimate partner violence education and training is important in improving nurses' responses to intimate partner violence. Getting this right can lead to enhanced safety planning and better health outcomes for women who experience intimate partner violence. Although difficult to measure as an outcome, nurses' improved responses can contribute to higher rates of referral for help and reduction in intimate partner violence rates.
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Affiliation(s)
| | - Maria T Clark
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Jayne Parry
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Julie Taylor
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.,Edgbaston and Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
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Kopeykina I, Kim HJ, Khatun T, Boland J, Haeri S, Cohen LJ, Galynker II. Hypersexuality and couple relationships in bipolar disorder: A review. J Affect Disord 2016; 195:1-14. [PMID: 26851616 DOI: 10.1016/j.jad.2016.01.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Although change in sexual behavior is recognized as an integral part of bipolar disorder, most of the relevant literature on sexual issues in patients with this illness concerns medication side effects and does not differentiate bipolar disorder from other serious mental disorders. Surprisingly, little has been published on mania-induced hypersexuality and the effects of mood cycling on couple relationships. In this review, we examine the extant literature on both of these subjects and propose a framework for future research. METHODS A search of PsycINFO and PubMed was conducted using keywords pertaining to bipolar disorder, hypersexuality and couple relationships. A total of 27 articles were selected for review. RESULTS Despite lack of uniformity in diagnosis of bipolar disorder and no formal definition of hypersexuality, the literature points to an increased incidence of risky sexual behaviors in bipolar patients during manic episodes compared to patients with other psychiatric diagnoses. Further, it appears that bipolar patients are more similar to healthy controls than to other psychiatric patients when it comes to establishing and maintaining couple relationships. Nonetheless, the studies that examined sexuality in couples with one bipolar partner found decreased levels of sexual satisfaction associated with the diagnosis, varying levels of sexual interest across polarities, increased incidence of sexual dysfunction during depressive episodes, and disparate levels of satisfaction in general between patients and their partners. LIMITATIONS Due to changes in diagnostic criteria over time, there is a lack of uniformity in the definition of bipolar disorder across studies. Hypersexuality is not systematically defined and therefore the construct was not consistent across studies. Some of the older articles date back more than 30 years, making them subject to the biases of sexual and gender norms that have since become outdated. Finally, the heterogeneity of the samples, which include patients with comorbid substance use as well as inpatient, outpatient, symptomatic and euthymic patients, may limit the generalizability of results. CONCLUSIONS Although bipolar patients experience disease-specific sexual problems of mania-induced hypersexuality and specific effects of mood cycling on couple relationships, the existing literature is mostly outdated and lacks a consistent definition of hypersexuality. Novel research is needed to address sexual symptomatology in bipolar disorder within the context of current sexual, cultural and gender norms.
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Affiliation(s)
- Irina Kopeykina
- Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA.
| | - Hae-Joon Kim
- Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA.
| | - Tasnia Khatun
- Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA.
| | - Jennifer Boland
- Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA.
| | - Sophia Haeri
- Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA.
| | - Lisa J Cohen
- Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA.
| | - Igor I Galynker
- Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA.
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Hunter KM, Ahmed AO. Sexuality and Sexual Health. EVIDENCE-BASED PRACTICES IN BEHAVIORAL HEALTH 2016. [DOI: 10.1007/978-3-319-40537-7_3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Miller LJ, Ghadiali NY, Larusso EM, Wahlen KJ, Avni-Barron O, Mittal L, Greene JA. Bipolar disorder in women. Health Care Women Int 2014; 36:475-98. [PMID: 25315819 DOI: 10.1080/07399332.2014.962138] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This article summarizes research pertinent to the clinical care of women with bipolar disorder. With bipolar disorder, female gender correlates with more depressive symptoms and different comorbidities. There is a high risk of symptom recurrence postpartum and possibly during perimenopause. Women with bipolar disorder have increased risk of sexually transmitted diseases, unplanned pregnancies, excessive weight gain, metabolic syndrome, and cardiovascular disease. Mood stabilizing medications, specific psychotherapies, and lifestyle changes can stabilize mood and improve functioning. Pharmacologic considerations include understanding interactions between mood stabilizing medications and contraceptive agents and risks and benefits of mood stabilizing medication during pregnancy and lactation.
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Affiliation(s)
- Laura J Miller
- a Department of Psychiatry, Loyola Stritch School of Medicine, Edward Hines Jr. VA Hospital , Hines , Illinois , USA
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