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Do HP, Dunne MP, Vo TV, Nguyen LH, Luong-Thanh BY, Valdebenito S, Baker PRA, Tran BX, Hoang TD, Eisner M. Applying the WHO INSPIRE Framework to Ending Violence Against Pregnant Women and Unborn Children: A Case Study in Vietnam. Violence Against Women 2024:10778012241230324. [PMID: 38380997 DOI: 10.1177/10778012241230324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
This article adapted the INSPIRE framework, developed by the World Health Organization to prevent violence against children, to the systematic analysis of city-level healthcare services for pregnant women who experienced intimate partner violence. A mixed-methods study conducted in-depth interviews with 22 health and social care professionals and 140 pregnant women in Vietnam. The women were more likely to report limited system-level support for partners regarding violence and mental health, while the professionals perceived more weaknesses in policies and management of services. Traditional values tend to isolate abused women from receiving social services. The INSPIRE framework is innovative and could be applied in other contexts.
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Affiliation(s)
- Huyen Phuc Do
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Institute of Health Economics and Technology, Hanoi, Vietnam
| | - Michael P Dunne
- Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thang Van Vo
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Lan Hoang Nguyen
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Bao-Yen Luong-Thanh
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Sara Valdebenito
- Institute of Criminology, University of Cambridge, Cambridge, UK
| | - Philip R A Baker
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Department of Health, Behaviours and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tuyen Dinh Hoang
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
- Faculty of Public Health, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, Cambridge, UK
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2
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Costin MR, Taut D, Baban A, Ionescu T, Murray A, Lindsay C, Secara E, Abbasi F, Sarfo Acheampong I, Katus L, Luong Thanh Bao Y, Hernandez SCLS, Randeny S, Du Toit S, Valdebenito S, Eisner MP. The Role of Maternal Depression Symptoms and Maternal Attachment in Predicting Exclusive Breastfeeding: A Multisite Prospective Study. J Womens Health (Larchmt) 2024; 33:187-197. [PMID: 38011004 DOI: 10.1089/jwh.2023.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Background: Previous research shows that 61% of children younger than 6 months in low- and middle-income countries (LMICs) are not exclusively breastfed. Although data on the role of pre- and postnatal depression on breastfeeding exclusivity is mixed, fetomaternal attachment might foster breastfeeding exclusivity. Thus, we tested the potential mediating role of fetomaternal attachment and postnatal depression in the relationship between maternal prenatal depression and exclusive breastfeeding. Materials and Methods: Data were collected as part of a prospective, cross-cultural project, Evidence for Better Lives Study, which enrolled 1208 expectant mothers, in their third trimester of pregnancy across eight sites, from LMICs. Of the whole sample, 1185 women (mean age = 28.32, standard deviation [SD] = 5.77) completed Computer-Aided Personal Interviews on prenatal depressive symptoms, fetomaternal attachment, and socioeconomic status. A total of 1054 women provided follow-up data at 3-6 months after birth, about postnatal depressive symptoms, exclusive breastfeeding, and infant health indicators. Path analysis was used to assess parallel mediation. Results: In the whole sample, the effect of prenatal depression on breastfeeding exclusivity was completely mediated by postnatal depression, whereas fetomaternal attachment did not mediate the relationship. The full mediation effect was replicated individually in Pakistan and Sri Lanka. Conclusions: The study results indicate that prenatal depression symptoms contributed to the development of depressive symptoms after birth, negatively affecting the probability of exclusive breastfeeding. Future research should explore this in early prevention interventions, increasing the chances of healthy child development in LMICs. Considering the mixed results around the sites, it is important to better understand the relationship between maternal depression, fetomaternal attachment and breastfeeding behavior in each site's socio-cultural context.
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Affiliation(s)
| | - Diana Taut
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Adriana Baban
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Thea Ionescu
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Aja Murray
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Carene Lindsay
- Department of Basic Medical Sciences, Epidemiology Research Unit, Caribbean Institute for Health Research, University of the West Indies, Mona, Kingston, Jamaica
| | - Eugen Secara
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Fahad Abbasi
- Department of Jhpiego-Gender and Research, Fazaia Medical College, Islamabad, Pakistan
| | - Isaac Sarfo Acheampong
- Department of Medical Laboratory Science, Koforidua Technical University, Koforidua, Ghana
| | - Laura Katus
- Institute for Lifecourse Development, School of Human Sciences, University of Greenwich, London, United Kingdom
- Centre for Family Research, University of Cambridge, Cambridge, United Kingdom
| | - Yen Luong Thanh Bao
- Department of Epidemiology-Biostatistics and Demography, Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Vietnam
| | | | - Shobhavi Randeny
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Stefani Du Toit
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Sara Valdebenito
- Institute of Criminology, University of Cambridge, Cambridge, United Kingdom
| | - Manuel P Eisner
- Institute of Criminology, University of Cambridge, Cambridge, United Kingdom
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
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Ramaj K, Eisner M. Adverse Childhood Experiences, Intimate Partner Violence, and Mental Well-Being Among Mothers of Toddlers in Tirana, Albania: A Cross-Sectional Mediation Analysis. Violence Against Women 2023:10778012231203659. [PMID: 37774772 DOI: 10.1177/10778012231203659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
This article examines the relationship between maternal exposure to adverse childhood experiences (ACEs), intimate partner violence (IPV), and two aspects of maternal mental well-being-stress and depressive symptoms in the context of Tirana, Albania. Data were obtained from a representative sample of 328 mothers of 2-3-year-old children, who were registered in Tirana's public nurseries. Findings show that maternal ACEs are positively associated with stress levels (β = .210, z = 4.03, p < .001) and depressive symptoms (β = .129, z = 2.62, p < .01). In addition, IPV partially mediates the effect of ACEs on maternal stress (β = .081, z = 3.75, p < .001) and fully mediates the effect of ACEs on depressive symptoms (β = .054, z = 2.87, p < .01). These results suggest that among mothers of toddlers in Tirana, ACEs influence stress levels both directly and via IPV, while they influence depressive symptoms only via IPV. The findings demonstrate long-term effects of maternal exposure to interpersonal violence on mental well-being.
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Affiliation(s)
- Klea Ramaj
- Institute of Criminology, University of Cambridge, Cambridge, UK
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, Cambridge, UK
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Murray AL, Taut D, Baban A, Hemady CL, Walker S, Osafo J, Sikander S, Tomlinson M, Toit SD, Marlow M, Ward CL, Fernando A, Madrid B, Van Thang V, Tuyen HD, Dunne M, Hughes C, Fearon P, Valdebenito S, Eisner M. Associations Between ADHD Symptoms and Maternal and Birth Outcomes: An Exploratory Analysis in a Multi-Country Cohort of Expectant Mothers. J Atten Disord 2022; 26:1882-1894. [PMID: 35815439 PMCID: PMC9597155 DOI: 10.1177/10870547221105064] [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] [Indexed: 12/26/2022]
Abstract
OBJECTIVE ADHD symptoms can adversely impact functioning in a range of domains relevant for maternal well-being and fetal development; however, there has been almost no research examining their impact during pregnancy. We aimed to address this gap. METHOD We used data (n = 1,204) from a longitudinal birth cohort study spanning eight countries to address this gap. RESULTS ADHD symptoms in the third trimester of pregnancy were associated with lower social support from family (b = -0.16, p = .031), friends (b = -0.16, p = .024), and significant others (b = -0.09, p = .001); higher stress (b = 0.34, p < .001) and depressive symptoms (b = 0.31, p < .001), and increased likelihood of an unwanted pregnancy (b = 0.30, p = .009). Significant associations with tobacco use (b = 0.36, p = .023) and premature birth (b = 0.35, p = .007) did not survive correction for multiple comparisons and there were no significant associations with alcohol use, low birth weight, or unplanned pregnancy. CONCLUSION Results suggest that women with ADHD symptoms could benefit from earlier, more regular screening for mental health difficulties and greater mental health support during pregnancy.
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Affiliation(s)
- Aja Louise Murray
- University of Edinburgh, UK,Aja Louise Murray, Department of
Psychology, University of Edinburgh, 7 George Square, Edinburgh EH8 9JZ, UK.
| | - Diana Taut
- Babes-Bolyai University, Cluj-Napoca,
Romania
| | | | | | - Susan Walker
- The University of the West Indies,
Kingston, Jamaica
| | | | | | - Mark Tomlinson
- Stellenbosch Uni`versity, Cape Town,
South Africa,Queens University, Belfast, UK
| | | | | | | | | | | | | | | | - Michael Dunne
- Queensland University of Technology,
Brisbane, Australia
| | | | | | | | - Manuel Eisner
- University of Cambridge, UK,University of Zurich,
Switzerland
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5
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Hemady CL, Speyer LG, Murray AL, Brown RH, Meinck F, Fry D, Do H, Sikander S, Madrid B, Fernando A, Walker S, Dunne M, Foley S, Hughes C, Osafo J, Baban A, Taut D, Ward CL, Van Thang V, Fearon P, Tomlinson M, Valdebenito S, Eisner M. Patterns of adverse childhood experiences and associations with prenatal substance use and poor infant outcomes in a multi-country cohort of mothers: a latent class analysis. BMC Pregnancy Childbirth 2022; 22:505. [PMID: 35733125 PMCID: PMC9215006 DOI: 10.1186/s12884-022-04839-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper enumerates and characterizes latent classes of adverse childhood experiences and investigates how they relate to prenatal substance use (i.e., smoking, alcohol, and other drugs) and poor infant outcomes (i.e., infant prematurity and low birthweight) across eight low- and middle-income countries (LMICs). METHODS A total of 1189 mother-infant dyads from the Evidence for Better Lives Study cohort were recruited. Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions was performed. RESULTS Three high-risk classes and one low-risk class emerged: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Pairwise comparisons between classes indicate higher probabilities of prenatal drug use in the highly maltreated and emotionally abused classes compared with the low household dysfunction and abuse class. Additionally, the emotionally and physically abused with intra-familial violence exposure class had higher probability of low birthweight than the three remaining classes. CONCLUSION Our results highlight the multifaceted nature of ACEs and underline the potential importance of exposure to childhood adversities on behaviors and outcomes in the perinatal period. This can inform the design of antenatal support to better address these challenges.
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Affiliation(s)
- Chad Lance Hemady
- Social Work Department, University of Edinburgh, Edinburgh, UK. .,School of Social and Political Science, 15a George Square, Edinburgh, EH8 9LD, UK.
| | | | | | | | - Franziska Meinck
- Social Work Department, University of Edinburgh, Edinburgh, UK.,Faculty of Humanities, North-West University, Potchefstroom, South Africa
| | - Deborah Fry
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Huyen Do
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Siham Sikander
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK.,Global Institute of Human Development, Shifa Tameer-E-Millat University, Islamabad, Pakistan
| | - Bernadette Madrid
- Child Protection Unit, University of the Philippines, Manila, Philippines
| | - Asvini Fernando
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Susan Walker
- Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Michael Dunne
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Australia
| | - Sarah Foley
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Claire Hughes
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Joseph Osafo
- Department of Psychology, University of Ghana, Accra, Ghana
| | - Adriana Baban
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Diana Taut
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Catherine L Ward
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Vo Van Thang
- Institute for Community Health Research, Hue University, Hue, Vietnam
| | - Pasco Fearon
- Division of Psychology & Language Sciences, University College London, London, UK
| | - Mark Tomlinson
- Department of Global Health, Institute of Life Course Health Research, Stellenbosch University, Cape Town, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Sara Valdebenito
- Institute of Criminology, University of Cambridge, Cambridge, UK
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, Cambridge, UK.,Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
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6
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Ikram N, Frost A, LeMasters K, Hagaman A, Baranov V, Gallis J, Sikander S, Scherer E, Maselko J. Adverse childhood experiences and implications of perceived stress, anxiety and cortisol among women in Pakistan: a cross-sectional study. BMJ Open 2022; 12:e052280. [PMID: 35428618 PMCID: PMC9014037 DOI: 10.1136/bmjopen-2021-052280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) are linked to poor maternal mental health. The goal of this study is to examine the associations between ACEs and multiple manifestations of stress (including perceived stress, anxiety and cortisol) among mothers in rural Pakistan. DESIGN This study used a cross-sectional design. Mothers were originally recruited during their third trimester of pregnancy and followed until 36 months post partum. Cortisol was collected at 12 months post partum, and self-report data were collected at 36 months post partum. SETTING All participants reside in rural villages in Rawalpindi, Pakistan. The measures were administered at home visits by field interviewers. PARTICIPANTS Data were collected from 889 mothers. All mothers in the sample provided data on ACEs and perceived stress, 623 provided data on anxiety and 90 provided hair cortisol. PRIMARY AND SECONDARY OUTCOMES MEASURES ACEs were captured retrospectively using an adapted version of the ACE International Questionnaire, and represented as a continuous variable and subdomains (neglect, home violence, family psychological distress, community violence). Primary outcomes included perceived stress measured with the Cohen Perceived Stress Scale (PSS) and anxiety measured with the Generalised Anxiety Disorder-7 scale (GAD-7). Hair-derived cortisol was included as a secondary outcome. Generalised linear models with cluster-robust SEs were used to estimate associations between ACEs and the outcome variables. RESULTS All models featured positive associations between ACE items and PSS. The continuous total ACE score (B=0.4; 95% CI 0.0 to 0.8) was associated with higher anxiety symptoms on the GAD-7. Home violence (B=6.7; 95% CI 2.7 to 10.8) and community violence (B=7.5; 95% CI 1.4 to 13.6) were associated with increased hair cortisol production. CONCLUSIONS All four ACE domains were associated with elevated levels of perceived stress, anxiety and cortisol, with varying precision and strength of estimates, indicating that the type of ACE has a differential impact. This study informed our understanding of the differential impact of specific ACEs on perceived stress, anxiety and hypothalamic pituitary adrenal-axis functioning, providing implications for future clinical intervention and research development.
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Affiliation(s)
- Naira Ikram
- Department of Program II, Duke University, Durham, North Carolina, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Allison Frost
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Katherine LeMasters
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale University, New Haven, Connecticut, USA
| | - Victoria Baranov
- Department of Economics, University of Melbourne, Melbourne, Victoria, Australia
| | - John Gallis
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Siham Sikander
- Department of Public Health, Human Development Research Foundation, Islamabad, Pakistan
| | - Elissa Scherer
- RTI International, Research Triangle Park, North Carolina, USA
| | - Joanna Maselko
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
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Anwer Y, Abbasi F, Dar A, Hafeez A, Valdebenito S, Eisner M, Sikander S, Hafeez A. Feasibility of a birth-cohort in Pakistan: evidence for better lives study. Pilot Feasibility Stud 2022; 8:29. [PMID: 35130958 PMCID: PMC8819840 DOI: 10.1186/s40814-022-00980-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Evidence for Better Lives Study Foundational Research (EBLS-FR) is a preliminary endeavor to establish the feasibility of a global birth cohort, and within this feasibility study, piloting the research instrument, with participants from eight lower middle-income countries across the globe. It aims to investigate mediators and moderators of child development and wellbeing; it envisages informing policy and practice change to promote child health and wellbeing globally. Pakistan is one of the resource poor lower middle-income country (LMIC) taking part in this global birth cohort; we report the feasibility of establishing such a birth cohort in Pakistan.
Method
From March 2019 to July 2019, 153 third trimester pregnant women were identified, using community health worker registers, and approached for baseline demographics and a number of maternal wellbeing, mental health, support-related information, and stress-related biomarkers from bio-samples in a peri-urban area of Islamabad Capital Territory. One hundred fifty of these women gave consent and participated in the study. From October 2019 to December 2019, we re-contacted and were able to follow 121 of these women in the 8–24 weeks postnatal period. All interviews were done after obtaining informed consent and data were collected electronically.
Results
One hundred fifty (98.0%) third trimester pregnant women consented and were successfully interviewed, 111 (74.0%) provided bio-samples and 121 (80.6%) were followed up postnatally. Their mean age and years of schooling was 27.29 (SD = 5.18) and 7.77 (SD = 4.79) respectively. A majority (82.3%) of the participants were housewives. Nearly a tenth were first time mothers. Ninety-two (61.3%) of the women reported current pregnancy to have been unplanned. Overall wellbeing and mental health were reported to be poor (WHO-5 mean scores 49.41 (SD = 32.20) and PHQ-9 mean scores 8.23 (SD = 7.0)). Thirty-eight (21.8%) of the women reported four or more adverse childhood experiences; 46 (31.3%) reported intimate partner violence during their current pregnancy. During the postnatal follow up visits, 72 (58.0%) of the women reported breastfeeding their infants.
Conclusion
The foundational research demonstrated that Pakistan site could identify, approach, interview, and follow up women and children postnatally, with a high response rates for both the follow up visits and bio-samples. Therefore, a future larger-scale pregnancy birth cohort study in Pakistan is feasible.
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Perceived stress during the prenatal period: assessing measurement invariance of the Perceived Stress Scale (PSS-10) across cultures and birth parity. Arch Womens Ment Health 2022; 25:633-640. [PMID: 35420323 PMCID: PMC9072510 DOI: 10.1007/s00737-022-01229-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
Maternal prenatal stress places a substantial burden on mother's mental health. Expectant mothers in low- and middle-income countries (LMICs) have thus far received less attention than mothers in high-income settings. This is particularly problematic, as a range of triggers, such as exposure to traumatic events (e.g. natural disasters, previous pregnancy losses) and adverse life circumstances (e.g. poverty, community violence), put mothers at increased risk of experiencing prenatal stress. The ten-item Perceived Stress Scale (PSS-10) is a widely recognised index of subjective experience of stress that is increasingly used in LMICs. However, evidence for its measurement equivalence across settings is lacking. This study aims to assess measurement invariance of the PSS-10 across eight LMICs and across birth parity. This research was carried out as part of the Evidence for Better Lives Study (EBLS, vrc.crim.cam.ac.uk/vrcresearch/EBLS). The PSS-10 was administered to N = 1,208 expectant mothers from Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam during the third trimester of pregnancy. Confirmatory factor analysis suggested a good model fit of a two-factor model across all sites, with items on experiences of stress loading onto a negative factor and items on perceived coping onto a positive factor. Configural and metric, but not full or partial scalar invariance, were established across all sites. Configural, metric and full scalar invariance could be established across birth parity. On average, first-time mothers reported less stress than mothers who already had children. Our findings indicate that the PSS-10 holds utility in assessing stress across a broad range of culturally diverse settings; however, caution should be taken when comparing mean stress levels across sites.
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The impact of maternal adverse childhood experiences and prenatal depressive symptoms on foetal attachment: Preliminary evidence from expectant mothers across eight middle-income countries. J Affect Disord 2021; 295:612-619. [PMID: 34509077 DOI: 10.1016/j.jad.2021.08.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/02/2021] [Accepted: 08/25/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and thus may be partially responsible for intergenerational transmission of risk associated with maternal ACEs. However, the extent to which prenatal depressive symptoms mediate the association between maternal ACEs and foetal attachment is unknown. METHODS Data on foetal attachment, ACEs, and prenatal depression came from mothers in their third trimester of pregnancy (n = 1,185) located across eight MICs, participating in the prospective birth cohort Evidence for Better Lives Study - Foundational Research (EBLS-FR). Data were from the baseline measurement. RESULTS Full-sample path mediation analyses, adjusting for relevant covariates, suggested a full mediating effect of prenatal depression. However, at the individual-country level, both positive and negative effects of ACEs on foetal attachment were observed after the inclusion of depressive symptoms as a mediator, suggesting cultural and geographical factors may influence a mother's empathic development after ACE exposure. LIMITATIONS As no follow-up measurements of depressive symptoms or postnatal attachment were included in the analyses, the findings cannot be extrapolated to the postnatal period and beyond. Further, causality cannot be inferred as the study was observational. CONCLUSIONS The findings reinforce the importance of screening for prenatal depression during antenatal care in MICs. Addressing prenatal depression within maternal health care may support foetal attachment and contribute to reducing the intergenerational transmission of disadvantage.
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10
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Do HP, Baker PRA, Van Vo T, Murray A, Murray L, Valdebenito S, Eisner M, Tran BX, Dunne MP. Intergenerational effects of violence on women's perinatal wellbeing and infant health outcomes: evidence from a birth cohort study in Central Vietnam. BMC Pregnancy Childbirth 2021; 21:648. [PMID: 34556095 PMCID: PMC8461881 DOI: 10.1186/s12884-021-04097-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/31/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Girls exposed to violence have a high risk of being victimized as adults and are more likely than non-abused women to have children who are treated violently. This intergenerational transmission may be especially serious when women suffer violence during pregnancy and early motherhood, as it impairs maternal wellbeing and infant health and development. This study examined the intergenerational effects of being exposed to childhood maltreatment (CM) and prenatal intimate partner violence (p-IPV) on perinatal mental distress and birth outcomes in central Vietnam. METHODS A birth cohort study in Hue City, Vietnam was conducted with 150 women in the third trimester of pregnancy (Wave 1) and 3 months after childbirth (Wave 2). Using multivariable logistic regression models, augmented inverse-probability-weighted estimators and structural equation modelling (SEM), we analyzed a theoretical model by evaluating adjusted risk differences and pathways between CM, p-IPV and subsequent perinatal adversity and indicators of infant health problems. RESULTS One in two pregnant women experienced at least one form of CM (55.03%) and one in ten pregnant women experienced both CM and p-IPV (10.67%). Mothers who experienced p-IPV or witnessed IPV as a child were approximately twice as likely to experience poor mental health during pregnancy [ARR 1.94, 95% CI (1.20-3.15)]. Infants had a two-fold higher risk of adverse birth outcomes (low birth weight, preterm birth, admission to neonatal intensive care) [ARR 2.45 95% CI (1.42, 4.25)] if their mothers experienced any form of p-IPV, with greater risk if their mothers were exposed to both CM and p-IPV [ARR 3.45 95% CI (1.40, 8.53)]. Notably, significant pathways to p-IPV were found via adverse childhood experience (ACE) events (β = 0.13), neighborhood disorder (β = 0.14) and partner support (β = - 1.3). CONCLUSION These results emphasize the detrimental and prolonged nature of the effect of violence during childhood and pregnancy. Exposure to childhood maltreatment and violence during pregnancy increases the risk of maternal mental health difficulties and adverse birth outcomes. Antenatal care systems need to be responsive to women's previous experiences of violence and maternal mental health. The significant protective role of partner support and social support should also be considered when designing tailored interventions to address violence during pregnancy.
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Affiliation(s)
- Huyen Phuc Do
- Queensland University of Technology (QUT), Faculty of Health, School of Public Health and Social Work, Brisbane, Australia
- Institute of Health Economics and Technology, Hanoi, Vietnam
| | - Philip R. A. Baker
- Queensland University of Technology (QUT), Faculty of Health, School of Public Health and Social Work, Brisbane, Australia
| | - Thang Van Vo
- Institute for Community Health Research, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
- Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Aja Murray
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Linda Murray
- College of Health Sciences, Massey University, Wellington, New Zealand
| | - Sara Valdebenito
- Institute of Criminology, University of Cambridge, Cambridge, UK
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, Cambridge, UK
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Michael P. Dunne
- Institute for Community Health Research, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
- Australian Centre for Health Law Research, Queensland University of Technology (QUT), Brisbane, Australia
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11
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Foley S, Hughes C, Murray AL, Baban A, Fernando AD, Madrid B, Osafo J, Sikander S, Abbasi F, Walker S, Luong-Thanh BY, Vo TV, Tomlinson M, Fearon P, Ward CL, Valdebenito S, Eisner M. Prenatal attachment: using measurement invariance to test the validity of comparisons across eight culturally diverse countries. Arch Womens Ment Health 2021; 24:619-625. [PMID: 33559754 PMCID: PMC8266779 DOI: 10.1007/s00737-021-01105-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/19/2021] [Indexed: 01/21/2023]
Abstract
Studies in high-income countries (HICs) have shown that variability in maternal-fetal attachment (MFA) predict important maternal health and child outcomes. However, the validity of MFA ratings in low- and middle-income countries (LMICs) remains unknown. Addressing this gap, we assessed measurement invariance to test the conceptual equivalence of the Prenatal Attachment Inventory (PAI: Muller, 1993) across eight LMICs. Our aim was to determine whether the PAI yields similar information from pregnant women across different cultural contexts. We administered the 18-item PAI to 1181 mothers in the third trimester (Mean age = 28.27 years old, SD = 5.81 years, range = 18-48 years) expecting their first infant (n = 359) or a later-born infant (n = 820) as part of a prospective birth cohort study involving eight middle-income countries: Ghana, Jamaica, Pakistan, Philippines, Romania, South Africa, Sri Lanka and Vietnam. We used Multiple Group Confirmatory Factor Analyses to assess across-site measurement invariance. A single latent factor with partial measurement invariance was found across all sites except Pakistan. Group comparisons showed that mean levels of MFA were lowest for expectant mothers in Vietnam and highest for expectant mothers in Sri Lanka. MFA was higher in first-time mothers than in mothers expecting a later-born child. The PAI yields similar information about MFA across culturally distinct middle-income countries. These findings strengthen confidence in the use of the tool across different settings; future studies should explore the use of the PAI as a screen for maternal behaviour that place children at risk.
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Affiliation(s)
- Sarah Foley
- Centre for Family Research, University of Cambridge, Cambridge, UK.
| | - Claire Hughes
- grid.5335.00000000121885934Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Aja Louise Murray
- grid.4305.20000 0004 1936 7988Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Adriana Baban
- grid.7399.40000 0004 1937 1397Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Asvini D. Fernando
- grid.45202.310000 0000 8631 5388Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Bernadette Madrid
- grid.11159.3d0000 0000 9650 2179Child Protection Unit, University of the Philippines, Manila, Philippines
| | - Joseph Osafo
- grid.8652.90000 0004 1937 1485Department of Psychology, University of Ghana, Legon, Accra, Ghana
| | - Siham Sikander
- grid.413930.c0000 0004 0606 8575Health Services Academy, Islamabad, Pakistan
| | - Fahad Abbasi
- grid.413930.c0000 0004 0606 8575Health Services Academy, Islamabad, Pakistan
| | - Susan Walker
- grid.461576.70000 0000 8786 7651Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Bao-Yen Luong-Thanh
- grid.440798.6Institute for Community Health Research, Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Thang Van Vo
- grid.440798.6Institute for Community Health Research, Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Mark Tomlinson
- grid.11956.3a0000 0001 2214 904XDepartment of Psychology, Stellenbosch University, Stellenbosch, South African Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa ,grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Pasco Fearon
- grid.83440.3b0000000121901201Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Catherine L. Ward
- grid.7836.a0000 0004 1937 1151Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Sara Valdebenito
- grid.5335.00000000121885934Institute of Criminology, University of Cambridge, Cambridge, UK
| | - Manuel Eisner
- grid.5335.00000000121885934Institute of Criminology, University of Cambridge, Cambridge, UK
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12
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Do HP, Baker PRA, Vo TV, Luong-Thanh BY, Nguyen LH, Valdebenito S, Eisner M, Tran BX, Hoang TD, Dunne MP. Brief screening for maternal mental health in Vietnam: Measures of positive wellbeing and perceived stress predict prenatal and postnatal depression. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2020.100047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Luong-Thanh BY, Nguyen LH, Murray L, Eisner M, Valdebenito S, Hoang TD, Phuc Do H, Vo TV. Depression and its associated factors among pregnant women in central Vietnam. Health Psychol Open 2021; 8:2055102920988445. [PMID: 33598304 PMCID: PMC7841685 DOI: 10.1177/2055102920988445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To date, little attention has been given to prenatal depression, especially in low and middle-income countries. The aim of this research was to assess the prevalence of depression and its associated factors amongst pregnant women in a central Vietnamese city. This cross-sectional study included 150 pregnant women from 29 to 40 weeks of gestation, from eight wards of Hue city, via quota sampling from February to May 2019. We employed the Patient Health Questionnaire (PHQ-9) to assess depression. Findings suggest the need to provide routine screening of pregnant women in primary care for depressive symptoms and other mental health problems.
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Affiliation(s)
- Bao-Yen Luong-Thanh
- Faculty of Public Health and Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Vietnam
| | - Lan Hoang Nguyen
- Faculty of Public Health and Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Vietnam
| | - Linda Murray
- College of Health Sciences, Massey University, New Zealand
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, United Kingdom
| | - Sara Valdebenito
- Institute of Criminology, University of Cambridge, United Kingdom
| | - Tuyen Dinh Hoang
- Faculty of Public Health and Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Vietnam
| | - Huyen Phuc Do
- School of Public Health and Social Work, Queensland University of Technology (QUT), Australia
| | - Thang Van Vo
- Faculty of Public Health and Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Vietnam
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