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Ravaldi C, Mosconi L, Crescioli G, Lombardo G, Russo I, Morese A, Ricca V, Vannacci A. Are midwives trained to recognise perinatal depression symptoms? Results of MAMA (MAternal Mood Assessment) cross-sectional survey in Italy. Arch Womens Ment Health 2024; 27:567-576. [PMID: 38308142 PMCID: PMC11230996 DOI: 10.1007/s00737-024-01439-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/29/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE To assess the knowledge, clinical experience, and attitudes of Italian midwives toward perinatal depression (PND) and to explore how these factors impact the quality of care. METHODS We conducted a cross-sectional online survey among 152 midwives employed in public hospitals across Italy. The questionnaire covered a range of topics, including demographic data, professional experience, knowledge of PND symptoms, risk factors, and clinical management, as well as communication skills and personal experiences with PND cases. RESULTS A concerning 76.3% of midwives displayed inadequate knowledge of PND based on current scientific literature. Those with a more comprehensive understanding were notably more confident in their practice, expressing significantly fewer apprehensions about communicating with mothers (25.8% vs 74.2%) and lesser concerns about the mothers' future well-being (38.9% vs 62.95%). The survey results also emphasised the midwives' call for specialised guidelines and formal training in PND management and underscored the value of communication skills, continuity of care, and family engagement in supporting affected mothers. CONCLUSION This inaugural study sheds light on the current state of knowledge and attitudes among Italian midwives regarding PND. It pinpoints crucial areas for educational enhancement and practice improvement, suggesting that elevated levels of midwife expertise in PND could significantly elevate the standard of care and expedite early diagnosis and treatment.
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Affiliation(s)
- Claudia Ravaldi
- PEARL Perinatal Research Laboratory, CiaoLapo Foundation, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Laura Mosconi
- PEARL Perinatal Research Laboratory, CiaoLapo Foundation, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Giada Crescioli
- PEARL Perinatal Research Laboratory, CiaoLapo Foundation, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
| | - Giulia Lombardo
- Unit of Obstetrics and Gynecology, Parma University Hospital, Parma, Italy
| | - Ilenia Russo
- Unit of Obstetrics and Gynecology, "S. Marta E S. Verera" Hospital, ASP Catania, Acireale, Italy
| | - Angelo Morese
- Section of Pediatrics, Obstetrics and Gynecology and Nursing, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Section of Psychiatry, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alfredo Vannacci
- PEARL Perinatal Research Laboratory, CiaoLapo Foundation, Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy.
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Werner E, Le HN, Babineau V, Grubb M. Preventive interventions for perinatal mood and anxiety disorders: A review of selected programs. Semin Perinatol 2024:151944. [PMID: 39048416 DOI: 10.1016/j.semperi.2024.151944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Perinatal mood and anxiety disorders (PMADs) have high prevalence rates and profound deleterious effects on birthing people, families, and society. Counseling interventions have been shown to be effective and carry minimal risk. We review here the protocols and clinical trial data of four preventive counseling interventions that are effective at preventing PMADs. We present the Mothers and Babies (MB) program, a cognitive-behavioral preventive intervention, and Reach Out, Stay Strong, Essentials for mothers of newborns (ROSE), an interpersonal psychotherapy preventive intervention. We also present Mindfulness-Based Cognitive Therapy for Perinatal Depression (MBCT- PD), a preventive intervention that combines a cognitive-behavioral and mindfulness-based approach, and Practical Resources for Effective Postpartum Parenting (PREPP), a parent-infant dyadic intervention with psychodynamic, cognitive-behavioral, mindfulness-based, and psychoeducational elements. We recommend that screening for risk of PMADs (not just current mood symptoms) and providing preventive interventions to those at risk should be included as part of standard obstetrics care.
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Affiliation(s)
- Elizabeth Werner
- Department of Psychiatry, Columbia University Irving Medical Center, USA; Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, USA.
| | - Huynh-Nhu Le
- Department of Psychological and Brain Sciences, George Washington University, USA
| | - Vanessa Babineau
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, USA
| | - Myrriam Grubb
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, USA
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Mathew A, Akpotu IC, Lockwood MB, Tirkey AJ, Patil CL, Doorenbos AZ. Critical Realism in Symptom Science - A Scoping Review. ANS Adv Nurs Sci 2024:00012272-990000000-00091. [PMID: 38864677 DOI: 10.1097/ans.0000000000000534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
There has been an increasing interest in research positioned within critical realism (CR). This analysis aimed to determine how CR has been applied in symptom science through a scoping review of the literature. Fifty-two articles were identified through searches in seven databases and search engines, and grey literature. Quantitative and qualitative analyses were performed using Excel and ATLAS.ti 8.0. Review findings indicate that CR has been used to examine two key aspects of symptoms - symptom experiences and symptom interventions. The details of how CR was operationalized are presented. This first scoping review highlights how a critical realist lens would help examine individual and contextual factors that influence symptom experiences, response to interventions, and outcomes.
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Affiliation(s)
- Asha Mathew
- Author Affiliations: Department of Surgical Nursing, College of Nursing, Christian Medical College Vellore, The Tamil Nadu Dr M.G.R. Medical University, Chennai, India (Dr. Mathew); Head and Neck Surgery Unit II, Christian Medical College Vellore, India (Dr. Tirkey); Department of Biobehavioral Sciences, College of Nursing, University of Illinois, Chicago, USA (Ms Akpotu and Drs. Lockwood and Doorenbos); Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan (Dr. Patil); and University of Illinois Cancer Center, Chicago, USA (Dr. Doorenbos)
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Vázquez-Vázquez A, Rougeaux E, Dib S, Fewtrell M, Wells JC. The impact of maternal mood and economic stress during Covid-19 pandemic on infant behaviour: Findings from the cross-sectional UK Covid-19 New Mum Study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003095. [PMID: 38630667 PMCID: PMC11023226 DOI: 10.1371/journal.pgph.0003095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
The UK Covid-19 New Mum Study (cross-sectional study) recorded maternal experience during the early stages of the pandemic. Our previous analyses showed that the pandemic and 2020 national lockdown negatively impacted maternal mental health. Here, we describe changes in infant behaviour (crying and fussiness) reported by the mother during the Covid-19 pandemic compared to beforehand, and test whether these changes are associated with maternal variables (mental health, coping, financial insecurity, income and household support). We included only responses of mothers whose infants were born before the pandemic started (n = 2,031). Composite scores for maternal mental health and coping were obtained using principal components analysis. Multivariable logistic regression analysis was used to test whether maternal mood and coping and household financial stresses were associated with changes in infant behaviour considered negative (becoming fussier, crying more). Adjusting for confounders, the odds of the infant being fussier and crying more increased by 52% (OR = 1.52, 95% CI = 1.35;1.72) and 64% (OR = 1.64, 95% CI = 1.38;1.95), respectively, if the mother experienced poorer mental health. If the mother coped better and had more time to focus on her health and interests, the odds of these outcomes decreased by 27% (OR = 0.73, 95% CI = 0.65;0.83) and 23% (OR = 0.77, 95% CI = 0.65;0.91), respectively. Mothers who reported that, during the lockdown, household chores were more equally divided 'to a high extent' had 40% (OR = 0.60, 95% CI = 0.39;0.92) lower odds of reporting that their babies became fussier. Reporting major/moderate impact on food expenses was associated with the infant crying more (OR = 2.52, 95% CI = 1.16;5.50). Our results are consistent with previous studies showing that maternal wellbeing plays a significant role in children's behavioural changes during lockdowns. We need strategies to improve mental health and enable women to develop the skills to maintain resilience and reassure their children in challenging times.
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Affiliation(s)
- Adriana Vázquez-Vázquez
- Childhood Nutrition Research Centre, Population, Policy & Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Emeline Rougeaux
- Childhood Nutrition Research Centre, Population, Policy & Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sarah Dib
- Childhood Nutrition Research Centre, Population, Policy & Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mary Fewtrell
- Childhood Nutrition Research Centre, Population, Policy & Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jonathan C. Wells
- Childhood Nutrition Research Centre, Population, Policy & Practice Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
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Premji S, McNeil DA, Santana MJ, Spackman E. Examining the Relationship Between Screening for Postpartum Depression and Associated Child Health Service Utilization and Costs: A Study Using the All Our Families Cohort and Administrative Data. Matern Child Health J 2024; 28:567-577. [PMID: 37938441 PMCID: PMC10914927 DOI: 10.1007/s10995-023-03831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Despite a recognized association between maternal postpartum depression (PPD) and adverse child health outcomes, evidence examining the relationship between PPD symptoms and associated child health service utilization and costs remains unclear. In addition, there is a paucity of evidence describing the relationship between early identification of maternal PPD and associated health service utilization and costs for children. This study aims to address this gap by describing the secondary associations of screening for maternal PPD and annual health service utilization and costs for children over their first five years of life. METHODS Mothers and children enrolled in the prospective All Our Families cohort were linked to provincial administrative data in Alberta, Canada. Multivariable generalized linear models were used to estimate the average annual inpatient, outpatient, physician, and total health service utilization and costs from a public health system perspective for children of mothers screened high risk for PPD, low/moderate risk for PPD, or unscreened. RESULTS Total mean costs were greatest for children during their first year of life than other years. Those whose mothers were not screened had significantly lower costs compared to those whose mothers were screened low/moderate risk, despite equivalent health service utilization. DISCUSSION Findings from this study describe the secondary associations of screening for maternal PPD using a public health system perspective. More research is required to fully understand variations in health costs for children across maternal PPD screening categories.
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Affiliation(s)
- Shainur Premji
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Centre for Health Economics, University of York, York, UK.
| | - Deborah Ann McNeil
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Maria Jose Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Chee RM, Capper TS, Muurlink OT. Social media influencers' impact during pregnancy and parenting: A qualitative descriptive study. Res Nurs Health 2024; 47:7-16. [PMID: 37845594 DOI: 10.1002/nur.22350] [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: 05/19/2023] [Revised: 09/26/2023] [Accepted: 10/07/2023] [Indexed: 10/18/2023]
Abstract
Pregnant people and parents engage with social media networking sites seeking support and information that is shared in a relatable way. Engaging with social media influencers (SMIs) and their followers, however, may have both affirming and harmful effects. SMIs can facilitate information-sharing, discussion, and supportive behaviors, but engaging with SMIs can lead to negative experiences and exposure to misinformation. To date, little is known about the impacts of following influencers during pregnancy and early parenthood. The aim of this study was to explore how engaging with SMIs impacts pregnant people and parents of children aged 5 or under in Australia. A qualitative descriptive approach was taken. Qualitative data from 85 anonymously completed online written surveys were thematically analyzed using Braun & Clarke's six-step process. Five overarching themes and two subthemes were identified. The first theme, "Comparisons of self," held two subthemes: "Unfavorable comparisons of self to SMIs" and "Favorable comparisons of self to SMIs." Additional themes were "A virtual community of inspiration and togetherness," "Sharing of information, opinions & experiences," "Gatekeeping self-efficacy," and "Credibility." The findings of the study indicated that discordance between influencer-mediated expectations of parenthood and a person's actual experience may affect well-being and perceptions of parental self-efficacy. Information sought from influencers may substitute for face-to-face education by clinicians. Health professionals who are also influencers may possess the ability to provide evidence-based information. This content, however, is not without risk for bias or incompleteness.
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Affiliation(s)
- Rachelle M Chee
- School of Nursing, Midwifery & Social Sciences, CQUniversity Australia, Brisbane, Australia
| | - Tanya S Capper
- School of Nursing, Midwifery & Social Sciences, CQUniversity Australia, Brisbane, Australia
| | - Olav T Muurlink
- School of Business & Law, CQUniversity Australia, Brisbane, Australia
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Ruan JM, Wu LJ. Postpartum depression and partner support during the period of lactation: Correlation research and its influencing factors. World J Psychiatry 2024; 14:119-127. [PMID: 38327897 PMCID: PMC10845228 DOI: 10.5498/wjp.v14.i1.119] [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: 10/26/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Postpartum depression (PPD) not only affects the psychological and physiological aspects of maternal health but can also affect neonatal growth and development. Partners who are in close contact with parturient women play a key role in communication and emotional support. This study explores the PPD support relationship with partners and its influencing factors, which is believed to establish psychological well-being and improve maternal partner support. AIM To explore the correlation between PPD and partner support during breastfeeding and its influencing factors. METHODS Convenience sampling was used to select lactating women (200 women) who underwent postpartum examinations at the Huzhou Maternity and Child Health Care Hospital from July 2022 to December 2022. A cross-sectional survey was conducted on the basic information (general information questionnaire), depression level [edinburgh postnatal depression scale (EPDS)], and partner support score [dyadic coping inventory (DCI)] of the selected subjects. Pearson's correlation analysis was used to analyze the correlation between PPD and DCI in lactating women. Factors affecting PPD levels during lactation were analyzed using multiple linear regression. RESULTS The total average score of EPDS in 200 lactating women was (9.52 ± 1.53), and the total average score of DCI was (115.78 ± 14.90). Dividing the EPDS, the dimension scores were: emotional loss (1.91 ± 0.52), anxiety (3.84 ± 1.05), and depression (3.76 ± 0.96). Each dimension of the DCI was subdivided into: Pressure communication (26.79±6.71), mutual support (39.76 ± 9.63), negative support (24.97 ± 6.68), agent support (6.87 ± 1.92), and joint support (17.39 ± 4.19). Pearson's correlation analysis demonstrated that the total mean score and individual dimension scores of EPDS during breastfeeding were inversely correlated with the total score of partner support, stress communication, mutual support, and co-support (P < 0.05). The total mean score of the EPDS and its dimensions were positively correlated with negative support (P < 0.05). Multiple linear regression analysis showed that the main factors affecting PPD during breastfeeding were marital harmony, newborn health, stress communication, mutual support, negative support, co-support, and the total score of partner support (P < 0.05). CONCLUSION PPD during breastfeeding was associated with marital harmony, newborn health, stress communication, mutual support, negative support, joint support, and the total DCI score.
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Affiliation(s)
- Ji-Ming Ruan
- Department of Obstetrics and Gynecology, Huzhou Maternity and Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
| | - Ling-Juan Wu
- Department of Obstetrics and Gynecology, Huzhou Maternity and Child Health Care Hospital, Huzhou 313000, Zhejiang Province, China
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O'Callaghan L, Chertavian E, Johnson SJ, Ferries E, Deligiannidis KM. The cost-effectiveness of zuranolone versus selective serotonin reuptake inhibitors for the treatment of postpartum depression in the United States. J Med Econ 2024; 27:492-505. [PMID: 38465615 DOI: 10.1080/13696998.2024.2327946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/05/2024] [Indexed: 03/12/2024]
Abstract
AIMS The objective of this research is to evaluate the cost-effectiveness of zuranolone, the first oral treatment indicated for postpartum depression (PPD) in adults approved by the United States Food and Drug Administration. METHODS Zuranolone and selective serotonin reuptake inhibitor (SSRI) trial-based efficacy was derived from an indirect treatment comparison. Long-term efficacy outcomes were based on a large longitudinal cohort study. Maternal health utility values were derived from trial-based, short-form 6-D responses. Other inputs were derived from literature and economic data from the US Bureau of Labor Statistics. We estimated costs (2023 US dollars) and quality-adjusted life-years (QALYs) for patients with PPD treated with zuranolone (14-day dosing) or SSRIs (chronic dosing). The indirect costs and QALYs of the children and partners were also estimated. RESULTS The incremental cost-effectiveness ratio for zuranolone versus SSRIs was $94,741 per QALY gained over an 11-year time horizon. Maternal total direct medical costs averaged $84,318 in the zuranolone arm, compared to $86,365 in the SSRI arm. Zuranolone-treated adults averaged 6.178 QALYs compared to 6.116 QALYs for the SSRI arm. Costs and utilities for the child and partner were also included in the base case. Drug and administration costs for zuranolone averaged $15,902, compared to $30 for SSRIs over the studied time horizon. Results were sensitive to the model time horizon. LIMITATIONS As head-to-head trials were not available to permit direct comparison, efficacy inputs were derived from an indirect treatment comparison which can be confounded by cross-trial differences. The data used are reflective of a general PPD population rather than marginalized individuals who may be at a greater risk for adverse PPD outcomes. The model likely excludes unmeasured effects for patient, child, and partner. CONCLUSIONS This economic model's results suggest that zuranolone is a more cost-effective therapy compared to SSRIs for treating adults with PPD.
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Affiliation(s)
| | | | | | | | - Kristina M Deligiannidis
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Meltzer-Brody S, Gerbasi ME, Mak C, Toubouti Y, Smith S, Roskell N, Tan R, Chen SYS, Deligiannidis KM. Indirect comparisons of relative efficacy estimates of zuranolone and selective serotonin reuptake inhibitors for postpartum depression. J Med Econ 2024; 27:582-595. [PMID: 38523596 DOI: 10.1080/13696998.2024.2334160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
AIMS Estimate relative efficacy of zuranolone, a novel oral, Food and Drug Administration-approved treatment for postpartum depression (PPD) in adults vs. selective serotonin reuptake inhibitors (SSRIs) and combination therapies used for PPD in the United States. MATERIALS AND METHODS Randomized controlled trials (RCTs) for zuranolone and SSRIs, identified from systematic review, were used to construct evidence networks, linking via common comparator arms. Due to heterogeneity in placebo responses, matching-adjusted indirect comparison (MAIC) was applied, statistically weighting the zuranolone treatment arm of Phase 3 SKYLARK Study (NCT04442503) to the placebo arm of RCTs investigating SSRIs for PPD. MAIC outputs were applied in Bucher indirect treatment comparisons (ITCs) and network meta-analysis (NMA), using Edinburgh Postnatal Depression Scale (EPDS) and 17-item Hamilton Rating Scale for Depression (HAMD-17) change from baseline (CFB) on Days 3, 15, 28 (Month 1), 45, and last observation (Day 45, Week 12/18). RESULTS Larger EPDS CFB was observed among zuranolone-treated vs. SSRI-treated patients from Day 15 onward. Zuranolone-treated (vs. SSRI-treated) patients exhibited 4.22-point larger reduction in EPDS by Day 15 (95% confidence interval: -6.16, -2.28) and 7.43-point larger reduction at Day 45 (-9.84, -5.02) with Bucher ITC. NMA showed EPDS reduction for zuranolone was 4.52 (-6.40, -2.65) points larger than SSRIs by Day 15 and 7.16 (-9.47, -4.85) larger at Day 45. Lack of overlap between study populations substantially reduced effective sample size post-matching, making HAMD-17 CFB analysis infeasible. LIMITATIONS Limited population overlap between SKYLARK Study and RCTs reduced feasibility of undertaking HAMD-17 CFB ITCs and may introduce uncertainty to EPDS CFB ITC results. CONCLUSIONS Analysis showed zuranolone-treated patients with PPD experienced greater symptom improvement than SSRI-treated patients from Day 15 onward, with largest mean difference at Day 45. Adjusting for differences between placebo arms, zuranolone may be associated with greater PPD symptom improvement (measured by EPDS) vs. SSRIs.
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Affiliation(s)
- Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | | | | | | | | | - Robin Tan
- Sage Therapeutics, Inc., Cambridge, MA, USA
| | - Shih-Yin Sharon Chen
- Sage Therapeutics, Inc., Cambridge, MA, USA
- Biogen Inc., Cambridge, MA, USA
- Lumanity Inc., Sheffield, UK
| | - Kristina M Deligiannidis
- Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Mattera JA, Campagna AX, Goodman SH, Gartstein MA, Hancock GR, Stowe ZN, Newport DJ, Knight BT. Associations between mothers' and fathers' depression and anxiety prior to birth and infant temperament trajectories over the first year of life: Evidence from diagnoses and symptom severity. J Affect Disord 2023; 343:31-41. [PMID: 37741466 PMCID: PMC10672733 DOI: 10.1016/j.jad.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/11/2023] [Accepted: 09/17/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Developmental shifts in infant temperament predict distal outcomes including emerging symptoms of psychopathology in childhood. Thus, it is critical to gain insight into factors that shape these developmental shifts. Although parental depression and anxiety represent strong predictors of infant temperament in cross-sectional research, few studies have examined how these factors influence temperament trajectories across infancy. METHODS We used latent growth curve modeling to examine whether mothers' and fathers' anxiety and depression, measured in two ways - as diagnostic status and symptom severity - serve as unique predictors of developmental shifts in infant temperament from 3 to 12 months. Participants included mothers (N = 234) and a subset of fathers (N = 142). Prior to or during pregnancy, both parents were assessed for lifetime diagnoses of depression and anxiety as well as current severity levels. Mothers rated their infants' temperament at 3, 6, and 12 months of age. RESULTS Mothers' depression and anxiety primarily predicted initial levels of temperament at 3 months. Controlling for mothers' symptoms, fathers' depression and anxiety largely related to temperament trajectories across infancy. Lifetime diagnoses and symptom severities were associated with distinct patterns. LIMITATIONS Infant temperament was assessed using a parent-report measure. Including an observational measure would provide a more comprehensive picture of the infants' functioning. CONCLUSIONS These results indicate that mothers' and fathers' mental health are uniquely associated with infant temperament development when measured using diagnostic status and/or symptom severity. Future studies should examine whether these temperament trajectories mediate intergenerational transmission of risk for depression and anxiety.
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Affiliation(s)
| | | | | | - Maria A Gartstein
- Department of Psychology, Washington State University, Pullman, WA, USA
| | - Gregory R Hancock
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD, USA
| | - Zachary N Stowe
- Department of Psychiatry and Behavioral Sciences, University of Wisconsin at Madison, Madison, WI, USA
| | - D Jeffrey Newport
- Departments of Psychiatry & Behavioral Sciences and Women's Health, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Bettina T Knight
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Pratt AA, Sadler AG, Thomas EBK, Syrop CH, Ryan GL, Mengeling MA. Incidence and risk factors for postpartum mood and anxiety disorders among women veterans. Gen Hosp Psychiatry 2023; 84:112-124. [PMID: 37433239 DOI: 10.1016/j.genhosppsych.2023.06.013] [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: 01/23/2023] [Revised: 06/15/2023] [Accepted: 06/23/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Our aim was to determine rates of postpartum mood and anxiety disorders (PMADs) among U.S. women Veterans and the overlap among PMADs. We further sought to identify PMAD risk factors, including those unique to military service. METHODS A national sample of women Veterans completed a computer-assisted telephone interview (N = 1414). Eligible participants were aged 20-45 and had separated from service within the last 10 years. Self-report measures included demographics, general health, reproductive health, military exposures, sexual assault, childhood trauma, and posttraumatic stress disorder (PTSD). The PMADs of interest were postpartum depression (PPD), postpartum anxiety (PPA) and postpartum PTSD (PPPTSD). This analysis included 1039 women Veterans who had ever been pregnant and who answered questions about PPMDs related to their most recent pregnancy. RESULTS A third (340/1039, 32.7%) of participants were diagnosed with at least one PMAD and one-fifth (215/1039, 20.7%) with two or more. Risk factors common for developing a PMAD included: a mental health diagnosis prior to pregnancy, a self-report of ever having had a traumatic birth experience, and most recent pregnancy occurring during military service. Additional risk factors were found for PPD and PPPTSD. CONCLUSION Women Veterans may be at an increased risk for developing PMADs due to high rates of lifetime sexual assault, mental health disorders, and military-specific factors including giving birth during military service and military combat deployment exposures.
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Affiliation(s)
- Alessandra A Pratt
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Building 42, Iowa City, IA 52246, USA.
| | - Anne G Sadler
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Building 42, Iowa City, IA 52246, USA; VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246, USA; Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Emily B K Thomas
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246, USA; Department of Psychological and Brain Sciences, University of Iowa College of Liberal Arts and Sciences, 340 Iowa Ave, Iowa City, IA 52246, USA
| | - Craig H Syrop
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Ginny L Ryan
- Puget Sound VA Healthcare System, 1660 S Columbian Way, Seattle, WA 98108, USA; University of Washington Medical Center, 1959 NE Pacific Street, Box 356460, Seattle, WA 98195, USA
| | - Michelle A Mengeling
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Building 42, Iowa City, IA 52246, USA; VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246, USA; Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
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12
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Bales M, Pambrun E, Maguet C, van der Waerden J, Glangeaud-Freudenthal N, Charles MA, Bois C, Melchior M, Milgrom J, Falissard B, Verdoux H, Sutter-Dallay AL. Pathways between Risk/Protective Factors and Maternal Postnatal Depressive Symptoms: The ELFE Cohort. J Clin Med 2023; 12:jcm12093204. [PMID: 37176644 PMCID: PMC10179307 DOI: 10.3390/jcm12093204] [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: 02/25/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVE The risk factors for postnatal depressive symptoms (PNDS) are numerous, but little is known about the protective factors or the interactions between different exposures. The present study explored the pathways between maternal, infant and parenthood vulnerabilities or risk/protective factors and PNDS at 2 months postpartum (PP) in a large sample of women from the general population. METHODS We used data from the French ELFE cohort, a nationally representative cohort of children followed-up from birth. The available information about vulnerabilities or risk/protective factors for PNDS was collected during the maternity ward stay (mother or medical records) and at 2 months PP (mother by phone). PNDS were evaluated with the Edinburgh Postnatal Depression Scale (EPDS) at 2 months. A measurement model was built based on the psychosocial model for PNDS of Milgrom and colleagues using exploratory factor analysis. The Structural Equation Model was used to investigate the pathways between vulnerability, risk/protective factors and PNDS at 2 months PP. RESULTS In the study sample (n = 11,583), a lack of a partner's perceived antenatal emotional support, consultation with a mental health specialist before pregnancy, family financial difficulties, prenatal psychological distress and a difficult pregnancy experience were directly associated with the severity of maternal PNDS at 2 months PP, as well as lack of perceived postnatal support. Family financial difficulties and consultation with a mental health specialist before pregnancy were also indirectly associated with the intensity of PNDS through a lack of perceived antenatal emotional support, a difficult pregnancy experience, prenatal psychological distress and a lack of perceived postnatal support. Regarding infant and parenthood characteristics, infant self-regulation difficulties, maternal difficulty in understanding infant crying and infant hospitalisation were directly associated with PNDS severity at 2 months PP, while maternal difficulty in understanding an infant's cries was also indirectly associated with infant self-regulation difficulties. CONCLUSIONS Perinatal professional support should begin antenatally and target the couple's prenatal functioning, with particular attention to women presenting a history of psychiatric disorders, especially those of low socioeconomic status. After delivery, addressing infant and parenthood characteristics is also recommended.
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Affiliation(s)
- Mélanie Bales
- Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux University, 33000 Bordeaux, France
- University Department of Child and Adolescent Psychiatry, Charles Perrens Hospital, 33076 Bordeaux, France
| | - Elodie Pambrun
- Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux University, 33000 Bordeaux, France
| | - Charlotte Maguet
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, INSERM U1136, Sorbonne Université, 75012 Paris, France
| | - Judith van der Waerden
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, INSERM U1136, Sorbonne Université, 75012 Paris, France
| | - Nine Glangeaud-Freudenthal
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris Descartes University, 75014 Paris, France
| | | | - Corinne Bois
- INED, INSERM EFS, Joint Unit ELFE, 75004 Paris, France
| | - Maria Melchior
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, Équipe de Recherche en Épidémiologie Sociale, INSERM U1136, Sorbonne Université, 75012 Paris, France
| | - Jeannette Milgrom
- Parent-Infant Research Institute, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne 3010, Australia
| | - Bruno Falissard
- CESP/INSERM 1018 (Centre de Recherche en Épidémiologie et Santé des Populations), Maison de Solenn, 75619 Paris, France
| | - Hélène Verdoux
- Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux University, 33000 Bordeaux, France
- University Department of Child and Adolescent Psychiatry, Charles Perrens Hospital, 33076 Bordeaux, France
| | - Anne-Laure Sutter-Dallay
- Inserm, Bordeaux Population Health Research Center, U1219, Bordeaux University, 33000 Bordeaux, France
- University Department of Child and Adolescent Psychiatry, Charles Perrens Hospital, 33076 Bordeaux, France
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13
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Tsai SY. Perinatal Depressive Symptoms among Pregnant Employees in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3354. [PMID: 36834062 PMCID: PMC9959548 DOI: 10.3390/ijerph20043354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
This was a longitudinal study of perinatal depressive symptoms among females employed in a large electronics manufacturer in Taiwan, conducted from August 2015 through October 2016. We used questionnaires to collect data on perceived job strain, social support, and the Edinburgh Postnatal Depression Scale (EPDS) scores at three perinatal time-points (pregnancy, delivery, and return to the workplace). Of the 153 employees who agreed to participate, 82 completed the three stages. The prevalence of perinatal depressive symptoms for the three stages was 13.7%, 16.8%, and 15.9%, respectively. The incidence at 3 weeks after childbirth and 1 month after returning to the workplace was 11.0% and 6.8%, respectively. During the third trimester of pregnancy, sleep problems (odds ratio [OR] = 6.2, 95% confidence Interval [95% CI] = 2.1-19.3), perceived job strain (OR = 4.4, 95% CI = 1.5-14.3), and lack of support from family or friends (OR = 7.0, 95% CI = 1.3-40.8) were significant risk factors. Sleep problems (OR = 6.0, 95% CI = 1.7-23.5) and lack of support from family or friends (OR = 27.6, 95% CI = 4.1-322.3) were associated with an increased risk of perinatal depressive symptoms at 3 weeks after childbirth. After returning to the workplace, perceived job strain (OR = 18.2, 95% CI = 2.2-435.7) was a significant risk factor. These findings could provide insight about early symptom detection, and more studies to clarify the association would be worthwhile.
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Affiliation(s)
- Su-Ying Tsai
- Department of Health Management, I-Shou University, Kaohsiung 82445, Taiwan
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14
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Sufredini F, Catling C, Zugai J, Chang S. The effects of social support on depression and anxiety in the perinatal period: A mixed-methods systematic review. J Affect Disord 2022; 319:119-141. [PMID: 36108877 DOI: 10.1016/j.jad.2022.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The social support offered to women in the perinatal period can buffer against depression and anxiety. The sources and types of support that reduce maternal levels of depression and anxiety are not well understood. AIMS To investigate the effects of structural and functional support on depression and anxiety in women in the perinatal period, and to explore the experiences of women around support during the perinatal period. METHOD A comprehensive search of six electronic databases was undertaken. Relevant studies published from January 2010 to April 2020 were included (PROSPERO reference number: CRD42020194228). Quantitative and qualitative studies were eligible if they reported the effects of, or had themes related to receiving functional or structural support in the perinatal period on women's levels of depression or anxiety. Qualitative data was synthesised using a thematic synthesis method. Quantitative data could not be pooled due to the lack of comparable RCTs or cohort studies and was thus presented in a narrative form. RESULTS Fifty-one articles (41 quantitative and 10 qualitative studies) were included. Analysis of quantitative studies demonstrated that insufficient support from partner, friends and family was associated with greater risk of symptoms of depression and anxiety. Distance-delivered interventions (via internet or telephone) diminished levels of depression and anxiety. Qualitative data revealed three overarching themes: appreciating all forms of support in the perinatal period, recognising appropriate and inappropriate support from health professionals and services, and having barriers to mobilising functional and structural support. LIMITATIONS Grey literature was not explored and search strategies only included English, Spanish and Portuguese language articles. The reviewed studies were heterogeneous and for this reason, quantitative assessments were not feasible. CONCLUSION Support from specific sources such as family members, friends who are also mothers, health professionals, neighbours, supervisors, co-workers and online communities still need to be further investigated. Implications for health professionals involved in the care of women in the perinatal period are discussed.
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Affiliation(s)
| | - Christine Catling
- Centre for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Australia
| | - Joel Zugai
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Midwifery and Health Sciences, University of Notre Dame, Australia
| | - Sungwon Chang
- Improving Care for Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Australia
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15
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Qiu X, Sun X, Li HO, Wang DH, Zhang SM. Maternal alcohol consumption and risk of postpartum depression: a meta-analysis of cohort studies. Public Health 2022; 213:163-170. [PMID: 36423494 DOI: 10.1016/j.puhe.2022.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/30/2022] [Accepted: 08/30/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The relationship between maternal alcohol consumption and postpartum depression (PPD) is still controversial. The objective of the present study was to assess the association between maternal alcohol consumption and the risk of developing PPD by means of a meta-analysis of cohort studies. STUDY DESIGN This was a meta-analysis. METHODS PubMed, Web of Science, Embase, Cochrane Library, China Biology Medicine disc, Chinese National Knowledge Infrastructure, Weipu, and Wanfang databases were searched up to February 4, 2021, to identify relevant studies that evaluated the association between maternal alcohol consumption and PPD. Meta-analysis was conducted using RevMan software and Stata software. Subgroup and sensitivity analyses were performed to explore the potential heterogeneity source, and Begg's funnel plots and Begg's linear regression test were conducted to assess the potential publication bias. RESULTS A total of 12 studies involving 50,377 participants were identified in our study. Overall, pregnant women who were exposed to alcohol were at a significantly greater risk of developing PPD compared with those who did not consume alcohol (odds ratio = 1.21; 95% confidence interval: 1.04-1.41; P = 0.020). CONCLUSIONS Maternal alcohol consumption is significantly associated with the risk of developing PPD. These results emphasize the necessity of enhancing health awareness, improving the public health policies and regulations concerning alcohol use, and strengthening the prevention and intervention of maternal alcohol consumption to promote maternal mental health.
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Affiliation(s)
- X Qiu
- Department of Nursing, Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - X Sun
- Department of Humanistic Nursing, School of Nursing, Changsha Medical University, Changsha, Hunan, China
| | - H O Li
- Department of Humanistic Nursing, School of Nursing, Changsha Medical University, Changsha, Hunan, China
| | - D H Wang
- Department of Humanistic Nursing, School of Nursing, Changsha Medical University, Changsha, Hunan, China
| | - S M Zhang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
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16
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Kusumawati Y, Widyawati W, Dewi FST. [Vulnerable to mental health problems: Pregnant women and husband's perception in Surakarta, Indonesia]. ENFERMERIA CLINICA (ENGLISH EDITION) 2022; 32:334-343. [PMID: 36084999 DOI: 10.1016/j.enfcle.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 12/10/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aims to explore the perception of women and their husbands on the vulnerability of pregnant women to mental health disorders. METHOD Qualitative study using a phenomenological approach. The inclusion criteria were pregnant women of the second and third-trimester gestation (13-35 weeks). The exclusion criteria were pregnant women with complications and who had a family record of mental disorders. Data was collected using focus group discussion and in-depth interviews at four Primary Health Cares in Surakarta, Indonesia. Then, the data were analyzed through thematic analysis, which was supported by the OpenCode 4.02® software. RESULTS This study uncovered two main topics, firstly the factors that trigger the vulnerability of pregnant women to experience mental disorders and secondly perceived barriers to managing mental health during pregnancy and postpartum. Pregnant women and husbands recognize that they need to get mental health information. CONCLUSION Unstable emotions during pregnancy are considered normal and neglected by their surroundings. Lack of knowledge about mental health in pregnancy justifies the need to increase education in this area in order to prevent prenatal and postpartum depression.
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Affiliation(s)
- Yuli Kusumawati
- Public Health Program, Faculty of Health Sciences, Universitas Muhammadiyah Surakarta, Central Java, Indonesia.
| | - Widyawati Widyawati
- Department of Pediatric and Maternity Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Fatwa Sari Tetra Dewi
- Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
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17
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Qiu X, Zhang S, Yan J. Gestational weight gain and risk of postpartum depression: A meta-analysis of observational studies. Psychiatry Res 2022; 310:114448. [PMID: 35227990 DOI: 10.1016/j.psychres.2022.114448] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/29/2022] [Accepted: 02/12/2022] [Indexed: 01/23/2023]
Abstract
The association between gestational weight gain (GWG) and postpartum depression (PPD) is still controversial. The present study aimed to assess the association between GWG and the risk of developing PPD by means of a meta-analysis. PubMed, Web of Science, Embase, Cochrane Library, China Biology Medicine disk, Chinese National Knowledge Infrastructure, Weipu, and Wanfang database were searched up to May 19, 2021 to identify relevant studies that evaluated the association between GWG and PPD. Meta-analysis was conducted by using RevMan software and Stata software. Subgroup and sensitivity analyses were carried out to explore the potential heterogeneity source, and Begg's funnel plots and Begg's linear regression test were performed to assess the potential publication bias. A total of sixteen studies involving 100,438 participants were identified in this study. Overall, the total, excessive and inadequate GWG was significantly associated with a higher risk of developing PPD. These results emphasize the necessity of strengthening the prevention and intervention of excessive and inadequate weight gain during pregnancy to promote maternal and infant health. However, further studies on the association between GWG at different stages of pregnancy and the risk of developing PPD are warranted.
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Affiliation(s)
- Xing Qiu
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Senmao Zhang
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jin Yan
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
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18
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Power C, Williams C, Brown A. Physical and Psychological Childbirth Experiences and Early Infant Temperament. Front Psychol 2022; 13:792392. [PMID: 35350728 PMCID: PMC8958029 DOI: 10.3389/fpsyg.2022.792392] [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: 10/10/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To examine how physical and psychological childbirth experiences affect maternal perceptions and experiences of early infant behavioural style (temperament). Background Unnecessary interventions may disturb the normal progression of physiological childbirth and instinctive neonatal behaviours that facilitate mother-infant bonding and breastfeeding. While little is known about how a medicalised birth may influence developing infant temperament, high impact interventions which affect neonatal crying and cortisol levels could have longer term consequences for infant behaviour and functioning. Methods A retrospective Internet survey was designed to fully explore maternal experiences of childbirth and her postnatal perceptions of infant behaviour. Data collected from 999 mother-infant dyads were analysed using Pearson's correlations and multiple analyses of covariance, employing the Bonferroni method of correction to establish initially significant variables. Multiple linear regressions were conducted to determine major perinatal contributors to perceived early infant temperament. Results Multiple regression analyses on each of the eight Mother and Baby Scales outcome variables indicated that early infant behavioural style (0-6 months) was largely predicted by subjective maternal states during and post-childbirth, postnatal depression scores, maternal personality traits and infant age. For example, infant age (Beta = 0.440, p = 0.000) was the most significant predictor of Alert-Responsive infant behaviour, followed by maternal Postnatal Positive experience (Beta = 0.181, p = 0.000). In contrast, depression (EPDS) scores (Beta = 0.370, p = 0.000) were the most significant predictor of Unsettled-Irregular infant behaviour, followed by Anxious-Afraid Birth Emotions (Beta = 0.171, p = 0.000) and infant age (Beta = -0.196, p = 0.000). Mothers also perceived their infants as more Alert-Responsive (Beta = 0.080, p = 0.010) and Easier overall (Beta = 0.085, p = 0.008) after a Supported birth experience. Conclusion Maternal and infant outcomes were influenced by multiple physical and psychological perinatal variables. The mother's subjective experience appeared to be of equal significance to more objective factors (e.g. birthplace/mode). Social support enhanced the mother's childbirth experience, benefitting her perceptions of her baby's early temperament. These findings provide further support for current World Health Organisation intrapartum guidelines (2018) on the importance of making childbirth a 'positive experience' for women.
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Affiliation(s)
- Carmen Power
- School of Health and Social Care, Faculty of Medicine, Health and Life Science, University of Swansea, Swansea, United Kingdom
| | - Claire Williams
- School of Psychology, Faculty of Medicine, Health and Life Science, University of Swansea, Swansea, United Kingdom
- Elysium Neurological Services, Elysium Healthcare, The Avalon Centre, Swindon, United Kingdom
| | - Amy Brown
- School of Health and Social Care, Faculty of Medicine, Health and Life Science, University of Swansea, Swansea, United Kingdom
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19
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Kmita G, Kiepura E, Niedźwiecka A. Maternal Mood and Perception of Infant Temperament at Three Months Predict Depressive Symptoms Scores in Mothers of Preterm Infants at Six Months. Front Psychol 2022; 13:812893. [PMID: 35153962 PMCID: PMC8826641 DOI: 10.3389/fpsyg.2022.812893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Postpartum depression is more prevalent in mothers and fathers of preterm infants compared to parents of full-term infants and may have long-term detrimental consequences for parental mental health and child development. The temperamental profile of an infant has been postulated as one of the important factors associated with parental depressiveness in the first months postpartum. This study aimed to examine the longitudinal relationship between depressive symptoms and perceived infant temperament at 3 months corrected age, and depressive symptoms at 6 months corrected age among mothers and fathers of infants born preterm. We assessed 59 families with infants born before the 34th gestational week using the Edinburgh Postnatal Depression Scale (EDPS) and the Infant Behavior Questionnaire-Revised. We found that mothers’ scores on EPDS and infants’ Orienting/regulation at 3 months corrected age predicted mothers’ EPDS scores at 6 months corrected age. In particular, higher depressive scores were related to higher depressive symptoms at 6 months corrected age, whereas higher infant Orienting/regulation was related to lower depressive symptoms at 6 months corrected age. Due to the low internal consistency of EPDS at 6 months for fathers, we were unable to conduct similar analyses for fathers. Our results point to the importance of considering both early indices of maternal mood as well as mother-reported measures of preterm infant temperament in the attempts to predict levels of maternal depressiveness in later months of an infant’s life. Further studies are urgently needed in order to better understand the associations between depressiveness and infant temperament in fathers, and with more consideration for the severity of the effects of infant prematurity.
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Affiliation(s)
- Grazyna Kmita
- Faculty of Psychology, University of Warsaw, Warsaw, Poland.,Institute of Mother and Child, Warsaw, Poland
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20
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Can the Healthy Start Risk Screen Predict Perinatal Depressive Symptoms among High-Risk Women? CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020180. [PMID: 35204899 PMCID: PMC8870092 DOI: 10.3390/children9020180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/01/2022] [Accepted: 01/28/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Early detection of depression in at-risk populations is critical for ensuring better maternal and child health outcomes. This study assessed whether Healthy Start Prenatal Risk Screening (HSPRS) could predict depressive symptoms in women enrolled in a Healthy Start (HS) program in under-resourced, high-risk communities of Hillsborough County. METHODS Data from HS participants were included for those who were evaluated using the HSPRS and the Edinburgh Postnatal Depression Scale (EPDS). A correlation analysis determined if the HSPRS score was associated with a positive EPDS screen, and HSPRS questions related to the participants psychosocial environment were assessed individually to determine their predictive potential. The crude odds ratio (OR) and adjusted OR (controlling for sociodemographic covariates) were calculated for each question of interest. RESULTS A total of 736 women were included, with 122 (16.5%) scoring 14 or greater on the EPDS, indicating probable depression risk. There were significant differences between women at risk for depression compared to those not at risk regarding maternal age (p-value = 0.03) and marital status (p-value = 0.01). There were no significant differences in education, ethnicity, or race. The total HSPRS score had a weak yet significant correlation with the EPDS score (r = 0.14, p-value = 0.0001), and seven individual HSPRS questions were significantly associated with risk for perinatal depression. Conclusions for Practice: By focusing on responses to key HSPRS questions rather than the overall score, women may receive access to much needed services more quickly, thereby reducing the risk for poorer maternal and developmental outcomes. SIGNIFICANCE A young maternal age and single marital status have been identified as risk factors for perinatal depression. Additionally, women from racial/ethnic minority groups or low-income populations are more likely to experience depression. Thus, in communities where women exhibit many pre-identified risk factors for perinatal depression, the ability to quickly identify those at the highest risk is imperative. This work indicates that among medically and socially high-risk mothers enrolled in a HS program, the overall HSPRS score was not as predictive of perinatal depression as individual responses to key questions. Attention to these responses could result in women receiving much needed services quicker.
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21
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Kusumawati Y, Widyawati W, Dewi FST. Vulnerable to mental health problems: Pregnant women and husband's perception in Surakarta, Indonesia. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Liu C, Butwick A, Sand A, Wikström AK, Snowden JM, Stephansson O. The association between postpartum hemorrhage and postpartum depression: A Swedish national register-based study. PLoS One 2021; 16:e0255938. [PMID: 34379698 PMCID: PMC8357098 DOI: 10.1371/journal.pone.0255938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background Postpartum hemorrhage is an important cause of maternal death and morbidity. However, it is unclear whether women who experience postpartum hemorrhage are at an increased risk of postpartum depression. Objectives To examine whether postpartum hemorrhage is associated with postpartum depression. Methods We conducted a national register-based cohort study of 486,476 Swedish-born women who had a singleton livebirth between 2007 and 2014. We excluded women with pre-existing depression or who filled a prescription for an antidepressant before childbirth. We classified postpartum depression up to 12 months after giving birth by the presence of an International Classification of Diseases, version 10 (ICD-10) diagnosis code for depression or a filled outpatient prescription for an antidepressant. We used Cox proportional hazard models, adjusting for maternal sociodemographic and obstetric factors. Results Postpartum depression was identified in 2.0% (630/31,663) of women with postpartum hemorrhage and 1.9% (8601/455,059) of women without postpartum hemorrhage. In our unadjusted analysis, postpartum hemorrhage was not associated with postpartum depression (unadjusted hazard ratio (HR) = 1.06, 95% confidence interval (CI) 0.97–1.15). After adjusting for maternal age, parity, education, cohabitation status, maternal smoking status, and early pregnancy maternal BMI, gestational age, and birthweight, the association did not appreciably change, with confidence intervals overlapping the null (adjusted HR = 1.08, 95% CI 0.99, 1.17). Conclusions Within a population-based cohort of singleton women in Sweden with no prior history of depression, postpartum hemorrhage was not associated with postpartum depression.
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Affiliation(s)
- Can Liu
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- * E-mail:
| | - Alexander Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Anna Sand
- Department of Women’s Health, Karolinska University Hospital, Stockholm, Sweden
| | - Anna-Karin Wikström
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Jonathan M. Snowden
- School of Public Health, Oregon Health & Science University–Portland State University, Portland, Oregon, United States of America
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s Health, Karolinska University Hospital, Stockholm, Sweden
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23
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Ando H, Shen J, Morishige KI, Suto S, Nakashima T, Furui T, Kawasaki Y, Watanabe H, Saijo T. Association between postpartum depression and social support satisfaction levels at four months after childbirth. Arch Psychiatr Nurs 2021; 35:341-346. [PMID: 34176574 DOI: 10.1016/j.apnu.2021.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/09/2021] [Accepted: 03/28/2021] [Indexed: 02/01/2023]
Abstract
This study clarifies the association between postpartum depression (PPD) and satisfaction with social support after childbirth through an anonymous survey of 427 postpartum mothers. Mothers' PPD was found to be significantly associated with satisfaction levels regarding formal-instrumental support (OR: 0.32, 95% CI: 0.162-0.632), informal-instrumental support (OR: 0.547, 95% CI: 0.313-0.955), and informal-psychological support (OR: 0.591, 95% CI: 0.384-0.912) in a multivariate logistic regression analysis. To prevent PPD, specialists as formal support providers must provide qualified care based on comprehensive judgments, and families as informal support providers should help with childcare, housework, and mental support.
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Affiliation(s)
- Hitomi Ando
- Department of Human Nursing, Faculty of Human Health, Sonoda Women's University, Japan; Division of Health Sciences, Graduate School of Medicine, Osaka University, Japan.
| | - Junyi Shen
- Research Institute for Economics and Business Administration, Kobe University, Japan
| | - Ken-Ichirou Morishige
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Gifu University, Japan
| | - Shunji Suto
- Department of Community Medicine, Nara Medical University, Japan
| | - Takako Nakashima
- Faculty of Economics, University of Marketing and Distribution Sciences, Japan
| | - Tatsuro Furui
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Gifu University, Japan
| | - Yuki Kawasaki
- Faculty of Nursing, Graduate School of Nursing, Kansai Medical University, Japan
| | - Hiroko Watanabe
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Japan
| | - Tatsuyoshi Saijo
- Research Institute for Humanity and Nature, Research Institute for Future Design at Kochitech, Japan
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Ahmed GK, Elbeh K, Shams RM, Malek MAA, Ibrahim AK. Prevalence and predictors of postpartum depression in Upper Egypt: A multicenter primary health care study. J Affect Disord 2021; 290:211-218. [PMID: 34004403 DOI: 10.1016/j.jad.2021.04.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/23/2021] [Accepted: 04/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postpartum depression (PPD) is highly prevalent with a major impact on the mother and child health. We aimed to determine the prevalence of PPD in primary health care centres which provide vaccinations services to infants in Assiut city and to evaluate the possible risk factors associated with PPD. METHODS In this multicentre study, 257 mothers attended three primary health care centres for immunization of their babies were recruited from January 2019 to January 2020. All participants were evaluated for socio-demographic features, Family affluence scale (FAS), Edinburgh Postnatal Depression Scale (EPDS) and associated risk factors. RESULTS The mean age of the participants was 27.98 ± 4.7. About half of the mothers and their husbands had low education level. Most of the families (89%) have low socioeconomic scale (SES). About (33.5%) women were found to have possible PPD. In the logistic regression analysis, SES, history of depression, history of PPD, history of stressful conditions, familial support, unwanted pregnancy, and male preference were significant statistical in PPD (p < 0.05). LIMITATIONS We did not investigate the medical and psychological problems during antenatal care. Also, we did not assess relation of the type of delivery and medical problems during delivery on the postnatal care. CONCLUSIONS PPD was prevalent in 33.5% The possible risk factors of PPD were low SES, history of depression, history of PPD, history of stressful conditions, familial support, unwanted pregnancy, and male preference.
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Affiliation(s)
- Gellan K Ahmed
- Department of Neurology and Psychiatry, Assiut University, 71516 Assiut, Egypt; Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
| | - Khaled Elbeh
- Department of Neurology and Psychiatry, Assiut University, 71516 Assiut, Egypt
| | - Randa M Shams
- Department of Public Health, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Ahmed K Ibrahim
- Department of Public Health, Faculty of Medicine, Assiut University, Assiut, Egypt
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Whittall H, Kahn M, Pillion M, Gradisar M. Parents matter: barriers and solutions when implementing behavioural sleep interventions for infant sleep problems. Sleep Med 2021; 84:244-252. [PMID: 34182352 DOI: 10.1016/j.sleep.2021.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Behavioural sleep interventions (eg, extinction-based methods) are among the most efficacious evidence-based techniques in the treatment of infant sleep problems. However, behavioural sleep interventions can be challenging for families to successfully implement. This review aims to summarise current research surrounding the potential barriers that arise when clinicians attempt to implement extinction-based methods with parents of infants. We provide a model that summarises 3 types of contextual-barriers; socio-cultural barriers, parent barriers, and infant barriers. Based on the current evidence, we propose that adopting a stepped care approach, planning ahead, increasing support, motivational interviewing, and/or emotional regulation may serve as useful tools for parents when implementing extinction-based methods. By considering these techniques, more families may receive the benefits of improved infant sleep.
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Affiliation(s)
- Hannah Whittall
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia.
| | - Michal Kahn
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
| | - Meg Pillion
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
| | - Michael Gradisar
- Flinders University, College of Education, Psychology and Social Work, Adelaide, South Australia, Australia
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Prevalence and incidence of postpartum depression and environmental factors: The IGEDEPP cohort. J Psychiatr Res 2021; 138:366-374. [PMID: 33932643 DOI: 10.1016/j.jpsychires.2021.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/25/2021] [Accepted: 04/01/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND IGEDEPP (Interaction of Gene and Environment of Depression during PostPartum) is a prospective multicenter cohort study of 3310 Caucasian women who gave birth between 2011 and 2016, with follow-up until one year postpartum. The aim of the current study is to describe the cohort and estimate the prevalence and cumulative incidence of early and late-onset postpartum depression (PPD). METHODS Socio-demographic data, personal and family psychiatric history, as well as stressful life events during childhood and pregnancy were evaluated at baseline. Early and late-onset PPD were assessed at 8 weeks and 1 year postpartum respectively, using DSM-5 criteria. RESULTS The prevalence of early-onset PPD was 8.3% (95%CI 7.3-9.3), and late PPD 12.9% (95%CI 11.5-14.2), resulting in an 8-week cumulative incidence of 8.5% (95%CI 7.4-9.6) and a one-year cumulative incidence of PPD of 18.1% (95%CI: 17.1-19.2). Nearly half of the cohort (N = 1571, 47.5%) had a history of at least one psychiatric or addictive disorder, primarily depressive disorder (35%). Almost 300 women in the cohort (9.0%) reported childhood trauma. During pregnancy, 47.7% women experienced a stressful event, 30.2% in the first 8 weeks and 43.9% between 8 weeks and one year postpartum. Nearly one in five women reported at least one stressful postpartum event at 8 weeks. CONCLUSION Incident depressive episodes affected nearly one in five women during the first year postpartum. Most women had stressful perinatal events. Further IGEDEPP studies will aim to disentangle the impact of childhood and pregnancy-related stressful events on postpartum mental disorders.
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Iwasa H, Yoshida Y, Ishii K, Yasumura S. Factors associated with cognitive failure among mothers involved in child care. COGENT PSYCHOLOGY 2021. [DOI: 10.1080/23311908.2021.1896119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Hajime Iwasa
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yuko Yoshida
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kayoko Ishii
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Seiji Yasumura
- Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan
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Social and Demographic Factors Associated with Postnatal Depression Symptoms among HIV-Positive Women in Primary Healthcare Facilities, South Africa. Healthcare (Basel) 2021; 9:healthcare9010065. [PMID: 33445414 PMCID: PMC7826739 DOI: 10.3390/healthcare9010065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Mothers living with HIV are at risk for mental health problems, which may have a negative impact on the management of their HIV condition and care of their children. Although South Africa has a high prevalence of HIV, there is a dearth of studies on sociodemographic predictors of postnatal depression (PND) among HIV-positive women in South Africa, even in KwaZulu Natal, a province with the highest prevalence of HIV in the country. Objective: The objective of the study was to determine sociodemographic factors associated with the prevalence of postnatal depression symptoms among a sample of HIV-positive women attending health services from primary healthcare facilities in Umhlathuze District, KwaZulu Natal. Methods: A quantitative cross-sectional survey was used to collect data from 386 HIV-positive women who had infants aged between 1 and 12 weeks. The Edinburgh Postnatal Depression Scale (EPNDS), to which sociodemographic questions were added, was used to collect data. Results: The prevalence of PND symptoms among this sample of 386 HIV-positive women was 42.5%. The age of the mothers ranged from 16 to 42 years, with a mean of 29 years. The majority of the mothers were single or never married (85.5%; n = 330), living in a rural setting (81.9%; n = 316%), with a household income of less than R 2000 (estimated 125 USD) per month (64.9%; n = 120). The government child support grant was the main source of income for most of the mothers (53%; n = 183). PND symptoms were significantly associated with the participant’s partner having other sexual partners (p-value < 0.001), adverse life events (p-value = 0.001), low monthly income (p-value = 0.015), and being financially dependent on others (p-value = 0.023). Conclusion: The prevalence of PND symptoms among the sample is high, with a number of social and demographic factors found to be significantly associated with PND. This requires the consideration of sociodemographic information in the overall management of both HIV and postnatal depression. Addressing the impact of these factors can positively influence the health outcomes of both the mother and the baby.
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Unintended pregnancy and postpartum depression: A meta-analysis of cohort and case-control studies. J Psychosom Res 2020; 138:110259. [PMID: 33002811 DOI: 10.1016/j.jpsychores.2020.110259] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The majority of original studies showed that unintended pregnancy is related to adverse obstetric outcomes, however, up to now, the influence of unintended pregnancy on the risk of developing postpartum depression (PPD) remains unclear. This study aimed to assess the association between unintended pregnancy and the risk of developing PPD by conducting a meta-analysis of cohort and case-control studies. METHODS PubMed, Web of Science, Embase, and Cochrane Library were searched up to December 31, 2019 to identify relevant studies evaluating the association between unintended pregnancy and PPD. Meta-analysis was performed using RevMan software and Stata software. Potential heterogeneity source was explored by subgroup and sensitivity analyses, and potential publication bias was tested using Begg's funnel plots and Begg's linear regression test. RESULTS A total of thirty studies involving 65,454 participants were included in our meta-analysis. Overall, women who get pregnant unintendedly compared with those who are intending to be pregnant were at a significantly higher risk of developing PPD (odds ratio [OR] = 1.53; 95% confidence interval [CI]: 1.35-1.74; P < 0.00001). CONCLUSIONS Unintended pregnancy is significantly associated with the risk of developing PPD. These findings highlight the necessity of screening for pregnancy intention and integrating family planning and personalized mental health services into primary healthcare to promote maternal mental health.
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Tennant E, Miller E, Costantino K, De Souza D, Coupland H, Fotheringham P, Eastwood J. A critical realist evaluation of an integrated care project for vulnerable families in Sydney, Australia. BMC Health Serv Res 2020; 20:995. [PMID: 33129332 PMCID: PMC7603742 DOI: 10.1186/s12913-020-05818-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 10/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Healthy Homes and Neighbourhoods (HHAN) Integrated Care Initiative was established to improve the care of families with complex health and social needs who reside in Sydney Local Health District. HHAN seeks to provide long-term multi-disciplinary care coordination as well as enhance capacity building and promote integrated care. The critical realist study reported here is part of the longitudinal development and evaluation of complex integrated health and social care interventions in Sydney, Australia. METHODS We describe the qualitative component of a critical realist pilot case study aimed at exploring, explaining and refining emerging HHAN programme theories in relation to care coordination. Qualitative interviews were undertaken with HHAN clients (n = 12), staff and other stakeholders (n = 21). Interviews and coding used a context (C), mechanism (M) and outcome (O) framework. Inductive, deductive, retroductive and abductive modes of reasoning were used with the CMO heuristic tool to inform the developing programme theory. RESULTS The mechanisms underpinning effective engagement of clients by care coordinators included: building trust, leveraging other family, social and organisational relationships, meeting clients on their own terms, demonstrating staff effectiveness as quickly as possible, and client empowerment. Mechanisms for enhancing care integration included knowledge transfer activities and shared learning among collaborators, structural and cultural changes, enhancing mutual respect, co-location of multidisciplinary and/or interagency staff and cultivating faith in positive change among staff. CONCLUSIONS Use of a critical realism case study approach served to elucidate the varied influences of contexts and mechanisms on programme outcomes, to highlight what works for whom and in what context. Findings supported the initial programme theory that engagement and trust building with clients, alongside enhanced collaboration and integration of services, improved outcomes for vulnerable families with complex needs. Further research is needed to explore the cost-effectiveness of integrated care initiatives, in view of the long term nature of service provision and the risk of staff burnout.
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Affiliation(s)
- E. Tennant
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, NSW 2052 Australia
| | - E. Miller
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
| | - K. Costantino
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
| | - D. De Souza
- Centre for Research in Education, Torrens University Australia, Flinders Street Campus, Melbourne, VIC 3000 Australia
| | - H. Coupland
- Drug Health Services, Royal Prince Alfred Hospital, Level 6, King George V Building Missenden Road, Camperdown, NSW 2050 Australia
- Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050 Australia
| | - P. Fotheringham
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
| | - J. Eastwood
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
- Population child health group, School of Women’s and Children’s Health, The University of New South Wales, Kensington, NSW 2052 Australia
- Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170 Australia
- Charles Perkins Centre, Menzies Centre for Health Policy, Discipline of Child and Adolescent Health, Central Clinical School, and School of Public Health, University of Sydney, Sydney, New South Wales 2006 Australia
- Sydney Institute for Women Children and their Families, Camperdown, NSW 2050 Australia
- Community Paediatrics, Croydon Community Health Centre, 24 Liverpool Road, Croydon, NSW 2132 Australia
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Monteiro F, Fonseca A, Pereira M, Canavarro MC. Is positive mental health and the absence of mental illness the same? Factors associated with flourishing and the absence of depressive symptoms in postpartum women. J Clin Psychol 2020; 77:629-645. [PMID: 33098665 DOI: 10.1002/jclp.23081] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Exploring a wide range of factors associated with flourishing and with the absence of depressive symptoms among postpartum women. METHODS A sample of 661 postpartum women completed a set of questionnaires assessing sociodemographic and infant-related data, flourishing, psychological flexibility, self-compassion, resilience, and maternal confidence. RESULTS Younger infant age, higher levels of maternal confidence, and resilience increased the likelihood of flourishing. In turn, higher income, fewer problems with an infant's sleep, perceiving an infant's temperament as easy, and higher psychological flexibility increased the likelihood of not having depressive symptoms. Appraising the support received by others as good and having higher self-compassion increased the likelihood of both outcomes. CONCLUSIONS Our results support positive mental health and mental illness being related but distinct dimensions. Promoting positive mental health in the postpartum period should be an additional goal in public health care as it may efficiently complement the prevention of psychopathology.
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Affiliation(s)
- Fabiana Monteiro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Ana Fonseca
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Marco Pereira
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Maria C Canavarro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
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Abstract
Introduction The Healthy Homes and Neighbourhoods (HHAN) Integrated Care Program seeks to enhance vulnerable family engagement with health and social services through a care coordination model. Besides servicing families in Sydney, HHAN has also established place-based initiatives (PBIs) in areas of disadvantage such as Redfern. The Redfern PBI co-locates HHAN with housing, drug and alcohol services, and financial and legal services. This integration aims to facilitate service access and multi-agency support for vulnerable families in Redfern. Hence, this study aims to evaluate for whom, when and why HHAN's PBI at Redfern works, or not, and what are its outcomes. Methods The project utilises critical realist methodology to undertake a qualitative evaluation of the impact of the PBI on clients, services and the community. Purposive sampling was used to identify 21 participants including HHAN clients, HHAN staff and stakeholders (HHAN partners). In-depth, semi-structured interviews were audio-recorded, transcribed, coded and analysed using a context (C), intervention (I), mechanism (M) outcome (O) (CIMO) approach to abductive analysis. Results Five key CIMO configurations of the Redfern PBI emerged - whole-of-family involvement, flexibility, trust, building connections and co-location. Whilst each theory had specific outcomes, overall client outcomes included improved access to services, better outlook, empowerment and engagement with services. Service outcomes included increased collaboration and foundation for integration between HHAN and other services. Negative outcomes included lack of full integration, the risk associated with integration and difficulty evaluating impact. Conclusion This study successfully refined the program theory for subsequent use in later implementation of critical realist evaluation studies.
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Feligreras-Alcalá D, Frías-Osuna A, del-Pino-Casado R. Personal and Family Resources Related to Depressive and Anxiety Symptoms in Women during Puerperium. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145230. [PMID: 32698403 PMCID: PMC7400701 DOI: 10.3390/ijerph17145230] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/13/2020] [Accepted: 07/18/2020] [Indexed: 01/06/2023]
Abstract
Introduction: This study investigated the relationship between personal and family resources (i.e., social support, family functioning, self-efficacy in care, sense of coherence and perceived burden of care) and depressive and anxiety symptoms in women during the puerperium, adjusting for stressors. Methods: This is a quantitative research design, carried out through a descriptive, cross-sectional correlation study. This study includes 212 women over the age of 19 who gave birth from March to September 2019 in Maternal and Child Hospital of Jaén (Spain). Women were selected during the immediate postpartum period. The variables analysed were postpartum depressive symptoms (Edinburgh scale), anxiety symptoms (STAI state anxiety questionnaire), perceived social support (Duke-UNC-11), family functioning (family APGAR), self-efficacy in care (Lawton), sense of coherence (SOC-13), perceived burden (Caregiver Strain Index) and stressful life events (Holmes and Rahe). The main analysis consisted of a multiple linear regression. Results: The regression model of depressive symptoms found a positive association with perceived burden (β = 0.230, p = 0.015) and negative associations with self-efficacy in care (β = -0.348, p < 0.001), social support (β = -0.161, p < 0.001) and sense of coherence (β = -0.081, p = 0.001). The regression model of anxiety symptoms obtained a positive association with perceived burden (β = 1.052, p < 0.001) and negative associations with self-efficacy in care (β = -0.329, p = 0.041), social support (β = -0.234, p = 0.001) and sense of coherence (β = -0.262, p < 0.001). Discussion: Firstly, depressive and anxiety symptoms in the puerperium period may be more prevalent than in other periods of a woman's life. Secondly, perceived social support, self-efficacy in caring for the newborn and sense of coherence may be protective factors for depressive and anxiety symptoms in the puerperium period. Finally, perceived burden in caring for the newborn may be a risk factor for these symptoms.
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Palumbo G, Mirabella F, Gigantesco A. Positive screening and risk factors for postpartum depression. Eur Psychiatry 2020; 42:77-85. [DOI: 10.1016/j.eurpsy.2016.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 11/15/2016] [Accepted: 11/19/2016] [Indexed: 11/29/2022] Open
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Hughes C, T Devine R, Foley S, D Ribner A, Mesman J, Blair C. Couples becoming parents: Trajectories for psychological distress and buffering effects of social support. J Affect Disord 2020; 265:372-380. [PMID: 32090762 DOI: 10.1016/j.jad.2020.01.133] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 12/11/2019] [Accepted: 01/21/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Becoming a parent is a time of both joy and stress. Associations between exposure to postnatal depression and negative child outcomes underscore the importance of understanding trajectories and correlates of perinatal depression and anxiety. METHODS In a study of 438 expectant couples (from the UK, USA and Netherlands) tracked across four time-points (third trimester, 4, 14 and 24 months), we used dyadic latent growth curve modeling (LGCM) of self-reported symptoms of anxiety and depression (CES-D, GHQ, STAI) to investigate the affective impact of becoming a parent. RESULTS Confirmatory factor analyses of anxious-depressive symptoms revealed a single latent factor with measurement invariance across time and parent. Dyadic LGCM intercepts showed greater prenatal problems in mothers compared with fathers. LGCM slopes revealed stable maternal problems but worsening paternal problems. Both intercepts and slopes showed significant within-couple associations. Controlling for prenatal salivary cortisol levels and perinatal couple relationship quality, support from friends attenuated mothers' psychological distress and support from family reduced fathers' psychological distress across the transition to parenthood. LIMITATIONS Our sample was low risk (i.e., predominantly well-educated and affluent and no history of serious mental illness), limiting the generalizability of findings. In addition, the inverse association between psychological distress and social support may, in part, reflect the use of self-report for both measures. CONCLUSIONS The international dyadic longitudinal design strengthens conclusions regarding variation in trajectories of psychological distress in both mothers and fathers. Crucially, social support appears pivotal in enabling new parents to flourish.
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Affiliation(s)
- Claire Hughes
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK.
| | | | - Sarah Foley
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK; Centre for Family Research, University of Cambridge, UK
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Retrospectiva da experiência de gestação de mulheres com depressão pós-parto: estudo comparativo. PSICO 2020. [DOI: 10.15448/1980-8623.2020.2.31889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A sobrecarga emocional própria das vivências do tornar-se mãe pode, freqüentemente, levar ao desenvolvimento da depressão pós-parto. Diante disto, este estudo buscou compreender, de forma retrospectiva, a experiência de gestação de mães com e sem depressão pós-parto. As participantes foram seis mães, com idades entre 28 e 38 anos. Três mães não apresentaram quaisquer transtornos de humor e três tiveram o diagnóstico de depressão pós-parto confirmado. A base para a análise qualitativa desse estudo foi uma entrevista sobre a gestação e o parto. Os resultados indicaram que a experiência de maternidade tem relação estreita com a forma como as mães lidaram com a necessidade de adaptação frente à maternidade, bem como com o desejo e o planejamento – ou não – da gestação. Os achados apóiam a sugestão da literatura que indica a presença de relatos negativos sobre a experiência de maternidade por mães deprimidas, inclusive sobre a gestação.
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Biggs LJ, McLachlan HL, Shafiei T, Small R, Forster DA. Peer supporters' experiences on an Australian perinatal mental health helpline. Health Promot Int 2020; 34:479-489. [PMID: 29346557 DOI: 10.1093/heapro/dax097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Perinatal mental health is an important public health issue, and peer support is a potentially important strategy for emotional well-being in the perinatal period. PANDA Perinatal Anxiety & Depression Australia provides support to individuals impacted by perinatal mental health issues via the National Perinatal Anxiety & Depression Helpline. Callers receive peer support from volunteers and counselling from paid professional staff. The views and experiences of PANDA peer support volunteers have not previously been studied. We conducted two focus groups and an online survey to explore the experiences of women providing volunteer peer support on the Helpline. Data collection took place in October and November 2013. Two social theories were used in framing and addressing the study aims and in interpreting our findings: the Empathy-Altruism Hypothesis, and the Helper Therapy Principle. All PANDA volunteers were invited to participate (n = 40). Eight volunteers attended a focus group, and 11 survey responses were received. Descriptive statistics were used to analyse quantitative data. All survey respondents 'strongly agreed' that they felt positive about being part of PANDA. Thematic analysis of data from focus groups and open-ended survey responses identified the following themes: motivated to help others, supported to support callers, helping to make a difference and emotional impacts for volunteers. Respondents described a strong desire to support others experiencing emotional distress as a motivator to volunteer. Although perinatal peer support services are designed to benefit those who receive support, this study suggests volunteers may also experience personal benefits from the role.
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Affiliation(s)
- Laura J Biggs
- Judith Lumley Centre, La Trobe University, corner of Plenty Road & Kingsbury Drive, Bundoora Victoria, Australia 3083
| | - Helen L McLachlan
- Judith Lumley Centre, La Trobe University, corner of Plenty Road & Kingsbury Drive, Bundoora Victoria, Australia 3083.,School of Nursing & Midwifery, La Trobe University, corner of Plenty Road & Kingsbury Drive, Bundoora Victoria, Australia 3083
| | - Touran Shafiei
- Judith Lumley Centre, La Trobe University, corner of Plenty Road & Kingsbury Drive, Bundoora Victoria, Australia 3083
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, corner of Plenty Road & Kingsbury Drive, Bundoora Victoria, Australia 3083
| | - Della A Forster
- Judith Lumley Centre, La Trobe University, corner of Plenty Road & Kingsbury Drive, Bundoora Victoria, Australia 3083.,The Royal Women's Hospital, Locked Bag 300 Grattan St & Flemington Road, Parkville Victoria, Australia 3052
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Petrenko A, Kanya MJ, Rosinski L, McKay ER, Bridgett DJ. Effects of infant negative affect and contextual factors on infant regulatory capacity: The moderating role of infant sex. INFANT AND CHILD DEVELOPMENT 2019. [DOI: 10.1002/icd.2157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Anton Petrenko
- Department of PsychologyNorthern Illinois University DeKalb Illinois
| | - Meghan J. Kanya
- Department of PsychologyNorthern Illinois University DeKalb Illinois
| | - Leanna Rosinski
- Department of PsychologyNorthern Illinois University DeKalb Illinois
| | - Erin R. McKay
- Department of PsychologyNorthern Illinois University DeKalb Illinois
| | - David J. Bridgett
- Department of PsychologyNorthern Illinois University DeKalb Illinois
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Takács L, Smolík F, Putnam S. Assessing longitudinal pathways between maternal depressive symptoms, parenting self-esteem and infant temperament. PLoS One 2019; 14:e0220633. [PMID: 31381596 PMCID: PMC6681961 DOI: 10.1371/journal.pone.0220633] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/19/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Previous studies of relations between parenting self-concepts, parental adjustment and child temperament have been ambiguous regarding the direction of influence; and have rarely followed families from pregnancy through the first year of life. The current study examines change and stability in maternal depressive symptoms, parenting competences and child temperament through the perinatal period until nine months postpartum. METHODS Czech mothers (N = 282) participated at three time points: the third trimester of pregnancy (Time 1), six weeks (Time 2) and nine months postpartum (Time 3). Questionnaire data concerned depressive symptoms (T1, T2, T3), maternal parenting self-esteem (T1, T2) and sense of competence (T3), and child temperament (T2, T3). A path model was used to examine concurrent and longitudinal relations between these variables. RESULTS The analyses indicated longitudinal stability of all constructs, as well as concurrent relations between them. Longitudinal relations supported child-to-parent, rather than parent-to-child, effects: child difficult temperament predicted decreases in perceived maternal parenting competences, but maternal variables did not predict change in infant temperament. In addition, we observed weak mutual relations between maternal depression levels and parenting competences, such that maternal depression diminished perceived parenting competences that in turn contributed to higher levels of depression. CONCLUSION Mothers' confidence in their ability to parent is influenced by their experience with a difficult infant and by their depressive symptoms during the child's first year of life. Depressive symptoms are, in turn, aggravated by mothers' low perceived competences in the parenting role.
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Affiliation(s)
- Lea Takács
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
- * E-mail:
| | - Filip Smolík
- Institute of Psychology, Czech Academy of Sciences, Prague, Czech Republic
| | - Samuel Putnam
- Department of Psychology, Bowdoin College, Brunswick, Maine, United States of America
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A Critical Realist Translational Social Epidemiology Protocol for Concretising and Contextualising a "Theory of Neighbourhood Context, Stress, Depression, and the Developmental Origins of Health and Disease (DOHaD)", Sydney Australia. Int J Integr Care 2019; 19:8. [PMID: 31367207 PMCID: PMC6659581 DOI: 10.5334/ijic.3962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: We will describe here a translational social epidemiology protocol for confirming a critical realist “Theory of Neighbourhood Context, Stress, Depression, and the Developmental Origins of Health and Disease (DOHaD). The approach will include the concretising and contextualising of the above causal theory into programme theories for child and adolescent interventions that aim to break intergenerational cycles of disadvantage and poor life outcomes. In undertaking this work we seek to advance realist translational methodology within the discipline of applied perinatal and paediatric social epidemiology. Theory and Methods: The research settings are in metropolitan Sydney. The design will be a longitudinal, multi-level, mixed method realist evaluation of applied programme interventions that seek to break the intergeneration cycle of social disadvantage and poor child health and developmental outcomes. The programme of research will consist of three components: 1) Operationalisation of the theory and designing of programme initiatives for implementation; 2) Evaluation of the translated programme and implementation theory using Theory of Change and critical realist evaluation; and 3) Theory Testing of realist hypotheses using both intensive and extensive critical realist research methods including realist structural modelling. Discussion: The proposed programme of research will assist in translating empirical explanatory theory building to theory driven interventions. The research will be situated in socially disadvantaged regions of Sydney where the local child and family inter-agencies will collaborate to design and implement new initiatives that address significant disparities in childhood development and adolescent outcomes attributed to neighbourhood circumstances, family stress and intergenerational cycles of disadvantage and poor mental health.
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Higher child-raising costs due to maternal social isolation: Large population-based study in Japan. Soc Sci Med 2019; 233:71-77. [PMID: 31185444 DOI: 10.1016/j.socscimed.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 05/28/2019] [Accepted: 06/02/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND To assess the association between maternal social isolation and the child-rearing costs among mothers with 6-month-old infants. METHODS Data was analyzed from a population-based birth-cohort study in Japan, the Longitudinal Survey of Babies in the 21st Century (n = 40,643). Maternal isolation was defined by lack of social support among mothers expressing difficulties with child rearing. Child-rearing costs for one month (when the infant was 6-months-old) were self-reported in units of JPY 10,000 (approximately 80 USD). The association between maternal social isolation and child-rearing cost was assessed using generalized linear models adjusted for child, maternal, and family level characteristics. RESULTS Of the sample, 258 (0.6%) women were classified as socially isolated. In the crude model, isolated mothers paid JPY 6980 (95% confidence interval [CI]: 4753-9207), approximately USD$87, more per month on child-rearing expenses compared to non-isolated mothers. This finding was similar in the multivariable adjusted model (marginal effect: JPY 4,186, 95% CI, 2235-6136). Stratified analysis comparing low income vs. non-low income mothers showed that, among the former group, socially isolated mothers spend more on child rearing than mothers who are not isolated (marginal effect: JPY 13,218, 95% CI:784 to 2565), while among the non-low income group, a significant association was not observed. CONCLUSIONS Socially isolated mothers spent JPY4,186 (approximately USD 35) more per month on child-rearing costs compared to non-isolated mothers when the infant was aged 6 months old. In nationwide terms, this cost could be roughly calculated as JPY 350 million (approximately USD 2.9 million) in 2001. Provision of social network connections and support for socially isolated mothers is suggested to be an efficient public health policy.
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Yokoyama Y, Hakulinen T, Sugimoto M, Silventoinen K, Kalland M. Maternal subjective well-being and preventive health care system in Japan and Finland. Eur J Public Health 2019; 28:652-657. [PMID: 29272457 DOI: 10.1093/eurpub/ckx211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Maternal well-being is an important issue not only for mothers but also for their offspring and whole families. This study aims to clarify differences in subjective well-being for mothers with infants and associated factors by comparing Japanese and Finnish mothers. Methods In Finland, 101 mothers with infants who received health check-ups at child's age 4 months participated in the study. In Japan, 505 mothers with infants who should receive health check-ups at child's age 4 months and, whose age, age of the infant and number of children matched with the Finnish mothers were selected. The factors associated with maternal subjective well-being were explored by the linear regression analysis. All Finnish mothers had individual infant health check-ups by nurses in Child Health Clinics nearly monthly. The same nurse was responsible for following up the family throughout the years. All Japanese participants received group health check-up once at child's age 3 to 4 months, and a nurse did not cover same child and their mother. Results Finnish mothers showed significantly better subjective well-being compared with Japanese mothers. Whereas 85% of Finnish mothers responded that they had obtained childcare information from public health nurses, significantly fewer Japanese mothers indicated the same response (8%). Linear regression analyses disclosed that mothers' subjective well-being was associated with country, mothers' stress and age. Conclusion Finnish mothers had better subjective well-being than Japanese mothers. Our results may indicate that the Finnish health care system supports mothers better than the Japanese health care system does.
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Affiliation(s)
- Yoshie Yokoyama
- Department of Public Health Nursing, Osaka City University, Osaka, Japan
| | - Tuovi Hakulinen
- Children, Adolescence and Families Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Masako Sugimoto
- Department of Public Health Nursing, Osaka City University, Osaka, Japan
| | - Karri Silventoinen
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Mirjam Kalland
- Swedish School of Social Science, University of Helsinki, Helsinki, Finland
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Moore Simas TA, Huang MY, Patton C, Reinhart M, Chawla AJ, Clemson C, Eldar-Lissai A. The humanistic burden of postpartum depression: a systematic literature review. Curr Med Res Opin 2019; 35:383-393. [PMID: 30468090 DOI: 10.1080/03007995.2018.1552039] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Postpartum depression (PPD) is the most common medical complication of childbirth. PPD can be disabling, with potential negative effects on maternal health-related quality-of-life (HRQoL) as well as on children and partners. The objective of this study was to systematically review and summarize recently published literature describing the humanistic burden of PPD on affected women, their children, and partners. METHODS Databases including Embase, MEDLINE, and PsycINFO, as well as conference proceedings were searched for keywords related to PPD. Searches were initially conducted in February 2017 and restricted to the prior 5 years for databases and the prior 2 years for conference proceedings. Searches were updated in February 2018. Two researchers independently reviewed 1154 unique records according to pre-defined inclusion and exclusion screening criteria. RESULTS Forty-eight studies were identified; over 40 studies assessed the effects of PPD on children of affected mothers, with many demonstrating a negative association with elements of parenting and childhood development. Furthermore, five studies that evaluated the effects of PPD symptoms on partners suggested that certain aspects of their relationships were negatively affected. Partners of affected women also experienced greater levels of their own stress, anxiety, and depression compared with partners of women without PPD symptoms. Despite limited data on HRQoL among women with PPD symptoms (four studies), a negative impact on physical and mental sub-scales was observed. CONCLUSIONS Findings suggest that PPD symptoms have a substantial humanistic burden on affected mothers as well as on their children and partners.
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Affiliation(s)
- Tiffany A Moore Simas
- a Departments of Obstetrics & Gynecology , Pediatrics, Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School/UMass Memorial Health Care , Worcester , MA , USA
| | | | - Cody Patton
- c Analysis Group, Inc. , Menlo Park , CA , USA
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Ramakrishna S, Cooklin AR, Leach LS. Comorbid anxiety and depression: a community-based study examining symptomology and correlates during the postpartum period. J Reprod Infant Psychol 2019; 37:468-479. [DOI: 10.1080/02646838.2019.1578870] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Sandhya Ramakrishna
- The Australian National University Medical School, The Australian National University, Canberra, Australia
| | | | - Liana S. Leach
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
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The effect of complementary medicines and therapies on maternal anxiety and depression in pregnancy: A systematic review and meta-analysis. J Affect Disord 2019; 245:428-439. [PMID: 30423471 DOI: 10.1016/j.jad.2018.11.054] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/16/2018] [Accepted: 11/03/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Depression and anxiety are common during the antenatal and postnatal period, and are known to have a significant impact on the woman and her unborn infant. Pregnant women state a preference for non-pharmacological treatment options, and use complementary medicines and therapies to manage these symptoms. We examined the effectiveness and safety of these modalities on depression and anxiety during pregnancy. METHODS CENTRAL, EMBASE and PubMed databases were searched for randomised controlled trials comparing complementary therapies and medicines to a control, for pregnant women with depression or anxiety. The primary outcome measure was antenatal depression or anxiety. RESULTS Twenty randomised controlled trials containing 1092 women were included in the review. We found some evidence of reduced antenatal depression from three modalities. Acupuncture reduced the number of women diagnosed with antenatal depression (RR 1.68, 95% CI 1.06-2.66, 1 trial). Massage reduced the severity of antenatal depression in one trial of 149 women (SMD -0.73, 95%CI -1.07--0.39). One small trial of bright light therapy found reduced antenatal depression (RR 4.80, 95% CI -8.39--1.21, 27 women). There was no evidence of a reduction in depression and anxiety from relaxation, yoga, mindfulness and fish oils. Overall the risk of bias was high or unclear for the majority of studies. LIMITATIONS There are few high quality randomised controlled trials of complementary medicines and therapies examining the effect on anxiety and depression. CONCLUSION Acupuncture, bright light therapy, and massage may reduce antenatal depression. There is a need for high quality and larger studies that include postnatal follow up and maternal and neonatal outcomes.
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Long MM, Cramer RJ, Jenkins J, Bennington L, Paulson JF. A systematic review of interventions for healthcare professionals to improve screening and referral for perinatal mood and anxiety disorders. Arch Womens Ment Health 2019; 22:25-36. [PMID: 29968128 DOI: 10.1007/s00737-018-0876-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
Postpartum depression affects approximately 11% of women. However, screening for perinatal mood and anxiety disorders (PMAD) is rare and inconsistent among healthcare professionals. When healthcare professionals screen, they often rely on clinical judgment, rather than validated screening tools. The objective of the current study is to review the types and effectiveness of interventions for healthcare professionals that have been used to increase the number of women screened and referred for PMAD. Preferred Reporting Items for Systematic Reviews and Meta-Analyses was utilized to guide search and reporting strategies. PubMed/Medline, PsychInfo/PsychArticles, Cumulative Index to Nursing, Allied Health Literature (CINAHL), and Health Source: Nursing/Academic Edition databases were used to find studies that implemented an intervention for healthcare professionals to increase screening and referral for PMAD. Twenty-five studies were included in the review. Based on prior quality assessment tools, the quality of each article was assessed using an assessment tool created by the authors. The four main outcome variables were the following: percentage of women screened, percentage of women referred for services, percentage of women screened positive for PMAD, and provider knowledge, attitudes, and/or skills concerning PMAD. The most common intervention type was educational, with others including changes in electronic medical records and standardized patients for training. Study quality and target audience varied among the studies. Interventions demonstrated moderate positive impacts on screening completion rates, referral rates for PMAD, and patient-provider communication. Studies suggested positive receptivity to screening protocols by mothers and providers. Given the prevalence and negative impacts of PMAD on mothers and children, further interventions to improve screening and referral are needed.
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Affiliation(s)
- Molly M Long
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA.
| | - Robert J Cramer
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA.,Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | - Jennika Jenkins
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | | | - James F Paulson
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA.,Department of Psychology, Old Dominion University, Norfolk, VA, USA
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Using Matching-Adjusted Indirect Comparisons and Network Meta-analyses to Compare Efficacy of Brexanolone Injection with Selective Serotonin Reuptake Inhibitors for Treating Postpartum Depression. CNS Drugs 2019; 33:1039-1052. [PMID: 31642037 PMCID: PMC6825025 DOI: 10.1007/s40263-019-00672-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Brexanolone injection, the first therapy approved by the US FDA for the treatment of postpartum depression (PPD) in adults, has been shown to produce a significantly greater decrease in the Hamilton Rating Scale for Depression (HAM-D) total score than placebo in randomised controlled trials (RCTs) of women with PPD. OBJECTIVES Given the rapid effect of brexanolone injection (within 60 h) sustained throughout the length of the trials (30 days), we sought to compare its efficacy data against selective serotonin reuptake inhibitors (SSRIs), the class of antidepressants most commonly prescribed for PPD, using HAM-D and Edinburgh Postnatal Depression Scale (EPDS) outcomes from currently available RCTs. METHODS We extracted data from 26 studies identified in a systematic literature review of pharmacological and pharmacological/nonpharmacological combination therapies in PPD. Six studies were suitable to form evidence networks through which to perform indirect treatment comparisons (ITCs) of HAM-D and EPDS outcomes between brexanolone and SSRIs. Having assessed the comparability and suitability of the available evidence for analysis, we discovered significant heterogeneity in the study designs, most notably in the placebo arms of the trials. We therefore conducted matching-adjusted indirect comparisons (MAICs) between brexanolone and the placebo arms of comparator studies, subsequently using the MAIC results of brexanolone versus placebo, and results for SSRIs versus placebo, to form ITCs of brexanolone versus SSRIs at three separate time points-day 3, week 4 and last observation. ITCs were calculated as the differences in change from baseline (CFB) in HAM-D and, separately, CFB in EPDS, between treatments, and reported with 95% confidence intervals (CIs). RESULTS For all time points, MAICs showed larger differences in CFB for brexanolone compared with SSRIs. Differences (95% CIs) between brexanolone and SSRIs were 12.79 (8.04-17.53) [day 3], 5.87 (- 1.62 to 13.37) [week 4] and 0.97 (- 6.35 to 8.30) [last observation] for the HAM-D. For the EPDS, the differences in CFB were 7.98 (5.32-10.64) [day 3], 6.35 (3.13-9.57) [week 4] and 4.05 (0.79-7.31) [last observation]. Other analytical approaches are also presented to demonstrate the similarity of results, using a network meta-analysis approach, and the importance of using the MAIC method to control for the important heterogeneity between placebo arms. CONCLUSIONS Acknowledging the limitations of ITCs and this evidence base, when compared with SSRIs, these analyses suggest that brexanolone demonstrated larger differences in CFB for both patient- and clinician-reported PPD outcomes and at all investigated time points after adjusting for differences between placebos in the included studies.
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Characteristics of women calling the PANDA Perinatal Anxiety & Depression Australia National Helpline: a cross-sectional study. Arch Womens Ment Health 2018; 21:801-812. [PMID: 29948297 DOI: 10.1007/s00737-018-0868-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
Abstract
The PANDA Perinatal Anxiety & Depression Australia National Helpline provides support for people affected by perinatal mental health issues. To describe the characteristics of women contacting the Helpline, specifically callers' health, past history and assessed risk factors. Analysis of routinely collected de-identified data of women making initial calls between July 2010 and October 2013. Five thousand eight hundred eighteen women made an initial call to the Helpline. Most were between 25 and 40 years old (79%) and married/partnered (94%); 52% were having or had their first child; and 23% were pregnant. Over half had no prior mental health diagnosis at the time of their initial call, and 40% were assessed as 'high needs'-experiencing significant bio-psychosocial symptoms, complex situations and/or inadequate care and support. There was a 70% increase in calls to PANDA over the data collection period. Concerns recorded by PANDA staff from the initial risk assessment included inadequate treatment for a mental health condition (31%), women not feeling connected to their baby (31%), low functioning (26%) and general thoughts of suicide (18%). The Helpline experienced a significant increase in demand during the study period, and a substantial proportion of callers had complex mental health needs. PANDA plays a major role in providing support to a large number of women experiencing perinatal mental health problems.
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Blais L, Salah Ahmed SI, Beauchesne MF, Forget A, Kettani FZ, Lavoie KL. Risk of Postpartum Depression Among Women with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:925-933.e2. [PMID: 30292921 DOI: 10.1016/j.jaip.2018.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Several epidemiological studies have suggested that the risk of depression is increased in patients with asthma, but the impact of asthma during pregnancy on postpartum depression remains unknown. OBJECTIVE To assess the association between maternal asthma and postpartum depression in a population-based cohort study retrieved from administrative databases. METHODS A cohort of 35,520 pregnancies in women with asthma during pregnancy and 197,057 pregnancies in women without asthma who delivered between 1998 and 2009 was extracted from the Quebec Asthma and Pregnancy Database. They were followed from the day of delivery up to 1 year postpartum. A generalized estimating equation model was used to estimate the adjusted odds ratios of postpartum depression with 95% CIs in women with asthma during pregnancy versus women without asthma. RESULTS Postpartum depression within 1 year after delivery occurred in 6.1% of women with asthma versus 2.9% of women without asthma. After adjusting for several potential confounders, including depression/postpartum depression up to 10 years before pregnancy, we found that women with asthma were 58% more likely to experience postpartum depression within 1 year after delivery than women without asthma during pregnancy (adjusted odds ratio, 1.58; 95% CI, 1.50-1.67). CONCLUSIONS Our findings suggest that women with asthma are more likely to suffer from postpartum depression. A close monitoring of signs of depression for pregnant women with asthma is indicated, allowing prompt and efficient interventions if needed.
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Affiliation(s)
- Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Center, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Ile-de-Montréal, Montréal, Québec, Canada.
| | | | - Marie-France Beauchesne
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Center, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Amélie Forget
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
| | | | - Kim L Lavoie
- Research Center, Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'Ile-de-Montréal, Montréal, Québec, Canada; Montreal Behavioral Medicine Center, Montréal, Québec, Canada; Psychology Department, Université du Québec à Montréal, Montréal, Québec, Canada
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Factors Associated with Quality of Life Among Mothers Rearing 4- and 18-Month Old Infants in Japan. Matern Child Health J 2018; 22:1217-1225. [PMID: 29435784 DOI: 10.1007/s10995-018-2493-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective The purpose of the present study was to investigate factors associated with quality of life (QOL) among mothers raising 4 and 18-month-old infants. Methods A cross-sectional study was conducted using self-report questionnaires. Participants included 400 women who took their infants for health checkups at a city in Aichi Prefecture, Japan (4-month-olds: n = 197, 18-month-olds: n = 203). Study variables included the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale, mother's lifestyle, support from family, and other factors potentially related to QOL. Results For mothers of 4-month-old infants, total QOL was associated with emotional support from families (OR 6.09, 95% CI 2.13-17.43) and having enough sleep (7 h or more; OR 4.18, 95% CI 1.86-9.36). These mothers had shorter sleeping hours than mothers of 18-month-old infants. QOL of mothers of 18-month-old infants was associated with emotional support from families (OR 3.06, 95% CI 1.14-8.22) and using childrearing support facilities (OR 2.02, 95% CI 1.01-4.01). Conclusion Different factors contributed to mothers' QOL as a function of infant age. Emotional support from families was associated with better QOL in both mother groups. Differences were that for mothers of 4-month-old infants, enough sleep was relevant to QOL, while in mothers of 18-month-old infants, childcare services helped improving their QOL.
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