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Fogarty A, Brown S, Gartland D, McMahon G, FitzPatrick K, Seymour M, Kimber M, MacMillan H, Giallo R. Patterns of intimate partner violence exposure across the first 10 years of life and children's emotional-behavioural outcomes at 10 years. CHILD ABUSE & NEGLECT 2024; 153:106814. [PMID: 38701670 DOI: 10.1016/j.chiabu.2024.106814] [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: 10/23/2023] [Revised: 02/14/2024] [Accepted: 04/19/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Childhood exposure to intimate partner violence (IPV) is associated with emotional-behavioural problems. However, little is known about children's emotional-behavioural outcomes following exposure to different long-term patterns of IPV. OBJECTIVE The current study aimed to investigate the emotional-behavioural functioning of children at 10 years of age following exposure to different patterns of IPV across the first 10 years of life. PARTICIPANTS AND SETTING Data for this study was drawn from the Mothers' and Young People's Study- a longitudinal study of 1507 first time mothers and their first born child. METHODS Women were recruited during pregnancy from six public hospitals in Victoria, Australia. Data was collected during pregnancy, and at one, four and ten years postpartum. Four patterns of IPV exposure were previously identified: (a) minimal IPV exposure; (b) early IPV; (c) Increasing IPV; and (d) persistent IPV. Logistic regression was used to assess associations between IPV exposure and emotional-behavioural outcomes. RESULTS Exposure to early, increasing, or persistent IPV was associated with increased odds of experiencing emotional-behavioural difficulties (OR 2.15-2.97). Children exposed to a persistent pattern of IPV experienced over 6 times the odds of conduct problems (OR = 6.15 CI = 2.3-16.44). CONCLUSIONS Children exposed to early, increasing, or persistent IPV experienced increased odds of emotional-behavioural problems at age 10, regardless of the duration or type of violence they were exposed to. However, children exposed to persistent IPV across childhood appeared to experience the highest odds of emotional-behavioural difficulties.
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Affiliation(s)
- Alison Fogarty
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia; School of Psychology, Deakin University, Geelong 3125, Australia.
| | - Stephanie Brown
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia; Department of General Practice, University of Melbourne, 780 Elizabeth St, Melbourne 3010, Australia
| | - Deirdre Gartland
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia
| | - Grace McMahon
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia
| | - Kelly FitzPatrick
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia
| | - Monique Seymour
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; School of Psychology, Deakin University, Geelong 3125, Australia
| | - Melissa Kimber
- Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Faculty of Health Sciences, Oxford Centre for Child Studies, Hamilton, Ontario, Canada
| | - Harriet MacMillan
- Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Faculty of Health Sciences, Oxford Centre for Child Studies, Hamilton, Ontario, Canada; Pediatrics, Faculty of Health Sciences McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Giallo
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia; School of Psychology, Deakin University, Geelong 3125, Australia
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2
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Fogarty A, Brown S, McMahon G, FitzPatrick KM, Gartland D, Seymour M, Giallo R. Pre-pandemic adversity and maternal mental health during the COVID-19 pandemic: the mediating role of pandemic stress and family relationships. J Affect Disord 2024; 346:102-109. [PMID: 37931755 DOI: 10.1016/j.jad.2023.11.006] [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: 06/09/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic was a time of increased stress for families. Parents with a history of adversity may have been at higher risk of experiencing mental health problems during this time. The current study aims to investigate the relationship between pre-pandemic adversity pandemic related stressors and maternal mental health outcomes during the pandemic. METHODS Data was drawn from the Mothers' and Young People's Study (MYPS), a longitudinal of first time mothers and their children. Participants were 418 mothers who completed the MYPS COVID-19 sub-study. Data was collected during pregnancy, at 1, 4, 10 years postpartum, and during the COVID-19 pandemic (approximately 14 years postpartum). Path-analysis was used to test the relationship indirect relationship between pre-pandemic adversity and maternal depressive and anxiety symptoms, via family functioning and pandemic related stress. RESULTS The hypothesised model was a good fit to the data accounting for 34 % and 33 % of the variance in maternal depressive and anxiety scores, respectively. A significant indirect effect was found between pre-pandemic adversity and both maternal anxiety and depressive systems via family relationships during the pandemic and pandemic related stress. LIMITATIONS MYPS participants who took part in the COVID-19 sub-study were more likely to be older, have a higher level of education, and speak English as a first language, compared to the total MYPS sample. CONCLUSIONS Family inclusive service responses which aim to strengthen family relationships may be particularly important for families where there is a history of adversity to support parental mental health.
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Affiliation(s)
- Alison Fogarty
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia; School of Psychology, Deakin University, Geelong 3125, Australia.
| | - Stephanie Brown
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia; Department of General Practice, University of Melbourne, 780 Elizabeth St, Melbourne 3010, Australia
| | - Grace McMahon
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Mental Health, Royal Children's Hospital, 50 Flemingston Road, Parkville, 3052, Australia
| | - Kelly M FitzPatrick
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia
| | - Deirdre Gartland
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia
| | - Monique Seymour
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; School of Psychology, Deakin University, Geelong 3125, Australia
| | - Rebecca Giallo
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia; School of Psychology, Deakin University, Geelong 3125, Australia
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3
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Ng C, Szücs A, Goh LH. Common maternal health problems and their correlates in early post-partum mothers. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241227879. [PMID: 38282548 PMCID: PMC10826383 DOI: 10.1177/17455057241227879] [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: 06/20/2023] [Revised: 12/16/2023] [Accepted: 01/04/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Mothers experience a wide range of maternal health problems after childbirth, which in turn, affect their well-being and ability to care for their newborn. These problems may be influenced by factors such as mode of delivery or socio-economic status. OBJECTIVE This study aims to investigate the prevalence of common maternal health problems and their correlates in a public primary healthcare institution in Singapore. DESIGN This was a cross-sectional study, based on a self-administered questionnaire. METHODS A total of 373 mothers (mean age 31.9 years) who accompanied their infants for their 4- to 8-week development assessments at a public primary care clinic in Singapore completed a self-administered questionnaire from June 2021 to December 2021. The questionnaire assessed demographic factors, mode of delivery, number of children, number of individuals providing significant help, and the frequency of common physical and mental maternal health problems using a 5-point Likert-type scale. RESULTS The five most common maternal health problems were fatigue (77.7%), lower back pain (59.3%), Caesarean wound pain (54.3%), upper back pain (53.0%) and vaginal pain (41.2%). The prevalence of depression and anxiety was 22.0% and 11.3%, respectively. With respect to the symptoms' correlates, pain on passing urine was more frequent after assisted vaginal deliveries than all other forms of deliveries (all pairwise p < 0.01), and pain on passing motion was more frequent in vaginal deliveries than in Caesarean deliveries (all pairwise p < 0.05). Mothers having a larger number of children more frequently experienced headaches (β = 0.17, SE = 0.05, p = 0.002) and less frequently experienced breastfeeding difficulties (β = -0.28, SE = 0.08, p < 0.001). CONCLUSION Mothers experienced a high prevalence of maternal health problems in multiple domains during the first 8 weeks after childbirth. Mode of delivery and number of children were associated with increased prevalence of certain problems. Mothers' physical and mental well-being should be investigated early after delivery and addressed with adequate treatments and resources.
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Affiliation(s)
- Christine Ng
- National University Polyclinics (NUP), Singapore
| | - Anna Szücs
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lay Hoon Goh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Pouranayatihosseinabad M, Taylor M, Hawrelak J, Peterson GM, Veal F, Ling T, Williams M, Whatley M, Ahdieh K, Mirkazemi C. Maternal Antibiotic Exposure and the Risk of Developing Antenatal or Postpartum Depressive Symptoms: The Maternal Experience Study Protocol. Methods Protoc 2023; 6:98. [PMID: 37888030 PMCID: PMC10609134 DOI: 10.3390/mps6050098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023] Open
Abstract
Limited epidemiological evidence suggests a link between antibiotic use and developing depression. This study seeks to investigate this association in depth, using a cohort of pregnant individuals. The primary aim is to explore any association between the use of antibiotics during pregnancy and the development of antenatal depressive symptoms up to the third trimester, as well as the use of antibiotics during pregnancy and within 12 months postpartum and the development of postpartum depressive symptoms. A national prospective, observational, longitudinal cohort study has been designed to examine these relationships. A sample size of 1500 pregnant individuals has been sought for this study, assuming 10 potential predictor variables (including antibiotic use) in the final multiple logistic regression model and allowing for a 30% drop-out rate. The development of depressive symptoms is considered either a diagnosis by a medical doctor and/or a scoring 13 or higher on the Edinburgh Postnatal Depression Scale. Data will be collected during the third trimester and at 6 weeks, 6 months, and 12 months postpartum. These surveys include variables previously identified as associated with antenatal and postpartum depression (e.g., level of social support, experience of intimate partner abuse, and obstetric complications), as well as antibiotic and probiotic use. This study will provide an update on the prevalence of the symptoms of depression during pregnancy and postpartum and its associated risk factors. It will also, for the first time, comprehensively explore the potential association between antibiotic use during pregnancy and up to 12 months postpartum and the development of depressive symptoms.
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Affiliation(s)
- Mahsa Pouranayatihosseinabad
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS 7005, Australia
| | - Maggie Taylor
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS 7005, Australia
| | - Jason Hawrelak
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS 7005, Australia
| | - Gregory M. Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS 7005, Australia
| | - Felicity Veal
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS 7005, Australia
| | - Tristan Ling
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS 7005, Australia
| | - Mackenzie Williams
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS 7005, Australia
| | - Megan Whatley
- Department of Obstetrics and Gynaecology, Royal Hobart Hospital, Hobart, TAS 7000, Australia
| | - Kyan Ahdieh
- Launceston Medical Centre, Health Hub, Launceston, TAS 7250, Australia
| | - Corinne Mirkazemi
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS 7005, Australia
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Fogarty A, Brown SJ, Gartland D, Mensah F, FitzPatrick KM, Giallo R. Mental health trajectories of women experiencing differing patterns of intimate partner violence across the first 10 years of motherhood. Psychiatry Res 2023; 325:115261. [PMID: 37244158 DOI: 10.1016/j.psychres.2023.115261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 05/29/2023]
Abstract
Intimate partner violence is commonly experienced by women and associated with poor mental health outcomes. Evidence regarding the patterns of IPV across time, and the associated long term course of depressive symptoms is lacking. The current study aimed to (a) identify patterns of physical and emotional IPV experienced by women over the 10 years since having their first child, and (b) identify trajectories depressive symptoms across the 10-year period for each pattern of IPV exposure. Data was drawn from the Mothers' and Young People's Study (MYPS), a longitudinal study of 1507 mothers and their first born child. Data was collected during pregnancy and at one, four, and ten years postpartum. Using Latent Class Analysis, four distinct classes of IPV were identified: (1) Minimal IPV, (2) Early IPV exposure, (3) Increasing IPV, and (4) Persistent IPV. Latent growth modelling revealed that all classes characterised by some IPV exposure experienced elevated trajectories of depressive symptoms in comparison to the minimal IPV class. Those experiencing increasing and persistent IPV experienced the most severe course of depressive symptoms.
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Affiliation(s)
- Alison Fogarty
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia.
| | - Stephanie J Brown
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia; Department of General Practice, University of Melbourne, 780 Elizabeth St, Melbourne 3010, Australia
| | - Deirdre Gartland
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia
| | - Fiona Mensah
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia
| | - Kelly M FitzPatrick
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia
| | - Rebecca Giallo
- Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Australia; Department of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville 3052, Australia; School of Psychology, Deakin University, Geelong, Australia
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6
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FitzPatrick KM, Brown SJ, Hegarty K, Mensah F, Gartland D. Timing of Physical and Emotional Intimate Partner Violence Exposure and Women's Health in an Australian Longitudinal Cohort Study. Violence Against Women 2023:10778012221147904. [PMID: 36748672 DOI: 10.1177/10778012221147904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Drawing on data from a prospective pregnancy cohort (N = 1,507), this study examines the relationship between exposure to physical and emotional intimate partner violence (IPV) across the first 10 years of motherhood and women's mental and physical health. A measure of IPV (Composite Abuse Scale) was included at 1, 4, and 10 years postpartum. Past year and prior experiences of IPV were associated with mental and physical health issues at 10 years, both for mothers who had experienced combined IPV and emotional IPV alone. Awareness of the health issues associated with different types of IPV can assist in tailoring responses for women who experience IPV.
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Affiliation(s)
- Kelly M FitzPatrick
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Stephanie J Brown
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Kelsey Hegarty
- University of Melbourne, Melbourne, Australia
- Royal Women's Hospital, Melbourne, Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
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Gartland D, Hegarty K, Papadopoullos S, Brown S. Patterns of health service utilisation of mothers experiencing mental health problems and intimate partner violence: Ten-year follow-up of an Australian prospective mother and child cohort. PLoS One 2022; 17:e0269626. [PMID: 35704627 PMCID: PMC9200341 DOI: 10.1371/journal.pone.0269626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/24/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Few studies have investigated health service use of mothers experiencing mental health problems or intimate partner violence (IPV). The aim of this study was to investigate health service utilisation of mothers experiencing mental health problems and intimate partner violence ten years after having a first baby. Methods Prospective cohort of 1507 first-time mothers recruited in Melbourne, Australia. Follow-up at ten years incorporated: Center for Epidemiologic Studies Depression Scale, Beck Anxiety Inventory, Posttraumatic Stress Disorder Checklist, Composite Abuse Scale. Results At ten years postpartum, one in four mothers (26.1%) reported depressive, anxiety or posttraumatic stress symptoms, and almost one in five (19.4%) reported recent IPV. Two-fifths of mothers reporting clinically significant mental health symptoms had experienced recent IPV (Odds Ratio = 5.6, 95% CI 3.9–8.1). Less than half of mothers experiencing mental health problems at ten-year follow-up had discussed their mental health with a general practitioner and around one in three had talked to a mental health professional. Two-thirds of mothers experiencing recent IPV had not disclosed this to a general practitioner or mental health professional. Conclusions The findings highlight the extent to which many women deal with IPV and mental health problems without the support that primary health care and mental health care could provide and point to the need for more concerted efforts to strengthen health system responses to these frequently related issues.
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Affiliation(s)
- Deirdre Gartland
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Australia
- Royal Women's Hospital, Melbourne, Australia
| | - Sandra Papadopoullos
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Australia
| | - Stephanie Brown
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of General Practice, The University of Melbourne, Melbourne, Australia
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8
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Fogarty A, Brown S, Gartland D, Mensah F, Seymour M, Savopoulos P, FitzPatrick K, Papadopoullos S, Giallo R. Psychosocial factors associated with adolescent depressive and anxiety symptoms during the COVID-19 pandemic. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2022. [DOI: 10.1177/01650254221084100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The COVID-19 pandemic has created many challenges for adolescents across the world. The current study aimed to investigate the prevalence of depressive and anxiety symptoms and suicidal ideation in adolescents living in Melbourne, Australia, during the state of Victoria’s second lockdown. The study also sought to identify pre-existing and current psychosocial stressors associated with adolescent’s depressive and anxiety symptoms, and to identify the extent to which adolescents experiencing mental health difficulties sought professional help during the pandemic. A COVID-19 sub-study of the Mothers’ and Young People’s Study—an 18-year longitudinal cohort study—was conducted between July and September 2020, an online survey completed by 257 adolescents aged 14–17 years and their mothers, which asked about pandemic-related stressors, remote learning, family life, and mental health. Descriptive statistics and hierarchical multiple regression analysis were conducted. Mental health difficulties were common with 38% and 20% of adolescents reporting clinically significant depressive and anxiety symptoms, respectively, and 21% reporting frequent suicidal or self-harm ideation. Factors associated with depressive and anxiety symptoms included being female, exposure to current maternal depressive symptoms, lower levels of resilience, experiences of loneliness, stressful life events, and school- and family-related stressors. Two-thirds of adolescents who were experiencing clinically significant depressive or anxiety symptoms had not sought professional help. Our findings highlight the urgent mental health need among adolescents and the importance of reducing barriers to accessing support.
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Affiliation(s)
| | - Stephanie Brown
- Murdoch Children’s Research Institute, Australia
- The University of Melbourne, Australia
| | - Deirdre Gartland
- Murdoch Children’s Research Institute, Australia
- The University of Melbourne, Australia
| | - Fiona Mensah
- Murdoch Children’s Research Institute, Australia
- The University of Melbourne, Australia
| | | | | | | | | | - Rebecca Giallo
- Murdoch Children’s Research Institute, Australia
- The University of Melbourne, Australia
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9
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Signorelli M, Taft A, Gartland D, Hooker L, McKee C, MacMillan H, Brown S, Hegarty K. How Valid is the Question of Fear of a Partner in Identifying Intimate Partner Abuse? A Cross-Sectional Analysis of Four Studies. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:2535-2556. [PMID: 32646314 DOI: 10.1177/0886260520934439] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Intimate partner abuse (IPA) affects women's health, requiring accurate questions to identify the abuse. We investigated the accuracy of three questions about fear of an intimate partner in identifying exposure to IPA. We compared the sensitivity and specificity of these questions with the Composite Abuse Scale (CAS) using secondary data analysis of four existing studies. All studies recruited adult women from clinical settings, with sample sizes ranging from 1,257 to 5,871. We examined associations between demographic factors and fear through multivariate logistic regression, and analysis of the sensitivity and specificity of the questions about fear and IPA (CAS), generating a receiver operating curve (ROC). The prevalence of lifetime fear of a partner ranged from 9.5% to 26.7%; 14.0% of women reported fear in the past 12 months; and current fear ranged from 1.3% to 3.3%. Comparing the three questions, the question "afraid of a partner in the past 12 months" was considered the best question to identify IPA. This question had the greatest area under the ROC (0.80, 95% confidence interval (CI) = [0.78-0.81]) compared with "are you currently afraid" (range 0.57-0.61) or "have you ever been afraid" (range 0.66-0.77); and demonstrated better sensitivity (64.8%) and specificity (94.8%). Demographic factors associated with "fear of a partner in the past 12 months" included being divorced/separated (odds ratio [OR] = 8.49, 95% CI = [6.70-10.76]); having a low income (OR = 4.21, 95% CI = [3.46-5.13]); and having less than 12 years of education (OR = 2.48, 95% CI = [2.04-3.02]). The question "In the last 12 months did you ever feel frightened by what your partner says or does?" has potential to identify a majority of women experiencing IPA, supporting its utilization where more comprehensive measures are not possible.
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Affiliation(s)
| | - Angela Taft
- La Trobe University, Melbourne, VIC, Australia
| | - Deirdre Gartland
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | | | | | - Stephanie Brown
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Kelsey Hegarty
- The Royal Women's Hospital, The University of Melbourne, Melbourne, VIC, Australia
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10
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Gartland D, Conway LJ, Giallo R, Mensah FK, Cook F, Hegarty K, Herrman H, Nicholson J, Reilly S, Hiscock H, Sciberras E, Brown SJ. Intimate partner violence and child outcomes at age 10: a pregnancy cohort. Arch Dis Child 2021; 106:1066-1074. [PMID: 33883191 DOI: 10.1136/archdischild-2020-320321] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/05/2021] [Accepted: 02/17/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Assess the mental health, physical health, cognitive and language development of 10-year old children in families where mothers have reported intimate partner violence (IPV) compared with children with no reported IPV exposure. DESIGN Prospective pregnancy cohort. Maternal report of IPV (Composite Abuse Scale) at 1, 4 and 10 years. Maternal and direct assessment of child mental health (probable psychiatric diagnosis, anxiety and emotional/behavioural difficulties), cognition (IQ and executive function), language (general, pragmatic and receptive) and physical health at 10 years. SETTING A subsample of 615 mother-child dyads drawn from a pregnancy cohort of 1507 nulliparous women recruited from six public hospitals in Melbourne, Australia. RESULTS Any IPV exposure from infancy to age 10 was associated with poorer child outcomes at age 10. Specifically, twice the odds of a probable psychiatric diagnosis, emotional/behavioural difficulties, impaired language skills (general and pragmatic), and having consulted a health professional about asthma or sleep problems. IPV exposure at age 10 associated with two to three times higher odds of all mental health outcomes, elevated blood pressure and sleep problems. Early life exposure alone (at 1 and/or 4 years) associated with three times higher odds of a general language problem and asthma at age 10. CONCLUSION The high prevalence of IPV and increased risk of poorer health and development among children exposed highlights the burden of ill health carried by children in families experiencing IPV. Fewer difficulties where exposure was limited to the early years builds the case for better identification, understanding and resourcing of effective early intervention.
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Affiliation(s)
- Deirdre Gartland
- Intergenerational Health Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia .,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Laura J Conway
- Intergenerational Health Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Giallo
- Intergenerational Health Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Fiona K Mensah
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fallon Cook
- Intergenerational Health Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia.,Centre of Family Violence Prevention, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Helen Herrman
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jan Nicholson
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.,School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sheena Reilly
- Menzies Health Institute, Griffith University, Brisbane, Queensland, Australia
| | - Harriet Hiscock
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Health Services Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Emma Sciberras
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Stephanie J Brown
- Intergenerational Health Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
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Fogarty A, Woolhouse H, Giallo R, Wood C, Kaufman J, Brown S. Mothers' Experiences of Parenting Within the Context of Intimate Partner Violence: Unique Challenges and Resilience. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:10564-10587. [PMID: 31690167 DOI: 10.1177/0886260519883863] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Maternal and child health are strongly linked, particularly in the presence of intimate partner violence (IPV). Women who experience IPV are at increased risk of negative physical and mental health difficulties. However, little is known about the experience of mothering within the context of IPV and what mothers perceive as contributing to resilience. This study had two aims. First, to explore women's experience and perceived challenges associated with being a mother within the context of being in a relationship where IPV is being used. Second, to explore what mothers found helpful in coping during this experience. A nested qualitative sub-study was conducted within a prospective study of mothers during pregnancy and following the birth of their first child. Nine women who reported experiencing IPV since becoming pregnant with their first child participated in semi-structured qualitative interviews, which were then transcribed and analyzed using interpretive phenomenological analysis (IPA). Three subthemes emerged within the theme of unique challenges experienced by mothers. These were partner control over parenting, other disrespectful and controlling behavior, and emotional exhaustion. Within the theme of mothers' sense of resilience and coping, career development, making sense of experiences, focusing on children, and help-seeking played important roles in helping mothers manage these difficulties. Our findings highlighted the impact that IPV can have on the experience of mothering and the importance of prioritizing women's health and well-being. Finally, these findings emphasize the importance of health-care professionals identifying and acknowledging the signs of IPV to support women to speak out about their experiences.
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Affiliation(s)
- Alison Fogarty
- Swinburne University of Technology, Hawthorn, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Hannah Woolhouse
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Rebecca Giallo
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Parkville, Melbourne, Australia
| | - Catherine Wood
- Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Jordy Kaufman
- Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Stephanie Brown
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Parkville, Melbourne, Australia
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12
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Brown SJ, Gartland D, Woolhouse H, Giallo R, McDonald E, Seymour M, Conway L, FitzPatrick KM, Cook F, Papadopoullos S, MacArthur C, Hegarty K, Herrman H, Nicholson JM, Hiscock H, Mensah F. The maternal health study: Study design update for a prospective cohort of first-time mothers and their firstborn children from birth to age ten. Paediatr Perinat Epidemiol 2021; 35:612-625. [PMID: 33956353 DOI: 10.1111/ppe.12757] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/22/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Maternal health is critical to the health and well-being of children and families, but is rarely the primary focus of pregnancy and birth cohort studies. Globally, poor maternal health and the exposure of women and children to family violence contribute to the perpetuation and persistence of intergenerational health inequalities. OBJECTIVES The Maternal Health Study was designed to investigate the contribution of social and obstetric risk factors to common maternal physical and psychological morbidities. Over time, our focus has expanded to include mother-child pairs and investigation of intergenerational trauma and family violence. POPULATION A total of 1507 first-time mothers were recruited in early pregnancy from six public hospitals in Melbourne, Australia, in 2003-2005. METHODS Women completed questionnaires or telephone interviews in early pregnancy (≤24 weeks); at 32 weeks' gestation; at three, six, nine, 12 and 18 months postpartum; and at four and ten years. At ten years, women and children were invited to participate in face-to-face interviews, which included direct assessment of children's cognitive and language development. A wide range of obstetric, social and contextual factors have been measured, including exposure to intimate partner violence (IPV) (1-year, 4-year and 10-year follow-up). RESULTS 1507 eligible women were recruited at a mean gestation of 15 weeks. At one year, four years and ten years postpartum, 90.0%, 73.1% and 63.2% of the original cohort took part in follow-up. One in three women in the study (34.5%) reported exposure to IPV in the first ten years of motherhood: 19% in the first 12 months postpartum, 20% in the year prior to four-year follow-up and 18.3% in the year prior to ten-year follow-up. CONCLUSION The study affords a unique opportunity to examine patterns of maternal and child health and health service use associated with exposure to IPV.
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Affiliation(s)
- Stephanie J Brown
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia.,Department of General Practice, The University of Melbourne, Melbourne, Vic., Australia
| | - Deirdre Gartland
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia
| | - Hannah Woolhouse
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Rebecca Giallo
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia
| | - Ellie McDonald
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Monique Seymour
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Laura Conway
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia
| | - Kelly M FitzPatrick
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia
| | - Fallon Cook
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia
| | - Sandra Papadopoullos
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Christine MacArthur
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Vic., Australia.,Royal Women's Hospital, Melbourne, Vic., Australia
| | - Helen Herrman
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic., Australia
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Melbourne, Vic., Australia
| | - Harriet Hiscock
- Health Services, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Centre for Community Child Health, Royal Children's Hospital, Melbourne, Vic, Australia
| | - Fiona Mensah
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia
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13
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Abstract
OBJECTIVE To identify profiles and predictors of maternal-reported infant sleep problems across the first postnatal year. METHODS Survey data examining maternal mental and physical health, intimate partner violence (IPV), and infant sleep problems and night waking were gathered from a cohort of 1,460 nulliparous women at 15 weeks' gestation and when their infants were 3, 6, 9, and 12 months old. RESULTS Latent class analysis revealed 5 profiles of infant sleep problems, including those who had few problems (24.7%), persistent moderate problems (27.3%), increased problems at 6 months (10.8%), increased problems at 9 months (17.8%), and persistent severe problems (19.4%). Persistent severe infant sleep problems were associated with prepartum and postpartum maternal depression (adjusted odds ratio [AOR] 2.13, 95% confidence interval [CI] 1.35-3.34, p < 0.01; AOR 2.52, 95% CI 1.64-3.87, p < 0.001, respectively), poorer prepartum and postpartum perception of health (adjusted mean difference [AMD] 23.48, 95% CI 24.9 to 22.1, p < 0.01; AMD 23.78, 95% CI 25.2 to 22.4, p < 0.001, respectively), increased postpartum anxiety (AOR 2.22, 95% CI 1.26-3.90, p < 0.01), and increased prevalence of IPV in the first year postpartum (AOR 1.86, 95% CI 1.20-2.87, p < 0.01). CONCLUSION Poorer prepartum and postpartum maternal mental and physical health, and IPV, were associated with maternal report of persistent severe infant sleep problems. Women experiencing prenatal physical and mental health difficulties may benefit from advice on managing infant sleep and settling. Health professionals working with unsettled infants must be equipped to enquire about and respond appropriately to disclosures of IPV.
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14
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Conway LJ, Cook F, Cahir P, Brown S, Reilly S, Gartland D, Mensah F, Giallo R. Children's language abilities at age 10 and exposure to intimate partner violence in early childhood: Results of an Australian prospective pregnancy cohort study. CHILD ABUSE & NEGLECT 2021; 111:104794. [PMID: 33160647 DOI: 10.1016/j.chiabu.2020.104794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/15/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Approximately one in four children in Australia have mothers who experience intimate partner violence (IPV). These children are at risk of poor mental health. Less is known about their language outcomes, despite evidence that childhood adversity threatens neurodevelopment, and the home environment effects language development. OBJECTIVE This study aimed to examine the relationship between early childhood IPV exposure and language outcomes (receptive vocabulary, general language, pragmatic language) at age 10, including the influence of maternal depressive symptoms. PARTICIPANTS AND SETTING Participants were 615 mothers and their first-born child participating in a prospective, community-based pregnancy cohort study in Melbourne. METHODS Mothers reported their experience of IPV and depressive symptoms in the first and fourth year postpartum. At 10 years postpartum, children's receptive vocabulary was directly assessed and mothers reported on their child's general and pragmatic language skills. RESULTS Exposure to IPV was related to scores indicating poorer abilities in receptive vocabulary (d=-0.26, p = .009), general language (d = 0.23, p = .047) and pragmatic language skills (d = 0.41, p < .001) at age 10. After adjusting for maternal depressive symptoms, evidence remained for the relationship with pragmatic language (d=-0.32, p = .006), and a trend for receptive vocabulary (d=-0.20, p = .052). CONCLUSIONS At a community-level, children whose mothers experienced IPV during the child's first four years had poorer language skills in middle childhood than children whose mothers did not experience IPV. This is important because poor child language skills are associated with adverse outcomes across the lifespan including academic under-achievement and mental health problems. Clinical implications are discussed.
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Affiliation(s)
- Laura J Conway
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia.
| | - Fallon Cook
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia
| | - Petrea Cahir
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia
| | - Stephanie Brown
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Sheena Reilly
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia
| | - Deirdre Gartland
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia
| | - Rebecca Giallo
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia; La Trobe University, Bundoora, Australia
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15
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Brown SJ, Conway LJ, FitzPatrick KM, Hegarty K, Mensah FK, Papadopoullos S, Woolhouse H, Giallo R, Gartland D. Physical and mental health of women exposed to intimate partner violence in the 10 years after having their first child: an Australian prospective cohort study of first-time mothers. BMJ Open 2020; 10:e040891. [PMID: 33371030 PMCID: PMC7754634 DOI: 10.1136/bmjopen-2020-040891] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate mental and physical health of mothers exposed to recent and early postpartum intimate partner violence (IPV) in the 10 years after having their first child. DESIGN Prospective pregnancy cohort study. SETTING Women were recruited at six metropolitan public maternity hospitals in Melbourne, Australia and followed up at 1, 4 and 10 years post partum. STUDY MEASURES Exposure to physical and/or emotional IPV was measured using the Composite Abuse Scale at 1, 4 and 10 years. At 10-year follow-up, mothers reported on physical and mental health, and functional health status. PARTICIPANTS 1507 first-time mothers enrolled at mean of 15 weeks' gestation. RESULTS One in three women experienced IPV during the 10 years after having their first child. Women experiencing recent IPV (19.1%) reported worse physical and mental health than women not reporting IPV. Compared with women not reporting IPV, women experiencing recent IPV had higher odds of poor functional health status (Adj OR=4.5, 95% CI 3.2 to 6.3), back pain (Adj OR=2.0, 95% CI 1.4 to 2.9), incontinence (Adj OR=1.8, 95% CI 1.2 to 2.6), depressive symptoms (Adj OR=4.9, 95% CI 3.2 to 7.5), anxiety (Adj OR=5.1, 95% CI 3.0 to 8.6) and post-traumatic stress symptoms (Adj OR=7.2, 95% CI 4.6 to 11.1) at 10 years. Women with past IPV at 1 and/or 4 years (15.7% of the cohort) also had higher odds of physical and mental health problems. There was evidence of a gradient in health outcomes by recency of exposure to IPV. CONCLUSIONS Both recent and past exposure to IPV are associated with poor maternal physical and mental health 10 years after a first birth. Health services and advocacy organisations providing support to women need to be aware of the consistent relationship between IPV and a range of physical and mental health conditions, which may persist even after IPV appears to have ceased.
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Affiliation(s)
- Stephanie J Brown
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Laura J Conway
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly M FitzPatrick
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Kelsey Hegarty
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona K Mensah
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Sandra Papadopoullos
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Hannah Woolhouse
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Rebecca Giallo
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Deirdre Gartland
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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16
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Szafrańska M, Begley C, Carroll M, Daly D. Factors associated with maternal readmission to hospital, attendance at emergency rooms or visits to general practitioners within three months postpartum. Eur J Obstet Gynecol Reprod Biol 2020; 254:251-258. [PMID: 33032101 DOI: 10.1016/j.ejogrb.2020.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022]
Abstract
While most women remain healthy after giving birth to their baby, others experience complications that require medical attention or readmission to hospital. However, data on maternal attendance for medical care postpartum or readmission to hospital are not collected or reported routinely in many countries so the extent of health problems experienced remain unknown. Collecting data on the proportion of women who seek medical care in the early postpartum period may deepen understanding of risk factors, the consequences for women, their families and the maternity care system and, ultimately, help identify preventative strategies and processes. OBJECTIVE To identify the factors associated with maternal rehospitalisation, attendance at emergency rooms or visits to general practitioners, the three main sources of medical services postpartum in Ireland, within the first three months postpartum. STUDY DESIGN A prospective cohort study, embedded in a larger maternal health and morbidity study, with 1668 nulliparous women recruited from two maternity hospitals in Ireland. Univariate and multivariable logistic regression analyses were used to explore associations with postpartum rehospitalisation, emergency room attendance and general practitioner visits within the first three months postpartum, for maternal health-related reasons. RESULTS Four percent (n = 66) of women were rehospitalised, 10% (n = 166) attended an emergency room, and 13.6% (n = 223) attended their general practitioner three or more times, regarding their own health. Women aged 24 years or less were more likely to attend their doctor (p = 0.02, AOR 2.13, 95% CI 1.08-4.21) compared to women aged 25-29 years, the reference category. Women who were obese or very obese were also more likely to attend their doctor three or more times (p = 0.01, AOR 1.79, 95% CI 1.15-2.79) and also more likely to attend an emergency room (p = 0.04, AOR 1.69, 95% CI 1.02-2.80) within three months postpartum, for their own health reasons. CONCLUSION Findings indicate that considerable proportions of women seek medical care from various healthcare sources postpartum. These medical visits are not routinely reported and point to the need for interventions regarding the care, management and services available to first-time mothers birthing in Ireland, with specific attention on preventative postpartum health.
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Affiliation(s)
- Marcelina Szafrańska
- School of Nursing, Midwifery and Health Systems, University College Dublin, UCD Health Sciences Centre, 4, Stillorgan Rd, Belfield, Dublin, Ireland.
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street Dublin 2, Ireland
| | - Margaret Carroll
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street Dublin 2, Ireland
| | - Déirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street Dublin 2, Ireland
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17
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Cook F, Conway LJ, Giallo R, Gartland D, Sciberras E, Brown S. Infant sleep and child mental health: a longitudinal investigation. Arch Dis Child 2020; 105:655-660. [PMID: 32152038 DOI: 10.1136/archdischild-2019-318014] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether infants with severe persistent sleep problems are at increased risk of (1) meeting diagnostic criteria for a psychiatric disorder (age 10 years), and (2) having elevated symptoms of mental health difficulties (ages 4 and 10 years), in comparison with infants with settled sleep. DESIGN AND SETTING Prospective longitudinal community cohort study-the Maternal Health Study. Mothers completed questionnaires/interviews at 15 weeks' gestation; 3, 6, 9 and 12 months post partum; and when their child turned 4 and 10 years old. Measures included parental report of infant night waking and sleep problems and child mental health (Strengths and Difficulties Questionnaire; Spence Children's Anxiety Scale; Development and Well-being Assessment). PARTICIPANTS 1460 mother-infant dyads. RESULTS 283 (19.4%) infants had persistent severe sleep problems, 817 (56.0%) had moderate/fluctuating sleep problems and 360 (24.7%) infants were settled. Infants with persistent severe sleep problems were more likely to report emotional symptoms at age 4 (adjusted odds ratio (AOR)=2.70, 95% CI 1.21 to 6.05, p=0.02), and meet diagnostic criteria for an emotional disorder at age 10 (AOR=2.37, 95% CI 1.05 to 5.36, p=0.04). Infants with persistent severe sleep problems also had elevated symptoms of separation anxiety (AOR=2.44, 95% CI 1.35 to 4.41, p<0.01), fear of physical injury (AOR=2.14, 95% CI 1.09 to 4.18, p=0.03) and overall elevated anxiety (AOR=2.20, 95% CI 1.13 to 4.29, p=0.02) at age 10. CONCLUSIONS Infants with persistent severe sleep problems during the first postnatal year have an increased risk of anxiety problems and emotional disorders at age 10.
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Affiliation(s)
- Fallon Cook
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia .,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Laura J Conway
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Giallo
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Deirdre Gartland
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emma Sciberras
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Stephanie Brown
- Intergenerational Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of General Practice and Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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18
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Ear PH, Chadda A, Gumusoglu SB, Schmidt MS, Vogeler S, Malicoat J, Kadel J, Moore MM, Migaud ME, Stevens HE, Brenner C. Maternal Nicotinamide Riboside Enhances Postpartum Weight Loss, Juvenile Offspring Development, and Neurogenesis of Adult Offspring. Cell Rep 2020; 26:969-983.e4. [PMID: 30673618 DOI: 10.1016/j.celrep.2019.01.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 12/09/2018] [Accepted: 01/02/2019] [Indexed: 12/17/2022] Open
Abstract
Conditions of metabolic stress dysregulate the NAD metabolome. By restoring NAD, nicotinamide riboside (NR) provides resistance to such conditions. We tested the hypotheses that postpartum might dysregulate maternal NAD and that increasing systemic NAD with NR might benefit mothers and offspring. In postpartum mothers, the liver NAD metabolome is depressed while blood increases circulation of NAD metabolites to enable a >20-fold increase in mammary NAD+ and NADP+. Lactation and NR synergize in stimulating prolactin synthesis and mammary biosynthetic programs. NR supplementation of new mothers increases lactation and nursing behaviors and stimulates maternal transmission of macronutrients, micronutrients, and BDNF into milk. Pups of NR-supplemented mothers are advantaged in glycemic control, size at weaning, and synaptic pruning. Adult offspring of mothers supplemented during nursing retain advantages in physical performance, anti-anxiety, spatial memory, delayed onset of behavioral immobility, and promotion of adult hippocampal neurogenesis. Thus, postgestational maternal micronutrition confers lasting advantages to offspring.
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Affiliation(s)
- Po Hien Ear
- Department of Biochemistry, University of Iowa, Iowa City, IA 52242, USA
| | - Ankita Chadda
- Department of Biochemistry, University of Iowa, Iowa City, IA 52242, USA
| | | | - Mark S Schmidt
- Department of Biochemistry, University of Iowa, Iowa City, IA 52242, USA
| | - Sophia Vogeler
- Department of Biochemistry, University of Iowa, Iowa City, IA 52242, USA
| | - Johnny Malicoat
- Department of Biochemistry, University of Iowa, Iowa City, IA 52242, USA
| | - Jacob Kadel
- Department of Biochemistry, University of Iowa, Iowa City, IA 52242, USA
| | - Michelle M Moore
- Department of Biochemistry, University of Iowa, Iowa City, IA 52242, USA
| | - Marie E Migaud
- Department of Biochemistry, University of Iowa, Iowa City, IA 52242, USA
| | - Hanna E Stevens
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA
| | - Charles Brenner
- Department of Biochemistry, University of Iowa, Iowa City, IA 52242, USA.
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19
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Intimate partner violence and maternal mental health ten years after a first birth: An Australian prospective cohort study of first-time mothers. J Affect Disord 2020; 262:247-257. [PMID: 31732279 DOI: 10.1016/j.jad.2019.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/23/2019] [Accepted: 11/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to assess the relationship between intimate partner violence (IPV) and maternal mental health ten years after a first birth METHODS: 1507 first-time mothers completed questionnaires at 3, 6, 12 and 18 months postpartum and 4 and ten years post the index birth. Exposure to IPV was assessed using the Composite Abuse Scale at 1, 4 and ten years. Standardised measures of depressive (CES-D), anxiety (BAI) and post-traumatic stress symptoms (PCL-C) were completed at ten-year follow-up. RESULTS One in three (34%) women experienced IPV between the birth of their first child and their child turning 10. For the one in six women (18.6%) who experienced IPV in the year prior to ten-year follow-up, the prevalence of depressive symptoms was 38.9% compared with 14.2% for women who never reported IPV (adjusted odds ratio [AdjOR] 2.9, 95% confidence interval [CI] 1.9-4.5). Prevalence of anxiety symptoms was 28.1% compared with 8.5% (AdjOR 3.4, 95% CI 2.0-5.9); and prevalence of post-traumatic stress symptoms was 41.9% compared with 11.3% (AdjOR 4.9, 95% CI 3.0-7.9). LIMITATIONS Mental health symptoms and exposure to IPV were assessed by self-report and may be subject to misclassification bias as a result of non-disclosure. CONCLUSIONS The high prevalence of mental health symptoms among women exposed to IPV in the ten years after giving birth coupled with the extent of post-traumatic stress symptoms and co-morbid mental health symptoms reinforce the need to provide appropriate care and referral pathways to women in the decade after having a baby. Recognition of the context of IPV and nature of mental health concerns is needed in tailoring responses.
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20
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Moran PS, Wuytack F, Turner M, Normand C, Brown S, Begley C, Daly D. Economic burden of maternal morbidity - A systematic review of cost-of-illness studies. PLoS One 2020; 15:e0227377. [PMID: 31945775 PMCID: PMC6964978 DOI: 10.1371/journal.pone.0227377] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023] Open
Abstract
Aim To estimate the economic burden of common health problems associated with pregnancy and childbirth, such as incontinence, mental health problems, or gestational diabetes, excluding acute complications of labour or birth, or severe acute adverse maternal outcomes. Methods Searches for relevant studies were carried out to November 2019 in Medline, Embase, CINAHL, PsycINFO and EconLit databases. After initial screening, all results were reviewed for inclusion by two authors. An adapted version of a previously developed checklist for cost-of-illness studies was used for quality appraisal. All costs were converted to 2018 Euro using national consumer price indices and purchasing power parity conversion factors. Results Thirty-eight relevant studies were identified, some of which reported incremental costs for more than one health problem (16 gestational diabetes, 13 overweight/obesity, 8 mental health, 4 hypertensive disorders, 2 nausea and vomiting, 2 epilepsy, 1 intimate partner violence). A high level of heterogeneity was observed in both the methods used, and the incremental cost estimates obtained for each morbidity. Average incremental costs tended to be higher in studies that modelled a hypothetical cohort of women using data from a range of sources (compared to analyses of primary data), and in studies set in the United States. No studies that examined the economic burden of some common pregnancy-related morbidities, such as incontinence, pelvic girdle pain, or sexual health problems, were identified. Conclusion Our findings indicate that maternal morbidity is associated with significant costs to health systems and society, but large gaps remain in the evidence base for the economic burden of some common health problems associated with pregnancy and childbirth. More research is needed to examine the economic burden of a range of common maternal health problems, and future research should adopt consistent methodological approaches to ensure comparability of results.
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Affiliation(s)
- Patrick S. Moran
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
- * E-mail:
| | | | | | - Charles Normand
- Centre for Health Policy and Management, Trinity College, Dublin, Ireland
- Cicely Saunders Institute, King’s College, London, United Kingdom
| | - Stephanie Brown
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
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Gartland D, Giallo R, Woolhouse H, Mensah F, Brown S. Intergenerational Impacts of Family Violence - Mothers and Children in a Large Prospective Pregnancy Cohort Study. EClinicalMedicine 2019; 15:51-61. [PMID: 31709414 PMCID: PMC6833344 DOI: 10.1016/j.eclinm.2019.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 07/18/2019] [Accepted: 08/13/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Violence and other adversities commonly co-occur, yet are usually investigated individually. The primary objectives of this paper are to investigate: (i) the relationship between maternal exposure to violence (including childhood abuse and intimate partner violence) and postpartum mental and physical health; and (ii) the extent to which exposure to violence and poor maternal mental and physical health are associated with children's emotional-behavioral difficulties. METHODS Prospective pregnancy cohort (n = 1507) followed up to 4 year postpartum. Validated measures used: Composite Abuse Scale; Edinburgh Postnatal Depression Scale, SF-36, Child Maltreatment History Self Report; Strengths and Difficulties Questionnaire. Logistic regression was used to investigate associations between maternal childhood abuse, intimate partner violence (IPV), maternal health and child emotional and behavioral difficulties at age 4. OUTCOMES Two out of five women (41%) reported abuse in childhood, and almost one in three (29%) reported IPV during the first four years of motherhood. Women reporting both physical and sexual childhood abuse had markedly raised odds of IPV and poor physical and mental health at all time points (pregnancy, first year postpartum and four year postpartum). For the index child, violence exposures (maternal childhood abuse or IPV) and poor maternal physical or mental health were associated with higher odds of emotional/behavioral difficulties at age four. In multivariable models (adjusted for child gender and maternal age), cumulative exposures (multiple violence exposures or poor maternal mental or physical health at multiple time points) each independently added to increased odds of emotional-behavioral difficulties. Children of mothers who reported a history of childhood abuse but were not exposed to IPV had odds of difficulties similar to children of mothers not reporting any violence exposure, suggesting resilient outcomes where violence experiences are not repeated in the next generation. INTERPRETATION The clustering of risk (child and adult violence experiences) and the accumulation of risk within families (IPV, poor maternal health, child difficulties) highlight the need for effective early intervention to limit or ameliorate the impact of violence across the lifespan, and to break the intergenerational cycle of disadvantage.
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Affiliation(s)
- D. Gartland
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia
- Corresponding author at: Intergenerational Health, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Vic., Australia.
| | - R. Giallo
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia
| | - H. Woolhouse
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - F. Mensah
- Department of Paediatrics, The University of Melbourne, Melbourne, Vic., Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - S.J. Brown
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic., Australia
- Department of Paediatrics, Department of General Practice, The University of Melbourne, Melbourne, Vic., Australia
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Fogarty A, Woolhouse H, Giallo R, Wood C, Kaufman J, Brown S. Promoting resilience and wellbeing in children exposed to intimate partner violence: A qualitative study with mothers. CHILD ABUSE & NEGLECT 2019; 95:104039. [PMID: 31234129 DOI: 10.1016/j.chiabu.2019.104039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/21/2019] [Accepted: 06/04/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Children exposed to intimate partner violence (IPV) are at increased risk of disruptions to their health and development. Few studies have explored mothers' perceptions of what helps their children cope throughout this experience. OBJECTIVE The aim of the study was to explore mothers' perceptions of their children's resilience and coping following IPV exposure, and the strategies they have used to support their children and promote resilience. METHODS In depth semi-structured interviews were conducted with nine women from the Maternal Health Study (MHS), a prospective study of women during pregnancy and following the birth of their first child. All women involved in the qualitative interviews reported experiencing IPV during their involvement in the MHS. Transcribed interviews were analysed using interpretative phenomenological analysis which has a focus on how individuals make meaning of their experience. RESULTS Women discussed parenting strategies such as role modelling, stable and consistent parenting, and talking with their children about healthy relationships to promote their children's resilience. Mothers also spoke about the ways they tried to reduce their child's direct exposure to IPV, as well as reflecting on the difficulty of attending to their child emotionally when they were experiencing distress. CONCLUSIONS This study highlights that there are many strategies used by mothers who experience IPV to promote resilience and wellbeing in their children. Understanding what mothers see as useful for their children is essential in providing appropriate services to families following experiences of family violence.
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Affiliation(s)
- Alison Fogarty
- Swinburne University of Technology, Hawthorn, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Hannah Woolhouse
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Rebecca Giallo
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Departments of Paediatrics, The University of Melbourne, Victoria, Australia
| | - Catherine Wood
- Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Jordy Kaufman
- Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Stephanie Brown
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Departments of Paediatrics, The University of Melbourne, Victoria, Australia
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Woolhouse H, Gartland D, Papadopoullos S, Mensah F, Hegarty K, Giallo R, Brown S. Psychotropic medication use and intimate partner violence at 4 years postpartum: Results from an Australian pregnancy cohort study. J Affect Disord 2019; 251:71-77. [PMID: 30904778 DOI: 10.1016/j.jad.2019.01.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/08/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the perinatal period, maternal mental health problems and intimate partner violence often co-occur. We aimed to examine associations between psychotropic medication use and intimate partner violence (IPV) in an Australian population-based sample. METHODS Prospective cohort study of 1507 first-time mothers recruited in early pregnancy (mean gestation 15 weeks) from public maternity hospitals in Melbourne Australia. Follow-up questionnaires at 12 months and four years included validated measures of intimate partner violence (Composite Abuse Scale), and maternal mental health (Edinburgh Postnatal Depression Scale, SF-36). Data on use of psychotropic medications was collected using a self-report measure at four years postpartum. RESULTS At four years postpartum, almost one in eight mothers (13.9%) were taking psychotropic medication. The prevalence of psychotropic medication use in women experiencing concurrent IPV was considerably higher compared to women not experiencing IPV (25% vs 11%, Odds Ratio = 2.68, 95% CI 1.73-4.15). Women experiencing IPV were significantly more likely to be taking psychotropic medication, even after adjusting for sociodemographic factors and depressive symptoms (Adj OR = 1.86, 95% CI 1.16 to 2.96). Only 5% of women reporting IPV at four years postpartum had discussed this with a general practitioner. LIMITATIONS Limitations include use of a self-report measure to assess psychotropic medication use, lack of data on the use of psychological counselling and/or other specialist mental health services and potential for attrition to bias results (addressed using multiple imputation). CONCLUSIONS Our findings reinforce the need for health professionals treating women for depressive symptoms to inquire about IPV and tailor responses accordingly.
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Affiliation(s)
- Hannah Woolhouse
- Intergenerational Health Group, Murdoch Children's Research Institute, Flemington Road, Parkville, VIC 3052, Australia
| | - Deirdre Gartland
- Intergenerational Health Group, Murdoch Children's Research Institute, Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville VIC 3052, Australia
| | - Sandra Papadopoullos
- Intergenerational Health Group, Murdoch Children's Research Institute, Flemington Road, Parkville, VIC 3052, Australia
| | - Fiona Mensah
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Parkville VIC 3052, Australia
| | - Rebecca Giallo
- Intergenerational Health Group, Murdoch Children's Research Institute, Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville VIC 3052, Australia
| | - Stephanie Brown
- Intergenerational Health Group, Murdoch Children's Research Institute, Flemington Road, Parkville, VIC 3052, Australia; Department of Paediatrics, The University of Melbourne, Parkville VIC 3052, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, 3052, Australia; Department of General Practice, The University of Melbourne, Parkville VIC 3052, Australia; South Australian Health and Medical Research Institute, North Terrace, Adelaide SA 5000, Australia.
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Fogarty A, Giallo R, Wood C, Kaufman J, Brown S. Emotional-behavioral resilience and competence in preschool children exposed and not exposed to intimate partner violence in early life. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2019. [DOI: 10.1177/0165025419830241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Exposure to intimate partner violence (IPV) during childhood is a risk factor for poor emotional-behavioral functioning. Despite this, many children show resilience in the face of IPV exposure. The current study aimed to identify characteristics associated with positive emotional-behavioral outcomes in 4-year-old children exposed to IPV in early life. Data were drawn from the Maternal Health Study (MHS), a prospective study of women during pregnancy and following the birth of their first child. Women were recruited from six Melbourne public hospitals between 2003 and 2005. Mother–child dyads ( n = 1060) were included in the study using data collected during pregnancy; 12 months postpartum; and four years postpartum. Of the children exposed to IPV in early life, 38% displayed emotional-behavioral resilience at four years. Maternal physical wellbeing, mothers’ return to work or study and no exposure to IPV at four years were associated with child resilience. These results highlighted the importance of prioritizing mothers’ physical wellbeing and access to employment in promoting positive outcomes for their children. The results also reinforced the significant role of early intervention; when exposure to IPV stops at an early age, children are more likely to experience emotional-behavioral resilience.
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Affiliation(s)
- Alison Fogarty
- Swinburne University of Technology, Hawthorn, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Rebecca Giallo
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, Royal Children’s Hospital, University of Melbourne, Australia
| | - Catherine Wood
- Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Jordy Kaufman
- Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Stephanie Brown
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Pediatrics, Royal Children’s Hospital, University of Melbourne, Australia
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McDonald EA, Gartland D, Woolhouse H, Brown SJ. Resumption of sex after a second birth: An Australian prospective cohort. Birth 2019; 46:173-181. [PMID: 29907972 DOI: 10.1111/birt.12363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few longitudinal studies have examined women's experiences of sex after childbirth. Much of the advice given to couples about what to expect in relation to sex after childbirth is based on cross-sectional studies. OBJECTIVE To investigate timing of resumption of sex after a second birth and assess associations with obstetric factors (method of birth and perineal trauma) and time interval between first and second births. METHOD Prospective cohort of 1507 nulliparous women recruited before 25 weeks' gestation in Melbourne, Australia followed up at 3, 6, 9, and 12 months after first births, and 6 and 12 months after second births. Measures include: obstetric factors and resumption of vaginal sex after first and second births. RESULTS By 8 weeks after their second birth, 56% of women had resumed vaginal sex, compared with 65% after their first birth. Women were more likely to resume sex later than 8 weeks postpartum if they had a spontaneous vaginal birth with episiotomy or sutured perineal tear (aOR: 2.21, 95% CI: 1.5-3.2), operative vaginal birth (aOR: 2.60, 95% CI: 1.3-5.3) or cesarean delivery (aOR: 2.15, 95% CI: 1.4-3.3) compared with a vaginal birth with minimal or no perineal trauma. There was no association between timing of resumption of sex and the time interval between births. CONCLUSION For almost half of the cohort, sex was not resumed until at least 8 weeks after the second birth. Timing of resumption of sex was influenced by obstetric factors, but not the time interval between births.
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Affiliation(s)
- Ellie A McDonald
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - Deirdre Gartland
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - Hannah Woolhouse
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - Stephanie J Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, Vic., Australia.,Departments of Paediatrics and General Practice, The University of Melbourne, Parkville, Vic., Australia
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O’Malley D, Higgins A, Begley C, Daly D, Smith V. Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum; a longitudinal prospective cohort study (the MAMMI study). BMC Pregnancy Childbirth 2018; 18:196. [PMID: 29855357 PMCID: PMC5984394 DOI: 10.1186/s12884-018-1838-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/21/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Many women are not prepared for changes to their sexual health after childbirth. The aim of this paper is to report on the prevalence of and the potential risk factors (pre-pregnancy dyspareunia, mode of birth, perineal trauma and breastfeeding) for sexual health issues (dyspareunia, lack of vaginal lubrication and a loss of interest in sexual activity) at 6 and 12 months postpartum. METHODS A longitudinal cohort study of 832 first-time mothers who were recruited in early pregnancy and returned postnatal surveys at 3, 6, 9 and 12 months postpartum were assessed for sexual health issues and associated risk factors. RESULTS Nearly half of the women (46.3%) reported a lack of interest in sexual activity, 43% experienced a lack of vaginal lubrication and 37.5% of included women had dyspareunia 6 months after birth. On univariate analysis, vacuum-assisted birth, 2nd degree perineal tears, 3rd degree perineal tears and episiotomy were all associated with dyspareunia 6 months postpartum, but, of these only 3rd degree tears, in association with breastfeeding and pre-existing dyspareunia, remained significant on multivariable analysis. Breastfeeding, in combination, with other significant factors, was associated with dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity 6 months postpartum, and, dissatisfaction with body image emerged as a significant factor associated with lack of interest in sexual activity at 12 months postpartum. Pre-pregnancy dyspareunia and breastfeeding emerged as common factors associated with all three outcomes of dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity at 6 months postpartum. CONCLUSION Breastfeeding and pre-existing dyspareunia are associated with sexual health issues at 6 months postpartum. Pre-existing dyspareunia is associated with a lack of vaginal lubrication at 12 months postpartum and breastfeeding is associated with dissatisfaction with body image. Preparing women and their partners during the antenatal period and advising on simple measures, such as use of lubrication to avoid or minimise sexual health issues, could potentially remove stress, anxiety and fears regarding intimacy after birth. Introducing the topic of pre-existing sexual health issues antenatally may facilitate appropriate support, treatment or counselling for women.
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Affiliation(s)
- Deirdre O’Malley
- Health Research Board, Research Fellow, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Reilly S, Cini E, Gold L, Goldfeld S, Law J, Levickis P, Mensah F, Morgan A, Nicholson JM, Le HND, Pezic A, Tomblin B, Wake M, Wardrop L. Data resource profile: The Child LAnguage REpository (CLARE). Int J Epidemiol 2018; 47:688-688j. [DOI: 10.1093/ije/dyy034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/07/2018] [Accepted: 02/21/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sheena Reilly
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Eileen Cini
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Lisa Gold
- School of Health and Social Development, Deakin University, Burwood, VIC, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Sharon Goldfeld
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, Australia
| | - James Law
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Penny Levickis
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Mensah
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Angela Morgan
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Audiology and Speech Pathology, The University of Melbourne, Parkville, VIC, Australia
| | - Jan M Nicholson
- Judith Lumley Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Ha N D Le
- Centre for Community Child Health, The Royal Children's Hospital, Parkville, VIC, Australia
- Population Health Strategic Research Center, Deakin Health Economics, Deakin University, Geelong, VIC, Australia
| | - Angela Pezic
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Bruce Tomblin
- Department of Communication Sciences and Disorders, University of Iowa, Iowa City, IA, USA
| | - Melissa Wake
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Department of Paediatrics and Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Louise Wardrop
- Murdoch Children’s Research Institute, The Royal Children's Hospital, Parkville, VIC, Australia
- Centre for Neuroscience of Speech, The University of Melbourne, Parkville, VIC, Australia
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Giallo R, Pilkington P, Borschmann R, Seymour M, Dunning M, Brown S. The prevalence and correlates of self-harm ideation trajectories in Australian women from pregnancy to 4-years postpartum. J Affect Disord 2018; 229:152-158. [PMID: 29310064 DOI: 10.1016/j.jad.2017.12.064] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/02/2017] [Accepted: 12/31/2017] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Women in the perinatal period are at increased risk of experiencing self-harm ideation. The current study longitudinally examines the prevalence, trajectories, and correlates of self-harm ideation in a population-based sample of Australian women from pregnancy through to the early years of parenting. METHODS Drawing on data from 1507 women participating in a prospective pregnancy cohort study, data were collected during pregnancy, at 3-, 6-, 12-, and 18-months postpartum, and 4-years postpartum. Longitudinal Latent Class Analysis was conducted to identify groups of women based on their responses to thoughts of self-harm at each time-point. Logistic regression analysis was used to identify factors associated with group membership. RESULTS Approximately 4-5% of women reported experiencing self-harm ideation at each time-point from pregnancy to 4-years postpartum. Cross-sectional analyses revealed that self-harm ideation was most frequently endorsed in the first 12-months postpartum (4.6%), and approximately 15% of women reported self-harm ideation at least once during the study period. Longitudinally, approximately 7% of women had an enduring pattern of self-harm ideation from pregnancy to 4-years postpartum. Women who had experienced a range of preconception and current social health issues and disadvantage were at increased risk of self-harm ideation over time. LIMITATIONS Limitations included use of brief measures, along with an underrepresentation of participants with particular socio-demographic characteristics. CONCLUSIONS A proportion of women are at increased risk of experiencing self-harm ideation during the perinatal period and in the early years of parenting, underscoring the need for early identification during pregnancy and early postpartum to facilitate timely early intervention.
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Affiliation(s)
- Rebecca Giallo
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
| | - Pamela Pilkington
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia; Health Service and Population Research Department; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry, The University of Melbourne, Australia
| | - Monique Seymour
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Melissa Dunning
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Department of General Practice and Primary Health Care Academic Centre, The University of Melbourne, Parkville, VIC, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, type, and risk factors. Int Urogynecol J 2018; 29:353-362. [DOI: 10.1007/s00192-018-3554-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
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30
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Physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum. Soc Psychiatry Psychiatr Epidemiol 2017; 52:815-828. [PMID: 28451700 DOI: 10.1007/s00127-017-1387-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Few studies have examined the course of maternal depressive across pregnancy and early parenthood. The aim of this study was to identify the physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum. METHOD Data were drawn from 1102 women participating in the Maternal Health Study, a prospective pregnancy cohort study in Melbourne, Australia. Self-administered questionnaires were completed at baseline (<24 weeks gestation), and at 3-, 6-, 12-, and 18 months, and 4 years postpartum. RESULTS Latent class analysis modelling identified three distinct classes representing women who experienced minimal depressive symptoms (58.4%), subclinical symptoms (32.7%), and persistently high symptoms from pregnancy to 4 years postpartum (9.0%). Risk factors for subclinical and persistently high depressive symptoms were having migrated from a non-English speaking country, not being in paid employment during pregnancy, history of childhood physical abuse, history of depressive symptoms, partner relationship problems during pregnancy, exhaustion at 3 months postpartum, three or more sexual health problems at 3 months postpartum, and fear of a partner since birth at 6 months postpartum. CONCLUSIONS This study highlights the complexity of the relationships between emotional, physical, sexual and social health, and underscores the need for health professionals to ask women about their physical and sexual health, and consider the impact on their mental health throughout pregnancy and the early postpartum.
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Giallo R, Gartland D, Woolhouse H, Mensah F, Westrupp E, Nicholson J, Brown S. Emotional–behavioral resilience among children of first-time mothers with and without depression across the early childhood period. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2017. [DOI: 10.1177/0165025416687413] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The deleterious effects of maternal depression on child emotional and behavioral development are well documented, yet many children exposed to maternal depression experience positive outcomes. The aim of this study was to identify psychosocial factors associated with the emotional–behavioral resilience of four-year-old children of first-time mothers experiencing depressive symptoms across the early childhood period. Data were from 1085 mother–child dyads in the Maternal Health Study collected prospectively at five time-points from pregnancy to child age four. Longitudinal trajectories of maternal depressive symptoms were identified, and children were regarded as resilient or competent if they scored in the normal range on the Total Difficulties subscale of the Strengths and Difficulties Questionnaire. We found that 22% of women had a pattern of moderate to high depressive symptoms, and within this group 78% of their children were identified as resilient. Maternal tertiary education and maternal involvement in home learning activities were unique predictors of children’s resilience. Higher maternal age at the time of pregnancy and financial security were factors associated with positive outcomes for all children. The findings highlight the importance of policy and intervention efforts to strengthen the quality of maternal–child interactions and the home learning environment to promote the emotional and behavioral functioning of children whose mothers are experiencing mental health difficulties in the early years of parenting.
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Affiliation(s)
- Rebecca Giallo
- Murdoch Childrens Research Institute, Parkville, Australia
| | | | | | - Fiona Mensah
- Murdoch Childrens Research Institute, Parkville, Australia
| | | | - Jan Nicholson
- La Trobe University Judith Lumley Centre, Melbourne, Australia
| | - Stephanie Brown
- Murdoch Childrens Research Institute, Parkville, Australia
- Department of Paediatrics, Royal Children’s Hospital, The University of Melbourne, Melbourne, Australia
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Woolhouse H, James J, Gartland D, McDonald E, Brown SJ. Maternal depressive symptoms at three months postpartum and breastfeeding rates at six months postpartum: Implications for primary care in a prospective cohort study of primiparous women in Australia. Women Birth 2016; 29:381-7. [DOI: 10.1016/j.wombi.2016.05.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/03/2016] [Accepted: 05/29/2016] [Indexed: 11/15/2022]
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Woolhouse H, Small R, Miller K, Brown SJ. Frequency of "Time for Self" Is a Significant Predictor of Postnatal Depressive Symptoms: Results from a Prospective Pregnancy Cohort Study. Birth 2016; 43:58-67. [PMID: 26678360 DOI: 10.1111/birt.12210] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to explore the relationship between frequency of time for self and maternal depressive symptoms at 6 months postpartum. METHODS A prospective cohort study of 1,507 first-time mothers in Australia, recruited in early pregnancy with follow-up at 6 months postpartum, was conducted. Scores of more than or equal to 13 on the Edinburgh Postnatal Depression Scale were used to identify depressive symptoms. RESULTS Of 1,507 women recruited to the study, 92.6 percent completed follow-up at 6 months postpartum. Almost half (48.5%) reported having time for themselves when someone else looked after their baby (time for self) once a week or more. Compared with women who reported less frequent time for self, women who had time for themselves once a week or more were less likely to report depressive symptoms (unadjusted OR 0.44 [95% CI 0.30-0.66]). Women who had more frequent time for themselves were more likely to have more practical and emotional support. However, this only partially explained the relationship between time for self and depressive symptoms, which remained significant in regression models after adjusting for other recognized risk factors for maternal depression, including social support (adjusted OR 0.60 [95% CI 0.39-0.94]). CONCLUSIONS Our findings suggest that having time for self at least once a week in the first 6 months after childbirth may have a beneficial influence on maternal mental health. Ensuring women get regular respite from the challenges of caring for a young baby may be a relatively simple and effective way of promoting maternal mental health in the year after childbirth.
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Affiliation(s)
- Hannah Woolhouse
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Rhonda Small
- Judith Lumley Centre, Latrobe University, Melbourne, Vic., Australia
| | - Kirsty Miller
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Stephanie J Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Vic., Australia
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Woolhouse H, Gartland D, Mensah F, Giallo R, Brown S. Maternal depression from pregnancy to 4 years postpartum and emotional/behavioural difficulties in children: results from a prospective pregnancy cohort study. Arch Womens Ment Health 2016; 19:141-51. [PMID: 26271281 DOI: 10.1007/s00737-015-0562-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 07/30/2015] [Indexed: 12/14/2022]
Abstract
Considerable attention has been focused on women's mental health in the perinatal period and the subsequent impacts on children. Comparatively, we know much less about maternal depression at later time points and the potential implications for child mental health. The objective of this paper was to explore the association between maternal depression and child emotional/behavioural difficulties at 4 years postpartum, taking into account earlier episodes of perinatal depression. The Maternal Health Study is a prospective cohort study of 1,507 nulliparous women. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) in early pregnancy and at 3, 6 and 12 months postpartum and again at 4 years postpartum. Maternal depressive symptoms at 4 years postpartum were associated with significantly increased odds of child emotional/behavioural difficulties (odds ratio (OR) = 3.46, 95 % confidence interval (CI) = 2.21-5.43). This remained significant after adjusting for earlier episodes of perinatal depression and socio-demographic characteristics (OR = 2.07, 95 % CI = 1.18-3.63). We also observed a robust association between child difficulties at age 4 and measures of socio-economic disadvantage. Our findings suggest a pressing need to rethink current paradigms of maternal health surveillance and extend mental health surveillance and support to at least 4 years postpartum.
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Affiliation(s)
- Hannah Woolhouse
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, WL5 Royal Childrens Hospital, Flemington Road Parkville, Victoria, 3052, Australia.
| | - Deirdre Gartland
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, WL5 Royal Childrens Hospital, Flemington Road Parkville, Victoria, 3052, Australia
| | - Fiona Mensah
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital, Victoria, Australia.,Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Rebecca Giallo
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, WL5 Royal Childrens Hospital, Flemington Road Parkville, Victoria, 3052, Australia
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, WL5 Royal Childrens Hospital, Flemington Road Parkville, Victoria, 3052, Australia.,General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, Australia
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Giallo R, Gartland D, Woolhouse H, Brown S. "I didn't know it was possible to feel that tired": exploring the complex bidirectional associations between maternal depressive symptoms and fatigue in a prospective pregnancy cohort study. Arch Womens Ment Health 2016; 19:25-34. [PMID: 25577337 DOI: 10.1007/s00737-014-0494-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 12/24/2014] [Indexed: 01/25/2023]
Abstract
Depressive and fatigue symptoms are common health concerns for women in the postnatal period. Few studies have sought to investigate the role of fatigue in the development and maintenance of depressive symptoms. The aim of this paper was to examine the relationship between depressive symptoms and fatigue over the course of the first 4 years postpartum, in particular focusing on the extent to which fatigue at earlier time points predicted later depressive symptoms and vice versa. Data from over 1000 women participating in a longitudinal study of Australian women's physical and psychological health and recovery after childbirth were used. An autoregressive cross-lagged panel model was tested to assess the mutual influences of fatigue and depressive symptoms across five time points at 3, 6, 12 and 18 months postpartum, and at 4 years postpartum. A complex bidirectional relationship between fatigue and depressive symptoms from 3 months to 4 years postpartum was observed, where fatigue at earlier time points predicted depressive symptoms at later time points, and vice versa. The findings of this study suggest interventions targeting the prevention and management of fatigue may also confer some benefit in improving or preventing the development of depression symptoms in the early parenting period.
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Affiliation(s)
- Rebecca Giallo
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, W5, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia. .,RMIT University, Melbourne, Australia.
| | - Deirdre Gartland
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, W5, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia
| | - Hannah Woolhouse
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, W5, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, W5, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia.,General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Australia
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36
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McDonald E, Woolhouse H, Brown SJ. Consultation about Sexual Health Issues in the Year after Childbirth: A Cohort Study. Birth 2015; 42:354-61. [PMID: 26467855 DOI: 10.1111/birt.12193] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Postnatal sexual health remains underresearched. The main aims of this study were to investigate the prevalence of postnatal sexual health issues, and the extent to which primary care practitioners routinely inquire about sexual health issues. METHOD 1,507 first time mothers were recruited in early pregnancy and followed up at 3, 6, and 12 months postpartum. Sexual health issues were assessed at every follow-up using a checklist. RESULTS Eighty-nine percent of women reported sexual health issues in the first 3 months postpartum. The most common sexual health issues at 3 months postpartum were: loss of interest in sex, pain during sex, vaginal tightness, and lack of lubrication. Fifty-one percent continued to report loss of interest in sex at 12 months postpartum, and around 30 percent reported persisting pain. Although most women had contact with primary care practitioners during the first 3 months postpartum, only 24 percent recalled being asked about sexual health issues by general practitioners and 14 percent by maternal and child health nurses. Women who had a cesarean delivery had equivalent or higher odds of reporting persisting sexual health issues, but had lower odds of being asked directly about sexual problems (OR 0.58 [95% CI 0.4-0.9]). CONCLUSIONS Sexual health issues are extremely common after childbirth. There was no evidence that women who had a cesarean delivery experienced fewer sexual health problems. Despite frequent contact with health professionals, women rarely discussed sexual health issues unless health professionals asked them directly. Given the high prevalence of postpartum sexual health issues routine inquiry is warranted.
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Affiliation(s)
- Ellie McDonald
- Healthy Mothers Healthy Families research group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Hannah Woolhouse
- Healthy Mothers Healthy Families research group, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Stephanie J Brown
- Healthy Mothers Healthy Families research group, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Department of General Practice, The University of Melbourne, Parkville, Vic., Australia
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Giallo R, Woolhouse H, Gartland D, Hiscock H, Brown S. The emotional-behavioural functioning of children exposed to maternal depressive symptoms across pregnancy and early childhood: a prospective Australian pregnancy cohort study. Eur Child Adolesc Psychiatry 2015; 24:1233-44. [PMID: 25572869 DOI: 10.1007/s00787-014-0672-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/29/2014] [Indexed: 02/01/2023]
Abstract
Children exposed to maternal depression during pregnancy and in the postnatal period are at increased risk of a range of health, wellbeing and development problems. However, few studies have examined the course of maternal depressive symptoms in the perinatal period and beyond on children's wellbeing. The present study aimed to explore the relationship between both the severity and chronicity of maternal depressive symptoms across the early childhood period and children's emotional-behavioural difficulties at 4 years of age. Data from over 1,085 mothers and children participating in a large Australian prospective pregnancy cohort were used. Latent class analysis identified three distinct trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum: (1) no or few symptoms (61%), (2) persistent subclinical symptoms (30%), and (3) increasing and persistently high symptoms (9%). Regression analyses revealed that children of mothers experiencing subclinical and increasing and persistently high symptoms were at least two times more likely to have emotional-behavioural difficulties than children of mothers reporting minimal symptoms, even after accounting for known risk factors for poor outcomes for children. These findings challenge policy makers and health professionals to consider how they can tailor care and support to mothers experiencing a broader spectrum of depressive symptoms across the early childhood period, to maximize opportunities to improve both short-and long-term maternal and child health outcomes.
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Affiliation(s)
- Rebecca Giallo
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, W5, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia. .,RMIT University, Melbourne, Australia.
| | - Hannah Woolhouse
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, W5, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Deirdre Gartland
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, W5, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Harriet Hiscock
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, W5, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Centre for Community Child Health, The Royal Children's Hospital, Parkville, Australia
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, W5, Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Australia
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38
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Gartland D, MacArthur C, Woolhouse H, McDonald E, Brown SJ. Frequency, severity and risk factors for urinary and faecal incontinence at 4 years postpartum: a prospective cohort. BJOG 2015; 123:1203-11. [DOI: 10.1111/1471-0528.13522] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/27/2022]
Affiliation(s)
- D Gartland
- Healthy Mothers Healthy Families Research Group Murdoch Children's Research Institute Melbourne Vic. Australia
| | - C MacArthur
- Public Health, Epidemiology and Biostatistics School of Health and Population Sciences University of Birmingham Birmingham UK
| | - H Woolhouse
- Healthy Mothers Healthy Families Research Group Murdoch Children's Research Institute Melbourne Vic. Australia
| | - E McDonald
- Healthy Mothers Healthy Families Research Group Murdoch Children's Research Institute Melbourne Vic. Australia
| | - SJ Brown
- Healthy Mothers Healthy Families Research Group Murdoch Children's Research Institute Melbourne Vic. Australia
- General Practice and Primary Health Care Academic Centre The University of Melbourne Melbourne Vic. Australia
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39
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Miller J, Ponsonby AL, Pezic A, Kemp A, Piper SE, Akikusa JD, Allen RC, Munro JE, Ellis JA. Sibling Exposure and Risk of Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2015; 67:1951-8. [DOI: 10.1002/art.39129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/19/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Jessica Miller
- Murdoch Childrens Research Institute; Parkville Victoria Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia, and University of Melbourne; Melbourne Victoria Australia
| | - Angela Pezic
- Murdoch Childrens Research Institute; Parkville Victoria Australia
| | - Andrew Kemp
- Murdoch Childrens Research Institute; Parkville Victoria Australia
| | - Susan E. Piper
- Monash Children's Hospital; Monash Medical Centre; Clayton Victoria Australia
| | - Jonathan D. Akikusa
- Murdoch Childrens Research Institute and Royal Children's Hospital; Parkville Victoria Australia
| | - Roger C. Allen
- Murdoch Childrens Research Institute and Royal Children's Hospital; Parkville Victoria Australia
| | - Jane E. Munro
- Murdoch Childrens Research Institute and Royal Children's Hospital; Parkville Victoria Australia
| | - Justine A. Ellis
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia, and University of Melbourne; Melbourne Victoria Australia
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40
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McDonald EA, Gartland D, Small R, Brown SJ. Dyspareunia and childbirth: a prospective cohort study. BJOG 2015; 122:672-9. [PMID: 25605464 DOI: 10.1111/1471-0528.13263] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2014] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the relationship between mode of delivery, perineal trauma and dyspareunia. DESIGN Prospective cohort study. SETTING Six maternity hospitals in Melbourne, Australia. SAMPLE A total of 1507 nulliparous women recruited in the first and second trimesters of pregnancy. METHOD Data from baseline and postnatal questionnaires (3, 6, 12 and 18 months) were analysed using univariable and multivariable logistic regression. MAIN OUTCOME MEASURE Study-designed self-report measure of dyspareunia at 18 months postpartum. RESULTS In all, 1244/1507 (83%) women completed the baseline and all four postpartum questionnaires; 1211/1237 (98%) had resumed vaginal intercourse by 18 months postpartum, with 289/1211 (24%) women reporting dyspareunia. Compared with women who had a spontaneous vaginal delivery with an intact perineum or unsutured tear, women who had an emergency caesarean section (adjusted odds ratio [aOR] 2.41, 95% confidence interval [95% CI] 1.4-4.0; P = 0.001), vacuum extraction (aOR 2.28, 95% CI 1.3-4.1; P = 0.005) or elective caesarean section (aOR 1.71, 95% CI 0.9-3.2; P = 0.087) had increased odds of reporting dyspareunia at 18 months postpartum, adjusting for maternal age and other potential confounders. CONCLUSIONS Obstetric intervention is associated with persisting dyspareunia. Greater recognition and increased understanding of the roles of mode of delivery and perineal trauma in contributing to postpartum maternal morbidities, and ways to prevent postpartum dyspareunia where possible, are warranted.
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Affiliation(s)
- E A McDonald
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Melbourne, Vic., Australia
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41
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Cromi A, Bonzini M, Uccella S, Serati M, Bogani G, Pozzo N, Ghezzi F. Provider contribution to an episiotomy risk model. J Matern Fetal Neonatal Med 2014; 28:2201-6. [PMID: 25380033 DOI: 10.3109/14767058.2014.982087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The extent to which the observed variation in episiotomy rates can be attributed to individual practitioners is not known. We sought to analyze the contribution of the attending midwife to a risk model for episiotomy. STUDY DESIGN We prospectively collected data on 736 consecutive vaginal deliveries in nulliparas at a tertiary maternity hospital. The study measures the impact of the attending midwife on the decision to perform an episiotomy, controlling for a host of patient and clinical characteristics. Midwife effect is evaluated in terms of its overall contribution to the explanatory power of logistic regression model. RESULTS The overall rate of episiotomy in primiparas was 40.6%. Individual midwife episiotomy rate ranged from 5.6% to 73.9% (p < 0.0001). After controlling for confounding factors with logistic regression, maternal age ≥35 years (OR 1.61, 95%CI: 1.02-2.52), vacuum extraction (OR 26.88, 95%CI: 2.57-280.7), fundal pressure (OR 62.90, 95%CI: 18.39-214.98), second-stage duration (OR 2.24, 95%CI: 1.53-3.28), and the individual midwife were all associated with episiotomy use. The midwife attending the birth and fundal pressure provided the greatest explanatory power of the model. CONCLUSIONS The attending provider adds a significant independent effect to the episiotomy risk model. This has implications for both practice and research in this clinical area.
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Affiliation(s)
- Antonella Cromi
- a Department of Obstetrics and Gynecology , University of Insubria , Varese , Italy and
| | - Matteo Bonzini
- b Research Center in Epidemiology and Preventive Medicine, Insubria University , Varese , Italy
| | - Stefano Uccella
- a Department of Obstetrics and Gynecology , University of Insubria , Varese , Italy and
| | - Maurizio Serati
- a Department of Obstetrics and Gynecology , University of Insubria , Varese , Italy and
| | - Giorgio Bogani
- a Department of Obstetrics and Gynecology , University of Insubria , Varese , Italy and
| | - Nadia Pozzo
- a Department of Obstetrics and Gynecology , University of Insubria , Varese , Italy and
| | - Fabio Ghezzi
- a Department of Obstetrics and Gynecology , University of Insubria , Varese , Italy and
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42
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Colson MH. [Female sexuality and parenthood]. ACTA ACUST UNITED AC 2014; 42:714-20. [PMID: 25262091 DOI: 10.1016/j.gyobfe.2014.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/27/2014] [Indexed: 10/24/2022]
Abstract
From the child conception to the early years of life, couples generally present less sexual activity. Parenthood constraints are a burden for the couple's relationships. Generally, persistent sexual difficulties six months after delivery, despite those generated by depression or altered health raise the question of an alteration in the quality of the couple's relationships and lack of satisfaction of the mother with her partner's involvement in family life. Numerous parameters can be implied, especially with persistent trouble of desire, such as fatigue, body image problems and libido lessening of the partner due to modifications of his status. Women who presented sexual difficulties before pregnancy remain the same. In all cases, appropriate information can avoid the intimacy's difficulties and contribute to maintain pleasure and intimacy even when vaginal penetration remains difficult.
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Affiliation(s)
- M-H Colson
- Hôpital Sainte-Marguerite, 270, boulevard de Sainte-Marguerite, 13009 Marseille, France.
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43
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Differentiating maternal fatigue and depressive symptoms at six months and four years post partum: Considerations for assessment, diagnosis and intervention. Midwifery 2014; 31:316-22. [PMID: 25281508 DOI: 10.1016/j.midw.2014.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/08/2014] [Accepted: 09/14/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE fatigue and depressive symptoms are common among women in the postpartum period, and it has been proposed that fatigue is a risk factor for later depression. To progress this research, there is a need to clarify the conceptual and measurement issue of whether these two sets of symptoms are distinct constructs. There is also a need to determine whether they are distinct constructs beyond the postnatal period. The aim of the study was to assess the construct and discriminant validity of fatigue and depressive symptoms as measured by the SF-36 Vitality subscale (SF-36) and the Edinburgh Postnatal Depression Scale (EPDS) at six months and at four years post partum. DESIGN, SETTING AND PARTICIPANTS data from over 1000 women participating in the Maternal Health Study, a longitudinal study of women׳s physical and psychological health and recovery after childbirth were used. FINDINGS confirmatory factor analysis revealed a two-factor model of fatigue and depressive symptoms represented as distinct but related constructs was a better fit to the data than a one-factor model of fatigue and depression sharing the same underlying construct at both six months and four years post partum. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE this study provides empirical evidence that maternal fatigue and depression in the first year after having a baby and at four years post partum are best understood as separate psychological constructs or experiences. The findings have important implications for clinical practice, in particular underlining the importance of differentiating tiredness from depression.
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44
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Woolhouse H, Gartland D, Mensah F, Brown SJ. Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: implications for primary health care. BJOG 2014; 122:312-21. [DOI: 10.1111/1471-0528.12837] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- H Woolhouse
- Healthy Mothers Healthy Families; Murdoch Childrens Research Institute and Royal Children's Hospital; Parkville Vic. Australia
| | - D Gartland
- Healthy Mothers Healthy Families; Murdoch Childrens Research Institute and Royal Children's Hospital; Parkville Vic. Australia
| | - F Mensah
- Clinical Epidemiology and Biostatistics Unit; Murdoch Childrens Research Institute and Royal Children's Hospital; Parkville Vic. Australia
- Department of Paediatrics; University of Melbourne; Melbourne Vic. Australia
| | - SJ Brown
- Healthy Mothers Healthy Families; Murdoch Childrens Research Institute and Royal Children's Hospital; Parkville Vic. Australia
- General Practice and Primary Health Care Academic Centre; University of Melbourne; Melbourne Vic. Australia
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45
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Woolhouse H, Gartland D, Perlen S, Donath S, Brown SJ. Physical health after childbirth and maternal depression in the first 12 months post partum: Results of an Australian nulliparous pregnancy cohort study. Midwifery 2014; 30:378-84. [DOI: 10.1016/j.midw.2013.03.006] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 03/12/2013] [Accepted: 03/17/2013] [Indexed: 01/04/2023]
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46
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Woolhouse H, McDonald E, Brown SJ. Changes to sexual and intimate relationships in the postnatal period: women’s experiences with health professionals. Aust J Prim Health 2014; 20:298-304. [DOI: 10.1071/py13001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 05/19/2013] [Indexed: 11/23/2022]
Abstract
Women navigate many social changes when they become a mother, often including considerable changes to intimate and sexual relationships. This paper draws on data collected in an Australian multicentre prospective nulliparous pregnancy cohort study and a nested qualitative substudy exploring women’s experiences of sex and intimacy after the birth of their first child. In all, 1507 women were recruited in early pregnancy (mean gestation 15 weeks) and completed self-administered questionnaires at 3, 6 and 12 months and 4.5 years postpartum. Eighteen participants were interviewed 2.5–3.5 years after the birth of their first child regarding sex and intimacy after having a baby. Interviews were transcribed verbatim and analysed using interpretive phenomenological analysis. Cohort data reveal a considerable drop in both emotional satisfaction and physical pleasure in intimate relationships after birth, with emotional satisfaction continuing to fall up until 4.5 years postpartum. Less than one-quarter of participants reported that their general practitioner had asked directly about sexual health or relationship problems in the first 3 months postpartum (23% and 18%, respectively). In contrast, 13% of women reported that a maternal and child health nurse had asked directly about sexual problems since the birth, and 31% had asked directly about relationship problems. In-depth interviews revealed that relationships with intimate partners were important issues for women following childbirth, and women were seeking reassurance from health professionals that their changing experiences of sex and intimacy after childbirth were ‘normal’. Some women felt they had ‘fallen through the gaps’ and there was not an opportunity provided by health professionals for them to discuss changes affecting their sexual and intimate relationships. The findings suggest that intimate relationships are significantly strained in the years following childbirth and women want more information from primary health care professionals regarding changes to intimate and sexual relationships after childbirth.
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Woolhouse H, McDonald E, Brown S. Women's experiences of sex and intimacy after childbirth: making the adjustment to motherhood. J Psychosom Obstet Gynaecol 2012; 33:185-90. [PMID: 22973871 DOI: 10.3109/0167482x.2012.720314] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to explore women's experiences of changes to their sexual relationship, sexuality and intimacy, as a result of pregnancy, childbirth and parenting. A sub-sample of women was purposively selected from a larger prospective pregnancy cohort study of nulliparous women in Melbourne, Australia. Eighteen women (including a mixture of parity, birth methods and relationship status) were interviewed 2.5-3.5 years after a first birth. Interviews were transcribed verbatim and analyzed using interpretive phenomenological analysis. Women identified numerous factors affecting sexual and intimate relationships including extreme tiredness, changing lifestyles and body image issues, leading to changes in libido and intimacy in relationships. Of particular note were feelings of guilt and failure women experienced as a result of a lowered libido. Finding ways to stay connected - whether through sex, quality time together or working as a team - helped women and their partners navigate the transition to parenthood. This study demonstrates that pregnancy, childbirth and parenting can bring about significant changes to women's experiences of sex and intimacy. Women who experience significant reductions in their libido may be vulnerable to feelings of guilt and failure, connected with high expectations that they should be able to "do it all".
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Affiliation(s)
- Hannah Woolhouse
- Murdoch Childrens Research Institute, Healthy Mothers, Healthy Families, Level 5, Royal Children's Hospital, Parkville, 3052 Australia.
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Ellis JA, Ponsonby AL, Pezic A, Chavez RA, Allen RC, Akikusa JD, Munro JE. CLARITY - ChiLdhood Arthritis Risk factor Identification sTudY. Pediatr Rheumatol Online J 2012; 10:37. [PMID: 23153063 PMCID: PMC3551677 DOI: 10.1186/1546-0096-10-37] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 11/08/2012] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The aetiology of juvenile idiopathic arthritis (JIA) is largely unknown. We have established a JIA biobank in Melbourne, Australia called CLARITY - ChiLdhood Arthritis Risk factor Identification sTudY, with the broad aim of identifying genomic and environmental disease risk factors. We present here study protocols, and a comparison of socio-demographic, pregnancy, birth and early life characteristics of cases and controls collected over the first 3 years of the study. METHODS Cases are children aged ≤18 years with a diagnosis of JIA by 16 years. Controls are healthy children aged ≤18 years, born in the state of Victoria, undergoing a minor elective surgical procedure. Participant families provide clinical, epidemiological and environmental data via questionnaire, and a blood sample is collected. RESULTS Clinical characteristics of cases (n = 262) are similar to those previously reported. Demographically, cases were from families of higher socio-economic status. After taking this into account, the residual pregnancy and perinatal profiles of cases were similar to control children. No case-control differences in breastfeeding commencement or duration were detected, nor was there evidence of increased case exposure to tobacco smoke in utero. At interview, cases were less likely to be exposed to active parental smoking, but disease-related changes to parent behaviour may partly underlie this. CONCLUSIONS We show that, after taking into account socio-economic status, CLARITY cases and controls are well matched on basic epidemiological characteristics. CLARITY represents a new study platform with which to generate new knowledge as to the environmental and biological risk factors for JIA.
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Affiliation(s)
- Justine A Ellis
- Genes, Environment and Complex Disease, Murdoch Childrens Research Institute, Parkville, VIC, Australia.
| | - Anne-Louise Ponsonby
- Environmental and Genetic Epidemiology Research, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Angela Pezic
- Environmental and Genetic Epidemiology Research, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Raul A Chavez
- Genes, Environment and Complex Disease, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Roger C Allen
- Arthritis & Rheumatology, Murdoch Childrens Research Institute, Parkville, VIC, Australia,Paediatric Rheumatology Unit, Department of General Medicine, The Royal Children’s Hospital, Parkville, VIC, Australia
| | - Jonathan D Akikusa
- Arthritis & Rheumatology, Murdoch Childrens Research Institute, Parkville, VIC, Australia,Paediatric Rheumatology Unit, Department of General Medicine, The Royal Children’s Hospital, Parkville, VIC, Australia
| | - Jane E Munro
- Arthritis & Rheumatology, Murdoch Childrens Research Institute, Parkville, VIC, Australia,Paediatric Rheumatology Unit, Department of General Medicine, The Royal Children’s Hospital, Parkville, VIC, Australia
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Woolhouse H, Perlen S, Gartland D, Brown SJ. Physical health and recovery in the first 18 months postpartum: does cesarean section reduce long-term morbidity? Birth 2012; 39:221-9. [PMID: 23281904 DOI: 10.1111/j.1523-536x.2012.00551.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research examining long-term health outcomes for women after childbirth has been limited. The objective of this study was to investigate the natural history of common morbidities in the 18 months after the birth of a first child, and to explore the hypothesis that women who have a cesarean section for a first birth experience less overall morbidity in the postnatal period. METHODS A prospective nulliparous pregnancy cohort study was conducted of 1,507 women recruited in early pregnancy from six public hospitals in Melbourne, Australia (mean gestation 15 weeks). Follow-up questionnaires at 3, 6, 12, and 18 months postpartum included standardized measures of urinary and fecal incontinence, and a symptom checklist asking about common physical health problems. RESULTS At 6, 12, and 18 months postpartum, no statistically significant differences were found in the proportion of women reporting three or more health problems by method of birth. Compared with women who had a spontaneous vaginal birth, women who had a cesarean section were more likely to report extreme tiredness at 6 months postpartum (adjusted OR: 1.39; 95% CI: 1.07-1.82) and at 12 months postpartum (adjusted OR: 1.40; 95% CI: 1.05-1.85), and were more likely to report back pain at 6 months postpartum (adjusted OR: 1.37; 95% CI: 1.06-1.77) and at 12 months postpartum (adjusted OR: 1.41; 95% CI: 1.06-1.87). Women who had a cesarean section were less likely to report urinary incontinence at 3, 6, and 12 months postpartum, respectively (adjusted OR: 0.26; 95% CI: 0.19-0.36; adjusted OR: 0.36; 95% CI: 0.25-0.52; adjusted OR: 0.48; 95% CI: 0.33-0.68). For all other physical health problems the pattern of morbidity did not differ between cesarean section and spontaneous vaginal birth. CONCLUSIONS Physical health problems commonly persist or recur throughout the first 18 months postpartum, with potential long-term consequences for women's health. Cesarean section does not result in women experiencing less overall morbidity in the postpartum period compared with women who have a spontaneous vaginal birth.
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Affiliation(s)
- Hannah Woolhouse
- Healthy Mothers Healthy Families Research Group at the Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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Gartland D, Donath S, MacArthur C, Brown SJ. The onset, recurrence and associated obstetric risk factors for urinary incontinence in the first 18 months after a first birth: an Australian nulliparous cohort study. BJOG 2012; 119:1361-9. [PMID: 22827735 DOI: 10.1111/j.1471-0528.2012.03437.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the contribution of obstetric risk factors to persistent urinary incontinence (UI) between 4 and 18 months postpartum. DESIGN Prospective pregnancy cohort. SETTING Six metropolitan public hospitals in Victoria, Australia. SAMPLE A total of 1507 nulliparous women recruited to the Maternal Health Study in early pregnancy (≤24 weeks of gestation). METHODS Data from hospital records and self-administered questionnaires/telephone interviews at ≤24 and 30-32 weeks of gestation and at 3, 6, 9, 12 and 18 months postpartum analysed using logistic regression. MAIN OUTCOME MEASURES Persistent UI 4-18 months postpartum in women continent before pregnancy. RESULTS Of the women who were continent before pregnancy, 44% reported UI 4-18 months postpartum, and 25% reported persistent UI (symptoms at multiple follow ups). Compared with spontaneous vaginal birth, women who had a caesarean before labour (adjusted odds ratio [aOR] 0.4, 95% confidence interval [95% CI] 0.2-0.9), in first-stage labour (aOR 0.4, 95% CI 0.2-0.6) or in second-stage labour (aOR 0.4, 95% CI 0.2-1.0) were less likely to report persistent UI 4-18 months postpartum. Prolonged second-stage labour in women who had an operative vaginal birth was associated with increased likelihood of UI (aOR 2.5, 95% CI 1.3-4.6). Compared with women who were continent in pregnancy, women reporting UI in pregnancy had a seven-fold increase in odds of persistent UI (aOR 7.4, 95% CI 5.1-10.7). CONCLUSIONS Persistent UI is common after childbirth and is more likely following prolonged labour in combination with operative vaginal birth. The majority of women reporting persistent UI at 4-18 months postpartum also experienced symptoms in pregnancy.
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Affiliation(s)
- D Gartland
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Melbourne, Australia
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