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Inness BE, Furtado M, Barrett E, Stallwood E, Streiner DL, McCabe RE, Green SM. Psychometric properties of the PSWQ in a sample of pregnant and postpartum women. J Reprod Infant Psychol 2024; 42:880-895. [PMID: 37139571 DOI: 10.1080/02646838.2023.2209101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Generalized anxiety disorder (GAD)-characterised by excessive and uncontrollable worry-is the most frequently diagnosed anxiety disorder during pregnancy and the postpartum period. Identification of GAD often relies on assessment of its cardinal feature, pathological worry. The Penn State Worry Questionnaire (PSWQ) is the most robust measure of pathological worry to date but has not been extensively evaluated for use during pregnancy and the postpartum period. This study evaluated the internal consistency, construct validity, and diagnostic accuracy of the PSWQ in a sample of pregnant and postpartum women with and without a principal GAD diagnosis. METHODS One hundred forty-two pregnant and 209 postpartum women participated in this study. Sixty-nine pregnant and 129 postpartum participants met criteria for a principal diagnosis of GAD. RESULTS The PSWQ demonstrated good internal consistency and converged with measures assessing similar constructs. Pregnant participants with principal GAD scored significantly higher on the PSWQ than those with no psychopathology and postpartum participants with principal GAD scored significantly higher than those with principal mood disorders, other anxiety and related disorders, and no psychopathology. A cut-off score of 55 and 61 or greater was determined for detecting probable GAD during pregnancy and the postpartum period, respectively. Screening accuracy of the PSWQ was also demonstrated. CONCLUSIONS This study underscores the robustness of the PSWQ as a measure of pathological worry and probable GAD and supports its use in the detection and monitoring of clinically significant worry symptoms during pregnancy and postpartum period.
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Affiliation(s)
- Briar E Inness
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Furtado
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Emily Barrett
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Emma Stallwood
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Sheryl M Green
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Hrdličková K, Banášová R, Nosková E, Vodičková R, Byatt N, Šebela A. Self-Reported Causes of Psychological Distress Among Czech Perinatal Women. J Am Psychiatr Nurses Assoc 2024; 30:545-558. [PMID: 36266976 DOI: 10.1177/10783903221131049] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Various risk factors to perinatal mental health disorders have been described; however, there is a dearth of data on the perspectives of women themselves regarding what increases the risk of psychological distress. This qualitative study explores women's perceptions of factors that increase the risk of perinatal psychological distress. AIM The aim of this study was to elucidate women's perceptions of factors that increase the risk of perinatal psychological distress. METHODS A qualitative design with an exploratory and descriptive approach is used. Women (N = 188) aged 18 to 45 years who self-report experiencing perinatal psychological distress complete an online survey. RESULTS Perceived causes of perinatal psychological distress include: adverse experiences with childbirth and/or breastfeeding, negative attitudes of people close to the participant, financial and social challenges, health challenges, staff behavior in a maternity hospital, a challenging baby, family circumstances, and the new role as mother. CONCLUSION Women's perceived causes of perinatal psychological distress may allow for women-centered innovations in perinatal mental health care. The results highlight the need to train maternity staff regarding perinatal mental health and communication. These findings can serve as important guidelines on women-centered planning of innovations of perinatal mental health care. Interventions need to focus on the role of partners and others close to women so as to support the women during the perinatal period.
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Affiliation(s)
- Kristýna Hrdličková
- Kristýna Hrdličková, MA, BA, National Institute of Mental Health, Klecany, Czech Republic; Charles University, Faculty of Arts, Prague, Czech Republic
| | - Renata Banášová
- Renata Banášová, MSc, National Institute of Mental Health, Klecany, Czech Republic; Palacky University Olomouc, Olomouc University Social Health Institute, Olomouc, Czech Republic
| | - Eliška Nosková
- Eliška Nosková, MD, National Institute of Mental Health, Klecany, Czech Republic; Charles University, Third Faculty of Medicine, Prague, Czech Republic
| | - Renata Vodičková
- Renata Vodičková, BA, Palacky University Olomouc, Olomouc University Social Health Institute, Olomouc, Czech Republic
| | - Nancy Byatt
- Nancy Byatt, DO, MS, MBA, FAPM, University of Massachusetts Chan Medical School and UMass Memorial Health Care, Worcester, MA, USA
| | - Antonín Šebela
- Antonín Šebela, MD, PhD, National Institute of Mental Health, Klecany, Czech Republic; Charles University, Third Faculty of Medicine, Prague, Czech Republic
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Inness BE, McCabe RE, Streiner DL, Barrett E, Green SM. The Worry Behaviors Inventory-Perinatal Revised: Adaptation and Initial Validation for Use in Perinatal Samples. Assessment 2024; 31:350-362. [PMID: 37005700 PMCID: PMC10822066 DOI: 10.1177/10731911231165071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Generalized anxiety disorder (GAD) is a leading mental health concern during pregnancy and the postpartum (perinatal) period. People with GAD engage in problematic behaviors to manage their distress. However, the extent of GAD behaviors during the perinatal period may not be adequately captured by the Worry Behaviors Inventory (WBI), the most comprehensive measure of GAD behaviors to date. We evaluated the structure of the initial WBI item-pool and then evaluated the internal consistency, construct validity, and predictive utility of the Perinatal Revised WBI (WBI-PR) in a sample of 214 perinatal women with and without GAD. A two-factor, 10-item scale was supported, and some of the retained items differed from the original WBI. Internal consistency of the WBI-PR was acceptable, and evidence of construct validity was demonstrated. The WBI-PR predicted GAD diagnostic status both alone and beyond existing generalized anxiety and depression symptoms. Implications of these findings are discussed.
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Affiliation(s)
| | - Randi E. McCabe
- McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | | | | | - Sheryl M. Green
- McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
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Banasova R, Noskova E, Vodickova R, Hasto J, Sebela A. Emotional difficulties, coping strategies, and help-seeking patterns among Czech perinatal women. Midwifery 2023; 116:103526. [PMID: 36323074 DOI: 10.1016/j.midw.2022.103526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 02/15/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To understand both, women´s perception of emotional difficulties in perinatal period and their related coping strategies. Further, we mapped and analysed help-seeking patterns utilized by these women to overcome their emotional difficulties. This study serve as an important piece of information for women-centred innovations in perinatal mental health care in Czechia, and more broadly in the region of Central and Eastern Europe. DESIGN A qualitative study with an exploratory and descriptive approach using thematic analysis. SETTING Online survey consisting of open-ended questions mapping women´s perception of emotional difficulties in perinatal period and their related coping strategies and help-seeking patterns. PARTICIPANTS Two hundred women self-reporting emotional difficulties in perinatal period, from whom 108 (54 %) stated that they had sought professional help with their emotional difficulties. FINDINGS Two themes were identified in the analysis of women´s perception of emotional difficulties including Experience of symptoms of mental disorders, and Mother-child relationship. Three themes were identified in the analysis of women´s coping with these difficulties (Personal resources, External resources, and No coping strategy used). Four themes were identified in the analysis of help seeking patterns utilized by study participants (Mental health specialists, Physicians of the first line of contact, Midwifes, and Peer consultants). KEY CONCLUSIONS Emotional difficulties of perinatal women stemmed in both, general symptoms of mental disorders and specific concerns connected to mother-child relationship. Therefore, the perinatal mental health services should cover both topics, preferably by a multidisciplinary team. Women search information about perinatal mental health, so thus, easy to reach valid resources are needed. Finally, Czech perinatal women experiencing emotional difficulties utilize various help-seeking patterns. Some of them naturalistically utilize integrated stepped care even when it is not systematically established.
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Affiliation(s)
- Renata Banasova
- National Institute of Mental Health, Klecany, Czech Republic; Olomouc University Social Health Institute, Palacky University, Olomouc, Czech Republic
| | - Eliska Noskova
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Renata Vodickova
- Department of Psychology, Faculty of Arts, Palacky University, Olomouc, Czech Republic
| | - Jozef Hasto
- Olomouc University Social Health Institute, Palacky University, Olomouc, Czech Republic; Psychiatric Clinic, Pro Mente Sana, Bratislava, Slovakia
| | - Antonin Sebela
- National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic.
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Early Recognition and Treatment for the Optimal Care of Individuals With Peripartum Cardiomyopathy. Nurs Womens Health 2022; 26:308-317. [PMID: 35714761 DOI: 10.1016/j.nwh.2022.05.004] [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: 11/28/2021] [Revised: 02/08/2022] [Accepted: 05/18/2022] [Indexed: 11/21/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a life-threatening pregnancy-associated condition that often develops within the last month of pregnancy and up to 5 months postpartum. Although it is uncommon, the incidence in the United States is on the rise, especially among Black individuals. Early recognition and treatment are crucial for long-term health and the recovery of left ventricular ejection fraction. Most people with PPCM will recover with time, but a multidisciplinary team is needed to help with long-term treatment. Informed contraception counseling is also needed to minimize the incidence of subsequent pregnancy before recovery, which could worsen conditions. The purpose of this article is to review PPCM and discuss early recognition and management options, which may minimize complications and improve outcomes.
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Gobin K, Boyd J, Green SM. Cognitive Processing Therapy for Childbirth-Related Posttraumatic Stress Disorder: A Case Report. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Green SM, Inness B, Furtado M, McCabe RE, Frey BN. Evaluation of an Augmented Cognitive Behavioural Group Therapy for Perinatal Generalized Anxiety Disorder (GAD) during the COVID-19 Pandemic. J Clin Med 2021; 11:jcm11010209. [PMID: 35011950 PMCID: PMC8745906 DOI: 10.3390/jcm11010209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/19/2021] [Accepted: 12/29/2021] [Indexed: 12/22/2022] Open
Abstract
The perinatal period is considered a window of vulnerability given the increased risk of psychiatric difficulties during this time, such as mood and anxiety disorders (ADs). Pre-pandemic rates of ADs in perinatal women were one in five but have since increased with the onset of the COVID-19 pandemic (COVID). In addition, recent research suggests that the focus of worry has shifted during the pandemic, with perinatal women reporting significantly more COVID-specific worries. The objective of this study was to augment our current evidence-based Cognitive Behavioural Group Therapy (CBGT) for perinatal anxiety protocol by targeting intolerance of uncertainty and tailoring existing strategies to address COVID-related worry and impact. Pregnant (n = 19) and postpartum (n = 49) women were recruited from regular clinic patient flow from a university-affiliated teaching hospital between September 2020 and March 2021. Improvements in generalized anxiety symptoms, worry, intolerance of uncertainty, and mood were observed at post-treatment, maintained at 3-months, and the intervention received high ratings of treatment satisfaction. This is the first study to examine an augmented CBGT for perinatal women with GAD during the pandemic and supports the inclusion of strategies that target intolerance of uncertainty as well as specific pandemic and perinatal worry content for effective outcomes.
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Affiliation(s)
- Sheryl M. Green
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada; (R.E.M.); (B.N.F.)
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada; (B.I.); (M.F.)
- Correspondence: ; Tel.: +1-905-522-1155 (ext. 33672)
| | - Briar Inness
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada; (B.I.); (M.F.)
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Melissa Furtado
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada; (B.I.); (M.F.)
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON L8N 3K7, Canada
| | - Randi E. McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada; (R.E.M.); (B.N.F.)
- Anxiety Treatment and Research Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada; (R.E.M.); (B.N.F.)
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare, Hamilton, ON L8N 3K7, Canada; (B.I.); (M.F.)
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Green SM, Furtado M, Inness BE, Frey BN, McCabe RE. Characterizing Worry Content and Impact in Pregnant and Postpartum Women with Anxiety Disorders During COVID-19. Clin Psychol Psychother 2021; 29:1144-1157. [PMID: 34931741 DOI: 10.1002/cpp.2703] [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: 02/10/2021] [Revised: 11/04/2021] [Accepted: 12/13/2021] [Indexed: 11/08/2022]
Abstract
The novel COVID pandemic has had a substantial impact on global mental health, including those populations that are inherently vulnerable such as pregnant and postpartum (perinatal) women. Anxiety disorders (ADs) are the most common mental health disorders during the perinatal period, affecting up to 1 in 5 women. However, since the onset of the pandemic, up to 60% of perinatal women are experiencing moderate to severe levels of anxiety. Given the substantial increase in perinatal anxiety during COVID, we sought to better understand its phenomenology by characterizing the collective worry content and impact of COVID using a content analysis. Eighty-four treatment-seeking pregnant (n = 35) and postpartum (n = 49) women with a principal AD, participated in this study between April and October 2020. In addition to completing questionnaire measures and a semi-structured diagnostic interview, participants were asked to 1) describe their top excessive and uncontrollable worries; 2) describe additional COVID and non-COVID worries; and 3) describe how the pandemic had affected their lives. All responses were given verbally and transcribed verbatim by assessors. A content analysis led to the emergence of various COVID and non-COVID worry and impact themes. One third of participant's principal worries were specific to COVID, and 40% of COVID worries were specific to the perinatal context. Understanding the worry content and impact of COVID may improve symptom detection and inform the development of targeted treatment strategies to support the mental health needs of perinatal women with ADs throughout the pandemic and thereafter. Understanding pandemic-specific worries is important for perinatal symptom screening and may allow for the development of targeted treatment strategies to address COVID-specific worries and impact.
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Affiliation(s)
- Sheryl M Green
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Melissa Furtado
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario
| | - Briar E Inness
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Randi E McCabe
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.,Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Furtado M, Frey BN, Green SM. Validation of the intolerance of uncertainty scale as a screening tool for perinatal anxiety. BMC Pregnancy Childbirth 2021; 21:829. [PMID: 34903196 PMCID: PMC8670292 DOI: 10.1186/s12884-021-04296-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background To date, there is a significant lack of research validating clinical tools for early and accurate detection of anxiety disorders in perinatal populations. Intolerance of uncertainty was recently identified as a significant risk factor for postpartum anxiety symptoms and is a key trait of non-perinatal anxiety disorders. The present study aimed to validate the Intolerance of Uncertainty Scale (IUS) in a perinatal population and evaluate its use as a screening tool for anxiety disorders. Methods Psychiatric diagnoses were assessed in a sample of perinatal women (n = 198), in addition to completing a self-report battery of questionnaires. Psychometric properties including internal consistency and convergent and discriminant validity were assessed. Determination of an optimal clinical cut-off score was measured through a ROC analysis in which the area under the curve, sensitivity, specificity, as well as positive and negative predictive values were calculated. Results The IUS demonstrated excellent internal consistency (α = 0.95) and an optimal clinical cut-off score of 64 or greater was established, yielding a sensitivity of 89%. The IUS also demonstrated very good positive (79%) and negative (80%) predictive values. Conclusions These findings suggest that the IUS represents a clinically useful screening tool to be used as an aid for the early and accurate detection of perinatal anxiety.
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Affiliation(s)
- Melissa Furtado
- Department of Psychology, Neuroscience and Behaviour, McMaster University, 1280 Main Street West, Ontario, Hamilton, L8S 4L8, Canada. .,Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.
| | - Benicio N Frey
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Administration B3, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada
| | - Sheryl M Green
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Level 1, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Administration B3, 100 West 5th Street, Hamilton, Ontario, L8N 3K7, Canada
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