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Albanese AM, Geller PA, Steinkamp JM, Elwy AR, Frank HE, Barkin JL. The education of experience: Mixed methods evidence demonstrates the benefit of multiparity. Midwifery 2024; 134:104015. [PMID: 38688050 DOI: 10.1016/j.midw.2024.104015] [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: 09/04/2023] [Revised: 03/29/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
PROBLEM Existing quantitative data is conflicting concerning whether multiparous birthing parents (individuals with an older child(ren)) experience an easier postpartum transition compared to primiparous birthing parents (first time parents). AIM This convergent mixed methods study leverages the depth of qualitative inquiry to seek a clearer understanding of the way in which acquired parenting experience contributes to observed quantitative differences in outcomes between parity groups. This work can serve as a first step in planning for supportive interventions that effectively address the postpartum needs of both parity groups. METHODS Thirty birthing parents (43.3% multiparous; 46.7% racial minorities) completed measures of postpartum functioning, perceived stress, anxiety symptoms, and depression symptoms as well as an interview inquiring about factors impacting postpartum functioning. Scores on postpartum functioning and emotional wellbeing were compared between parity groups, and these findings were merged with the qualitative data on firsthand parenting experience to clarify how acquired experience impacts functioning and emotional wellbeing during the postpartum transition. FINDINGS Primiparous parents reported significantly: worse postpartum functioning, higher perceived stress, higher levels of depression symptoms, and higher levels of anxiety symptoms. Participants' qualitative report of how acquired parenting experience impacts wellbeing suggests that experience grants parents skills, knowledge, and the opportunity to disconfirm maladaptive cognitions about parenting which allows for increased comfort and confidence in the parental role. CONCLUSIONS The practical and psychological resources gained from acquiring parenting experience during one's first postpartum period appear to be brought forward into subsequent pregnancies and protect against threats to functioning and emotional wellbeing.
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Affiliation(s)
- Ariana M Albanese
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Pamela A Geller
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA 19104, USA
| | | | - A Rani Elwy
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Hannah E Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jennifer L Barkin
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA 31207, USA
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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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Rambod M, Pasyar N, Mazarei Z, Soltanian M. The predictive roles of parental stress and intolerance of uncertainty on psychological well-being of parents with a newborn in neonatal intensive care unit: a hierarchical linear regression analysis. BMC Pediatr 2023; 23:607. [PMID: 38037025 PMCID: PMC10691133 DOI: 10.1186/s12887-023-04420-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Hospitalization of newborns in neonatal intensive care units (NICU) exposes parents to considerable stress. This study aimed to determine the predictive role of parental stress and intolerance of uncertainty on the psychological well-being of parents with a newborn in NICU using hierarchical linear regression analysis. METHODS This cross-sectional study included 130 parents of newborns hospitalized in the NICU. Data were collected using Parental Stress Scale, Intolerance of Uncertainty Scale, and Psychological Wellbeing Scale. The data were analyzed in SPSS v.26 using hierarchical linear regression analysis. RESULTS The mean scores of the parents' psychological well-being, parental stress, and intolerance of uncertainty were 79.08 (SD = 11.70), 63.06 (SD = 26.71), and 75.38 (SD = 19.40), respectively. The result of the hierarchical linear regression analysis revealed that, in step 1, academic education had a significant proportion of the variance of parents' psychological well-being (β = 0.26, P = 0.005). In step 2, it was shown that academic education (β=-0.25, P = 0.006) and parental stress (β=-0.25, P = 0.006) had a significant proportion of the variance of parents' psychological well-being. According to step 2, education levels, parental stress, and intolerance of uncertainty explained 22% of the changes in parents' psychological well-being. CONCLUSION There was a significant association between the parents' psychological well-being and education levels, intolerance of uncertainty, and parental stress. Academic education and parental stress were the predictors of parents' psychological well-being. Based on these findings, early detection of parents' education and stress are important for their psychological well-being.
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Affiliation(s)
- Masoume Rambod
- Community Based Psychiatric Care Research Center, Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nilofar Pasyar
- Community Based Psychiatric Care Research Center, Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zeinab Mazarei
- Student Research Committee of Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Soltanian
- Community Based Psychiatric Care Research Center, Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, Iran
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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 2023:1-16. [PMID: 37139571 DOI: 10.1080/02646838.2023.2209101] [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: 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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Zhou H, Hung EPW, Xie L, Yuan Z, Wu AMS. The Application of the Intolerance of Uncertainty Model to Gambling Urge and Involvement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14738. [PMID: 36429457 PMCID: PMC9690756 DOI: 10.3390/ijerph192214738] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Drawing on the intolerance of uncertainty model, this study aimed to examine whether intolerance of uncertainty and emotion regulation difficulties (in terms of impulse control difficulties and limited access to emotion regulation strategies) contributed to individual differences in gambling urge and involvement. METHODS Convenience sampling was used to recruit Chinese adult participants who had engaged in buying lottery tickets and other gambling activities in the past year. They were asked to complete an anonymous questionnaire survey, and a total of 580 valid cases (Mage = 34.07, SD = 13.36; 50.4% female) were collected for data analysis. RESULTS Path analysis showed that the total effect of intolerance of uncertainty on gambling urge and involvement was significant and positive. However, only impulse control difficulties and not limited access to emotion regulation strategies fully mediated the effect of intolerance of uncertainty. CONCLUSIONS As the first study to apply the intolerance of uncertainty model to real-life gambling, it found that individuals' intolerance of uncertainty and impulse control difficulties contributed to more gambling urge and involvement. Improving emotion regulation skill (e.g., impulse control training) may, therefore, be considered in programs for promoting responsible gambling among Chinese gamblers.
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Affiliation(s)
- Hui Zhou
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, China
- Centre for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Macao, China
| | - Eva P. W. Hung
- Department of Social Science, The Hang Seng University of Hong Kong, Hong Kong, China
| | - Li Xie
- School of Pre-School Education, Chongqing University of Education, Chongqing 400065, China
| | - Zhen Yuan
- Centre for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Macao, China
- Bioimaging Core, Faculty of Health Sciences, University of Macau, Macao, China
| | - Anise M. S. Wu
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macao, China
- Centre for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Macao, China
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Redshaw M, Wynter K. Maternal mental health: Women’s voices and data from across the globe. BMC Pregnancy Childbirth 2022; 22:796. [PMID: 36307777 PMCID: PMC9614766 DOI: 10.1186/s12884-022-05064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
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Wroblewski A, Hollandt M, Yang Y, Ridderbusch IC, Pietzner A, Szeska C, Lotze M, Wittchen HU, Heinig I, Pittig A, Arolt V, Koelkebeck K, Rothkopf CA, Adolph D, Margraf J, Lueken U, Pauli P, Herrmann MJ, Winkler MH, Ströhle A, Dannlowski U, Kircher T, Hamm AO, Straube B, Richter J. Sometimes I feel the fear of uncertainty: How intolerance of uncertainty and trait anxiety impact fear acquisition, extinction and the return of fear. Int J Psychophysiol 2022; 181:125-140. [PMID: 36116610 DOI: 10.1016/j.ijpsycho.2022.09.001] [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: 03/02/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022]
Abstract
It is hypothesized that the ability to discriminate between threat and safety is impaired in individuals with high dispositional negativity, resulting in maladaptive behavior. A large body of research investigated differential learning during fear conditioning and extinction protocols depending on individual differences in intolerance of uncertainty (IU) and trait anxiety (TA), two closely-related dimensions of dispositional negativity, with heterogenous results. These might be due to varying degrees of induced threat/safety uncertainty. Here, we compared two groups with high vs. low IU/TA during periods of low (instructed fear acquisition) and high levels of uncertainty (delayed non-instructed extinction training and reinstatement). Dependent variables comprised subjective (US expectancy, valence, arousal), psychophysiological (skin conductance response, SCR, and startle blink), and neural (fMRI BOLD) measures of threat responding. During fear acquisition, we found strong threat/safety discrimination for both groups. During early extinction (high uncertainty), the low IU/TA group showed an increased physiological response to the safety signal, resulting in a lack of CS discrimination. In contrast, the high IU/TA group showed strong initial threat/safety discrimination in physiology, lacking discriminative learning on startle, and reduced neural activation in regions linked to threat/safety processing throughout extinction training indicating sustained but non-adaptive and rigid responding. Similar neural patterns were found after the reinstatement test. Taken together, we provide evidence that high dispositional negativity, as indicated here by IU and TA, is associated with greater responding to threat cues during the beginning of delayed extinction, and, thus, demonstrates altered learning patterns under changing environments.
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Affiliation(s)
- Adrian Wroblewski
- Department of Psychiatry and Psychotherapy, Center for Mind, Brain and Behavior - CMBB, Philipps-University Marburg, Germany.
| | - Maike Hollandt
- Department of Psychology, University of Greifswald, Germany
| | - Yunbo Yang
- Department of Psychiatry and Psychotherapy, Center for Mind, Brain and Behavior - CMBB, Philipps-University Marburg, Germany
| | - Isabelle C Ridderbusch
- Department of Psychiatry and Psychotherapy, Center for Mind, Brain and Behavior - CMBB, Philipps-University Marburg, Germany
| | - Anne Pietzner
- Department of Psychology, University of Greifswald, Germany
| | | | - Martin Lotze
- Functional Imaging Unit, Diagnostic Radiology and Neuroradiology of the University Medicine Greifswald, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany; Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University Munich, Germany
| | - Ingmar Heinig
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Andre Pittig
- Translational Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - Volker Arolt
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Katja Koelkebeck
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, University of Duisburg-Essen, Germany
| | | | - Dirk Adolph
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Germany
| | - Ulrike Lueken
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Wuerzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Germany
| | - Paul Pauli
- Department of Psychology I, Biological Psychology, Clinical Psychology, and Psychotherapy, University of Würzburg, Germany
| | - Martin J Herrmann
- Center for Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Wuerzburg, Germany
| | - Markus H Winkler
- Department of Psychology I, Biological Psychology, Clinical Psychology, and Psychotherapy, University of Würzburg, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Germany corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin und Berliner Institut für Gesundheitsforschung, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Center for Mind, Brain and Behavior - CMBB, Philipps-University Marburg, Germany
| | - Alfons O Hamm
- Department of Psychology, University of Greifswald, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, Center for Mind, Brain and Behavior - CMBB, Philipps-University Marburg, Germany
| | - Jan Richter
- Department of Psychology, University of Greifswald, Germany
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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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