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Brown HK, Strauss R, Fung K, Mataruga A, Chan V, Mollayeva T, Urbach N, Colantonio A, Cohen E, Dennis CL, Ray JG, Saunders N, Vigod SN. Mental Illness in the 2 Years Prior to Pregnancy in a Population With Traumatic Brain Injury: A Cross-Sectional Study: La maladie mentale dans les deux ans précédant une grossesse dans une population souffrant de lésion cérébrale traumatique : une étude transversale. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:607-617. [PMID: 38659409 PMCID: PMC11298096 DOI: 10.1177/07067437241249957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Existing studies, in mostly male samples such as veterans and athletes, show a strong association between traumatic brain injury (TBI) and mental illness. Yet, while an understanding of mental health before pregnancy is critical for informing preconception and perinatal supports, there are no data on the prevalence of active mental illness before pregnancy in females with TBI. We examined the prevalence of active mental illness ≤2 years before pregnancy (1) in a population with TBI, and (2) in subgroups defined by sociodemographic, health, and injury-related characteristics, all compared to those without TBI. METHOD This population-based cross-sectional study was completed in Ontario, Canada, from 2012 to 2020. Modified Poisson regression generated adjusted prevalence ratios (aPRs) of active mental illness ≤2 years before pregnancy in 15,585 females with TBI versus 846,686 without TBI. We then used latent class analysis to identify subgroups with TBI according to sociodemographic, health, and injury-related characteristics and subsequently compared them to females without TBI on their outcome prevalence. RESULTS Females with TBI had a higher prevalence of active mental illness ≤2 years before pregnancy than those without TBI (44.1% vs. 25.9%; aPR 1.46, 95% confidence interval, 1.43 to 1.49). There were 3 TBI subgroups, with Class 1 (low-income, past assault, recent TBI described as intentional and due to being struck by/against) having the highest outcome prevalence. CONCLUSIONS Females with TBI, and especially those with a recent intentional TBI, have a high prevalence of mental illness before pregnancy. They may benefit from mental health screening and support in the post-injury, preconception, and perinatal periods. PLAIN LANGUAGE TITLE Mental illness in the 2 years before pregnancy in a population with traumatic brain injury.
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Affiliation(s)
- Hilary K. Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | | | | | | | - Vincy Chan
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tatyana Mollayeva
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Natalie Urbach
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Angela Colantonio
- KITE Research Institute-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
- Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cindy-Lee Dennis
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tannenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Joel G. Ray
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Natasha Saunders
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
- Edwin SH Leong Centre for Healthy Children, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Simone N. Vigod
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Lundborg L, Joseph KS, Lisonkova S, Chan WS, Wen Q, Ananth CV, Razaz N. Temporal changes in pre-existing health conditions five years prior to pregnancy in British Columbia, Canada, 2000-2019. Paediatr Perinat Epidemiol 2024; 38:383-393. [PMID: 38366741 DOI: 10.1111/ppe.13060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Pre-existing health conditions increase the risk of obstetric complications during pregnancy and birth. However, the prevalence and recent changes in the frequency of pre-existing health conditions in the childbearing population remain unknown. OBJECTIVES To estimate the temporal changes in the prevalence of pre-existing health conditions among pregnant women in British Columbia, Canada. METHODS We carried out a population-based cross-sectional study of 825,203 deliveries in BC between 2000 and 2019 and examined 17 categories of physical and psychiatric health conditions recorded within 5 years before childbirth. We also undertook age-period-cohort analyses to evaluate temporal changes in pre-existing health conditions. RESULTS The prevalence of any pre-existing health condition was 26.2% (n = 216,214) with overall trends remaining stable during the study period. Between 2000 and 2019, the prevalence rates of anxiety (5.6%-9.6%), bipolar (1.6%-3.4%), psychosis (0.7%-0.8%), and eating disorders (0.2%-0.3%) increased. The prevalence of hypertension increased sharply from 0.06% in 2000 to 0.3% in 2019. Diabetes mellitus and stroke rates increased, as did the prevalence of systemic lupus, multiple sclerosis, and chronic kidney disease. Advanced maternal age was strongly associated with both psychiatric and circulatory/metabolic conditions. A strong birth cohort effect was evident, with rates of psychiatric conditions increasing among women born after 1985. CONCLUSIONS In British Columbia, Canada, 1 in 4 mothers had a pre-existing health condition 5 years prior to pregnancy. These findings underscore the need for multi-disciplinary care for women with pre-existing health conditions to improve maternal, foetal, and infant health.
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Affiliation(s)
- Louise Lundborg
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - K S Joseph
- Department of Obstetrics and Gynaecology, Children's and Women's Hospital of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, Children's and Women's Hospital of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wee-Shian Chan
- Division of General Internal Medicine, Department of Medicine, Children's and Women's Hospital of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Qi Wen
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cande V Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Neda Razaz
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Thela L, Paruk S, Bhengu B, Chiliza B. Psychiatric emergencies during pregnancy and puerperium in low - And middle-income countries. Best Pract Res Clin Obstet Gynaecol 2024; 94:102478. [PMID: 38401484 DOI: 10.1016/j.bpobgyn.2024.102478] [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: 10/01/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
Pregnancy and puerperium are critical points in women's health, and various psychiatric emergencies may worsen or manifest (for the first time) during this period. In the presence of a psychiatric emergency, the pregnancy and puerperium outcomes may be compromised. In addition to the mother being at risk, the health of the fetus and the newborn may also be compromised if the psychiatric emergency is not managed appropriately. Early detection and collaborative approaches between mental health practitioners and obstetricians are of utmost importance in women who are at risk and those living with psychiatric illnesses during pregnancy and puerperium. Practitioners should also ensure that women with impaired capacity due to psychiatric disease are treated in a non-judgmental and respectful manner, even if their autonomies have been overridden.
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Affiliation(s)
- Lindokuhle Thela
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa.
| | - Saeeda Paruk
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
| | - Busisiwe Bhengu
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
| | - Bonginkosi Chiliza
- University of KwaZulu Natal, School of Clinical Medicine, Discipline of Psychiatry, South Africa
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Blackman A, Ukah UV, Platt RW, Meng X, Shapiro GD, Malhamé I, Ray JG, Lisonkova S, El-Chaâr D, Auger N, Dayan N. Severe Maternal Morbidity and Mental Health Hospitalizations or Emergency Department Visits. JAMA Netw Open 2024; 7:e247983. [PMID: 38652472 PMCID: PMC11040413 DOI: 10.1001/jamanetworkopen.2024.7983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/25/2024] [Indexed: 04/25/2024] Open
Abstract
Importance Severe maternal morbidity (SMM) can have long-term health consequences for the affected mother. The association between SMM and future maternal mental health conditions has not been well studied. Objective To assess the association between SMM in the first recorded birth and the risk of hospitalization or emergency department (ED) visits for a mental health condition over a 13-year period. Design, Setting, and Participants This population-based retrospective cohort study used data from postpartum individuals aged 18 to 55 years with a first hospital delivery between 2008 and 2021 in 11 provinces and territories in Canada, except Québec. Data were analyzed from January to June 2023. Exposure SMM, defined as a composite of conditions, such as septic shock, severe preeclampsia or eclampsia, severe hemorrhage with intervention, or other complications, occurring after 20 weeks' gestation and up to 42 days after a first delivery. Main Outcomes and Measures The main outcome was a hospitalization or ED visit for a mental health condition, including mood and anxiety disorders, substance use, schizophrenia, and other psychotic disorder, or suicidality or self-harm event, arising at least 43 days after the first birth hospitalization. Cox regression models generated hazard ratios with 95% CIs, adjusted for baseline maternal comorbidities, maternal age at delivery, income quintile, type of residence, hospital type, and delivery year. Results Of 2 026 594 individuals with a first hospital delivery, 1 579 392 individuals (mean [SD] age, 30.0 [5.4] years) had complete ED and hospital records and were included in analyses; among these, 35 825 individuals (2.3%) had SMM. Compared with individuals without SMM, those with SMM were older (mean [SD] age, 29.9 [5.4] years vs 30.7 [6.0] years), were more likely to deliver in a teaching tertiary care hospital (40.8% vs 51.1%), and to have preexisting conditions (eg, ≥2 conditions: 1.2% vs 5.3%), gestational diabetes (8.2% vs 11.7%), stillbirth (0.5% vs 1.6%), preterm birth (7.7% vs 25.0%), or cesarean delivery (31.0% vs 54.3%). After a median (IQR) duration of 2.6 (1.3-6.4) years, 1287 (96.1 per 10 000) individuals with SMM had a mental health hospitalization or ED visit, compared with 41 779 (73.2 per 10 000) individuals without SMM (adjusted hazard ratio, 1.26 [95% CI, 1.19-1.34]). Conclusions and Relevance In this cohort study of postpartum individuals with and without SMM in pregnancy and delivery, there was an increased risk of mental health hospitalizations or ED visits up to 13 years after a delivery complicated by SMM. Enhanced surveillance and provision of postpartum mental health resources may be especially important after SMM.
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Affiliation(s)
- Asia Blackman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Ugochinyere V. Ukah
- Pregnancy and Child Research Center, HealthPartners Institute, Minneapolis, Minnesota
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | - Robert W. Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Xiangfei Meng
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
- Douglas Research Centre, Montreal, Québec, Canada
| | - Gabriel D. Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Isabelle Malhamé
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | - Joel G. Ray
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Darine El-Chaâr
- Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Nathalie Auger
- Institut national de santé publique du Québec, Quebec City, Québec, Canada
| | - Natalie Dayan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
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King JD, Crowley G, El-Maraghy M, Davis W, Jauhari A, Wilson-Jones C. Perinatal mental health in medical school curricula: a national scoping survey of British universities and student psychiatry societies. BJPsych Bull 2024; 48:51-56. [PMID: 36632805 PMCID: PMC10801407 DOI: 10.1192/bjb.2022.91] [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: 01/27/2022] [Revised: 10/14/2022] [Accepted: 11/28/2022] [Indexed: 01/13/2023] Open
Abstract
AIMS AND METHOD With increasing recognition of the prevalence and impact of perinatal mental health (PMH) disorders comes a responsibility to ensure that tomorrow's doctors can support families during the perinatal period. Online surveys seeking information about the inclusion of PMH education in undergraduate curricula were sent to psychiatry curriculum leads and student psychiatry societies from each university medical school in the UK between April and September 2021. RESULTS Responses were received from 32/35 (91.4%) medical schools. Two-thirds reported specific inclusion of PMH content in the core curriculum, typically integrated into general adult psychiatry or obstetric teaching. Students at the remaining schools were all likely to be examined on the topic or see perinatal cases during at least one clinical attachment. CLINICAL IMPLICATIONS PMH education offers an opportunity for collaboration between psychiatry and other disciplines. Future work looking at educational case examples with objective outcomes would be valuable.
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Affiliation(s)
- Jacob D. King
- Imperial College London, UK
- Central and North West London NHS Foundation Trust, UK
| | - Grace Crowley
- South London and Maudsley NHS Foundation Trust, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Manal El-Maraghy
- Essex Partnership University NHS Foundation Trust, Wickford, UK
- Anglia Ruskin University, Chelmsford, UK
| | - William Davis
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
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Michalczyk J, Miłosz A, Soroka E. Postpartum Psychosis: A Review of Risk Factors, Clinical Picture, Management, Prevention, and Psychosocial Determinants. Med Sci Monit 2023; 29:e942520. [PMID: 38155489 PMCID: PMC10759251 DOI: 10.12659/msm.942520] [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: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 12/30/2023] Open
Abstract
Postpartum psychosis is rare, but is a serious clinical and social problem. On its own, it is not included in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) or ICD-10 (International Statistical Classification of Diseases and Related Health Problems) as a disease entity, and current diagnostic criteria equate it with other psychoses. This poses a serious legal problem and makes it difficult to classify. The disorder is caused by a complex combination of biological, environmental, and cultural factors. The exact pathophysiological mechanisms of postpartum psychosis remain very poorly understood. There is a need for further research and increased knowledge of the medical sector in the prevention and early detection of psychosis to prevent stigmatization of female patients during a psychiatric episode. It is necessary to regulate its position in the DSM5 and ICD-10. Attention should be paid to the social education of expectant mothers and their families. This article aims to review the current status of risk factors, prevention, and management of postpartum psychosis.
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Affiliation(s)
- Justyna Michalczyk
- II Department of Psychiatry and Psychiatric Rehabilitation, Student Scientific Association, Faculty of Medicine, Medical University of Lublin, Lublin, Poland
| | - Agata Miłosz
- II Department of Psychiatry and Psychiatric Rehabilitation, Student Scientific Association, Faculty of Medicine, Medical University of Lublin, Lublin, Poland
| | - Ewelina Soroka
- II Department of Psychiatry and Psychiatric Rehabilitation, Medical University of Lublin, Lublin, Poland
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Shridharmurthy D, Lapane KL, Nunes AP, Baek J, Weisman MH, Kay J, Liu SH. Postpartum Depression in Reproductive-Age Women With and Without Rheumatic Disease: A Population-Based Matched Cohort Study. J Rheumatol 2023; 50:1287-1295. [PMID: 37399461 DOI: 10.3899/jrheum.2023-0105] [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] [Accepted: 06/05/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To examine postpartum depression (PPD) among women with axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), or rheumatoid arthritis (RA) in comparison with a matched population without rheumatic disease (RD). METHODS A retrospective analysis using the 2013-2018 IBM MarketScan Commercial Claims and Encounters Database was conducted. Pregnant women with axSpA, PsA, or RA were identified, and the delivery date was used as the index date. We restricted the sample to women ≤ 55 years with continuous enrollment ≥ 6 months before date of last menstrual period and throughout pregnancy. Each patient was matched with 4 individuals without RD on: (1) maternal age at delivery, (2) prior history of depression, and (3) duration of depression before delivery. Cox frailty proportional hazards models estimated the crude and adjusted hazard ratios (aHR) and 95% CI of incident postpartum depression within 1 year among women with axSpA, PsA, or RA (axSpA/PsA/RA cohort) compared to the matched non-RD comparison group. RESULTS Overall, 2667 women with axSpA, PsA, or RA and 10,668 patients without any RD were included. The median follow-up time in days was 256 (IQR 93-366) and 265 (IQR 99-366) for the axSpA/PsA/RA cohort and matched non-RD comparison group, respectively. Development of PPD was more common in the axSpA/PsA/RA cohort relative to the matched non-RD comparison group (axSpA/PsA/RA cohort: 17.2%; matched non-RD comparison group: 12.8%; aHR 1.22, 95% CI 1.09-1.36). CONCLUSION Postpartum depression is significantly higher in women of reproductive age with axSpA/PsA/RA when compared to those without RD.
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Affiliation(s)
- Divya Shridharmurthy
- D. Shridharmurthy, MMBS, MPH, Division of Epidemiology, Department of Population and Quantitative Health Sciences, and Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Kate L Lapane
- K.L. Lapane, PhD, A.P. Nunes, PhD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Anthony P Nunes
- K.L. Lapane, PhD, A.P. Nunes, PhD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Jonggyu Baek
- J. Baek, PhD, Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts
| | - Michael H Weisman
- M.H. Weisman, MD, Division of Immunology and Rheumatology, School of Medicine, Stanford University, Palo Alto, California
| | - Jonathan Kay
- J. Kay, MD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Division of Rheumatology, Department of Medicine, UMass Chan Medical School, and Division of Rheumatology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Shao-Hsien Liu
- S.H. Liu, PhD, Division of Epidemiology, Department of Population and Quantitative Health Sciences, and Division of Rheumatology, Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA.
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Adane AA, Shepherd CC, Reibel T, Ayano G, Marriott R. The perinatal and childhood outcomes of children born to Indigenous women with mental health problems: A scoping review. Midwifery 2023; 125:103779. [PMID: 37562160 DOI: 10.1016/j.midw.2023.103779] [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: 04/05/2023] [Revised: 06/23/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Maternal mental health problems are common during the perinatal period and have been associated with several negative outcomes in children. However, few studies have examined the associations between maternal mental health problems and offspring outcomes among Indigenous people, and the findings across these studies have been inconsistent. This scoping review examined the birth and childhood (≤12 years) health and development outcomes of the children of Indigenous women with mental health problems. METHODS A scoping review was conducted following the methodological framework developed by Arksey and O'Malley and based on the PRISMA-ScR guidelines. Eight databases were searched electronically for studies examining the associations between any perinatal maternal mental health problems and birth and childhood outcomes among the Indigenous populations of Australia, Canada, New Zealand, and the USA. Two authors reviewed studies for inclusion. A narrative synthesis approach was adopted. RESULTS Of 2,836 records identified, 10 were eligible. One of three studies evaluating maternal depression and anxiety problems found a negative (adverse) association with birth and childhood behavioural outcomes. Six of seven studies that examined the associations between maternal substance use disorder (mainly alcohol use disorder) and several birth and childhood outcomes found at least one negative association. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Maternal substance use disorder appears to be associated with adverse birth and childhood outcomes among some Indigenous populations. However, there is preliminary evidence for the other common maternal mental health problems. Further research is critically required to draw definitive conclusions regarding the impact of maternal mental health problems on the birth and childhood outcomes.
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Affiliation(s)
- Akilew A Adane
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia; Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia.
| | - Carrington Cj Shepherd
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia; Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia; Curtin Medical School, Curtin University, Bentley, WA, Australia
| | - Tracy Reibel
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
| | - Getinet Ayano
- School of Indigenous Studies, The University of Western Australia, Crawley, WA, Australia; School of Population Health, Curtin University, Bentley, WA, Australia
| | - Rhonda Marriott
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, WA, Australia
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Votruba N, Praveen D, Mellers L, Rajan E, Thout SR, Arora V, Malik Y, Kashyap A, Majumdar S, Hirst J, Maulik PK. SMARThealth PRegnancy And Mental Health study: protocol for a situational analysis of perinatal mental health in women living in rural India. Front Glob Womens Health 2023; 4:1143880. [PMID: 37575961 PMCID: PMC10416114 DOI: 10.3389/fgwh.2023.1143880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction The situation for women experiencing mental health problems during pregnancy and postpartum in rural India is critical: a high burden of disease, a high estimated number of women are undiagnosed and untreated with mental health problems, a substantial gap in research on women's perinatal health, and severe stigma and discrimination. The SMARThealth Pregnancy study is a cluster randomised trial using a digital intervention to identify and manage anaemia, hypertension, and diabetes in the first year after birth in rural India. Within this study, the SMARThealth Pregnancy and Mental Health (PRAMH) study is a situational analysis to understand mental health problems during pregnancy and in the first year following birth in this population. Methods/design This situational analysis aims to analyse and to assess the context of perinatal mental health, health services, barriers, facilitators, and gaps in Siddipet district of Telangana state in India, to develop an implementation framework for a future intervention. A tested, standardised situational analysis tool will be adapted and applied to perinatal mental health in rural India. A desktop and policy review will be conducted to identify and analyse relevant mental health and pregnancy care policies at the national and state levels. We will conduct in-depth interviews with policymakers, planners, mental health professionals and other experts in perinatal mental health (n = 10-15). We will also conduct focus group discussions with key stakeholders, including women with perinatal mental health problems, their families and carers, and community health workers (n = 24-40). A theory of change workshop with key stakeholders will be conducted which will also serve as a priority setting exercise, and will clarify challenges and opportunities, priorities, and objectives for a pilot intervention study. The analysis of qualitive data will be done using thematic analysis. Based on the data analysis and synthesis of the findings, an implementation framework will be developed to guide development, testing and scale up of a contextually relevant intervention for perinatal mental health. Discussion The situational analysis will help to establish relationships with all relevant stakeholders, clarify the context and hypotheses for the pilot intervention and implementation.
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Affiliation(s)
- Nicole Votruba
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Devarsetty Praveen
- The George Institute for Global Health India, New Delhi, India
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Lucy Mellers
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Eldho Rajan
- The George Institute for Global Health India, New Delhi, India
| | | | - Varun Arora
- Post Graduate Institute of Medical Science, Rohtak, India
| | - Yogender Malik
- Department of Psychiatry, Institute of Mental Health (IMH), University of Health Sciences PGIMS, Rohtak, India
| | - Aditya Kashyap
- SVS Institute of Neurosciences, Government Medical College, Siddipet, India
| | - Sreya Majumdar
- The George Institute for Global Health India, New Delhi, India
| | - Jane Hirst
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Pallab K. Maulik
- The George Institute for Global Health India, New Delhi, India
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Tato Fernandes F, de Almeida AB, Fernandes M, Correia R, Magalhães R, Buchner G, Braga J, Freitas P. Perinatal depression and mental health uptake referral rate in an obstetric service. Sci Rep 2023; 13:10987. [PMID: 37419918 PMCID: PMC10328992 DOI: 10.1038/s41598-023-33832-6] [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: 02/04/2022] [Accepted: 04/19/2023] [Indexed: 07/09/2023] Open
Abstract
Perinatal depression is an important indicator of mothers' mental health. Studies have been carried out to identify and characterize women at risk of such affective disorder. The aim of this study is to assess mothers' adherence to our perinatal depression screening and eventual follow-up by a multidisciplinary team, including mental health and obstetrics professionals. Ultimately, a risk profile for the uptake rate of referral was described to psychological support. Pregnant women from a maternity of a tertiary center with on-site assessment and treatment (n = 2163) were included in this study. The identification of women at risk for depression was based on a two-question screening and the EPDS scale. Demographic and obstetric data were obtained from medical records. The number of screening evaluations, the uptake referral rate and the compliance to treatment were analyzed. Logistic regression was used to predict a risk profile for adherence. Among 2163 enrolled in the protocol, 10.2% screened positive for depression. Of these, 51.8% accepted referral for mental health assistance. 74.9% were compliant to Psychology appointments and 74.1% to Psychiatry appointments. Women who had a previous history of depression were more likely to accept referral for mental health support. With this study, we were able to understand the behaviour of this population towards the screening protocol we offer. Women with a previous history of depression are more likely to accept mental health assistance.
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Affiliation(s)
| | - Ana Beatriz de Almeida
- Gynaecology and Obstetrics Department, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Mónica Fernandes
- Clinical Psychology, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rosa Correia
- Clinical Psychology, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rui Magalhães
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Graça Buchner
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Gynaecology and Obstetrics Department, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jorge Braga
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Gynaecology and Obstetrics Department, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Paula Freitas
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
- Psychiatric Department, Cento Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
- CINTESIS, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Hannon S, Gartland D, Higgins A, Brown SJ, Carroll M, Begley C, Daly D. Physical health and comorbid anxiety and depression across the first year postpartum in Ireland (MAMMI study): A longitudinal population-based study. J Affect Disord 2023; 328:228-237. [PMID: 36801420 DOI: 10.1016/j.jad.2023.02.056] [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: 09/08/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Little is known of the associations between physical health issues and mental health issues such as anxiety, depression and comorbid anxiety and depression (CAD) occurring in the perinatal period. METHODS A longitudinal cohort study with 3009 first-time mothers giving birth in Ireland collected physical and mental health data in pregnancy and at 3, 6, 9 and 12 months postpartum. Mental health was measured using the depression and anxiety subscales of the Depression, Anxiety and Stress Scale. Experience of eight common physical health issues (e.g. severe headaches/migraines, back pain) were assessed in pregnancy, with an additional six assessed at each postpartum data collection point. RESULTS 2.4 % of women reported depression alone in pregnancy and 4 % reported depression across the first postpartum year. Anxiety alone was reported by 3.0 % of women in pregnancy, and 2 % in the first year postpartum. Prevalence of comorbid anxiety/depression (CAD) was 1.5 % in pregnancy and almost 2 % postpartum. A higher proportion of women reporting, compared to women not reporting, postpartum CAD were younger, not partnered, not in paid employment in pregnancy, have fewer years of education, and had a caesarean birth. Extreme tiredness/exhaustion and back pain were the most common physical health issues in pregnancy and postpartum. Constipation, haemorrhoids, bowel issues, breast issues, infection and pain in the perineum or caesarean wound, pelvic pain and urinary tract infections were highest at three months postpartum and gradually decreased thereafter. Women reporting depression alone or anxiety alone were equivalent in terms of physical health issues. However, women without mental health symptoms reported significantly fewer physical health issues than women reporting depressive or anxiety symptoms alone or CAD at every time point. Women with CAD reported a significantly higher number of health issues than women reporting depression alone or anxiety alone at 9 and 12 months postpartum. CONCLUSION Reports of mental health symptoms are associated with higher physical health burden demonstrating a need for integrated approaches in mental and physical health care pathways in perinatal services.
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Affiliation(s)
- Susan Hannon
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland; Trinity Centre for Maternity Care Research (TCMCR), School of Nursing and Midwifery, Trinity College Dublin, No. 2 Clare Street, Dublin 2, Ireland.
| | - Deirdre Gartland
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia.
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland; Trinity Centre for Maternity Care Research (TCMCR), School of Nursing and Midwifery, Trinity College Dublin, No. 2 Clare Street, Dublin 2, Ireland.
| | - Stephanie J Brown
- Intergenerational Health, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of General Practice, University of Melbourne, Melbourne, Vic, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Vic, Australia.
| | - Margaret Carroll
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland; Trinity Centre for Maternity Care Research (TCMCR), School of Nursing and Midwifery, Trinity College Dublin, No. 2 Clare Street, Dublin 2, Ireland.
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland; Trinity Centre for Maternity Care Research (TCMCR), School of Nursing and Midwifery, Trinity College Dublin, No. 2 Clare Street, Dublin 2, Ireland.
| | - Déirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin DO2 T283, Ireland; Trinity Centre for Maternity Care Research (TCMCR), School of Nursing and Midwifery, Trinity College Dublin, No. 2 Clare Street, Dublin 2, Ireland.
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12
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Sadath A, Troya MI, Nicholson S, Cully G, Leahy D, Ramos Costa AP, Benson R, Corcoran P, Griffin E, Phillip E, Cassidy E, Jeffers A, Shiely F, Alberdi-Páramo Í, Kavalidou K, Arensman E. Physical and mental illness comorbidity among individuals with frequent self-harm episodes: A mixed-methods study. Front Psychiatry 2023; 14:1121313. [PMID: 36970268 PMCID: PMC10033892 DOI: 10.3389/fpsyt.2023.1121313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundResearch has indicated an increased risk of self-harm repetition and suicide among individuals with frequent self-harm episodes. Co-occurring physical and mental illness further increases the risk of self-harm and suicide. However, the association between this co-occurrence and frequent self-harm episodes is not well understood. The objectives of the study were (a) to examine the sociodemographic and clinical profile of individuals with frequent self-harm (regardless of suicidal intent) episodes and, (b) the association between physical and mental illness comorbidity, self-harm repetition, highly lethal self-harm methods, and suicide intent.MethodsThe study included consecutive patients with five or more self-harm presentations to Emergency Departments across three general hospitals in the Republic of Ireland. The study included file reviews (n = 183) and semi-structured interviews (n = 36). Multivariate logistic regression models and independent samples t-tests were used to test the association between the sociodemographic and physical and mental disorders comorbidity on highly lethal self-harm methods and suicidal intent, respectively. Thematic analysis was applied to identify themes related to physical and mental illness comorbidity and frequent self-harm repetition.FindingsThe majority of individuals with frequent self-harm episodes were female (59.6%), single (56.1%), and unemployed (57.4%). The predominant current self-harm method was drug overdose (60%). Almost 90% of the participants had history of a mental or behavioral disorder, and 56.8% had recent physical illness. The most common psychiatric diagnoses were alcohol use disorders (51.1%), borderline personality disorder (44.0%), and major depressive disorder (37.8%). Male gender (OR = 2.89) and alcohol abuse (OR = 2.64) predicted the risk of a highly lethal self-harm method. Suicide intent was significantly higher among those with a diagnosis of major depressive disorder (t = 2.43; p = 0.020). Major qualitative themes were (a) the functional meaning of self-harm (b) self-harm comorbidity (c) family psychiatric history and (d) contacts with mental health services. Participants described experiencing an uncontrollable self-harm urge, and self-harm was referred to as a way to get relief from emotional pain or self-punishment to cope with anger and stressors.ConclusionPhysical and mental illness comorbidity was high among individuals with frequent self-harm episodes. Male gender and alcohol abuse were associated with highly lethal self-harm methods. The mental and physical illness comorbidity of individuals with frequent self-harm episodes should be addressed via a biopsychosocial assessment and subsequent indicated treatment interventions.
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Affiliation(s)
- Anvar Sadath
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
- *Correspondence: Anvar Sadath,
| | - M. Isabela Troya
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Sarah Nicholson
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Grace Cully
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Dorothy Leahy
- Kerry Primary Care Child, Adolescent and Family Psychology Service, Cork Kerry Community Healthcare, Health Service Executive, Kerry, Ireland
| | - Ana Paula Ramos Costa
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Ruth Benson
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Paul Corcoran
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Eve Griffin
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Eunice Phillip
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - Eugene Cassidy
- Liaison Psychiatry Services, Cork University Hospital, Cork, Ireland
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | | | - Frances Shiely
- School of Public Health, University College Cork, Cork, Ireland
- Health Research Board (HRB), Clinical Research Facility, University College Cork, Cork, Ireland
| | | | - Katerina Kavalidou
- National Suicide Research Foundation, University College Cork, Cork, Ireland
- National Clinical Programme for Self-Harm and Suicide-Related Ideation (NCPSHI), Health Service Executive, Dublin, Ireland
| | - Ella Arensman
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, University College Cork, Cork, Ireland
- School of Applied Psychology, Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD, Australia
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He L, Soh KL, Huang F, Khaza'ai H, Geok SK, Vorasiha P, Chen A, Ma J. The impact of physical activity intervention on perinatal depression: A systematic review and meta-analysis. J Affect Disord 2023; 321:304-319. [PMID: 36374719 DOI: 10.1016/j.jad.2022.10.026] [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: 05/30/2022] [Revised: 09/23/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND No meta-analysis has analyzed the effect of physical activity level, period of physical activity intervention, and duration of intervention, on perinatal depression. This study was to evaluate the impact of physical activity intensity, dose, period, and duration on perinatal depression. METHODS The literature was searched via the PubMed, Embase, Cochrane Library, and Web of Science databases. Weighted mean difference (WMD) or the risk ratio (RR) was used as the effect indicator, and the effect size was represented by the 95 % confidence interval (CI). Subgroup analysis based on the perinatal stage, physical activity intensity, physical activity equivalent, and intervention duration was performed. RESULTS Totally, 35 studies including 5084 women were included. Physical activity could reduce the incidence and severity of depression in perinatal women. Among depressed women with prenatal depression, low-intensity physical activity, with metabolic equivalents (METs)-min/week being <450, was associated with lower levels of depression. In the general population, the risk of postpartum depression was lower in the physical activity group when the duration of intervention was ≥12 weeks, being II, III stage, and ≥450 METs-min/week. Both low and moderate-intensity physical activity were beneficial to an improved depression severity among depressed women with postpartum depression, and moderate exercise intervention could decrease the risk of postpartum depression in general pregnant women. LIMITATIONS Different types of physical activities may affect the effectiveness of interventions. CONCLUSION Our study indicated physical activity specifically targeted at pregnant women could reduce depression risk and severity.
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Affiliation(s)
- Liping He
- Department of Nursing and Rehabilitations, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Department of Nursing, Chang Zhi Medical College, Changzhi 046000, PR China.
| | - Kim Lam Soh
- Department of Nursing and Rehabilitations, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia.
| | - Feifei Huang
- School of nursing, Fujian Medical University, Fuzhou 350000, PR China
| | - Huzwah Khaza'ai
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Soh Kim Geok
- Department of Sport Studies, Faculty of Education, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Ponpun Vorasiha
- College of Nursing and Health, Suan Sunandha Rajabhat University, Bangkok 10300, Thailand
| | - Aixiang Chen
- Department of Nursing, Chang Zhi Medical College, Changzhi 046000, PR China
| | - Jiangping Ma
- Department of Nursing, Chang Zhi Medical College, Changzhi 046000, PR China
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Alhusen JL, Hughes RB, Lyons G, Laughon K. Depressive symptoms during the perinatal period by disability status: Findings from the United States Pregnancy Risk Assessment Monitoring System. J Adv Nurs 2023; 79:223-233. [PMID: 36320150 PMCID: PMC9795828 DOI: 10.1111/jan.15482] [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: 07/01/2022] [Revised: 09/04/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
AIMS The aim of the current study was to compare the prevalence of depressive symptoms during the perinatal period among respondents with a disability as compared to those without a disability. DESIGN We conducted a secondary analysis of nationally representative data from the Pregnancy Risk Assessment Monitoring System data from 24 participating United States between 2018 and 2020. METHODS A cross-sectional sample of 37,989 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication and self-care. The outcome of interest was perinatal depressive symptoms, defined as experiencing depressive symptoms during the antenatal period or postpartum period. Regression models were used to calculate odds of depressive symptoms during these two time periods by disability status while controlling for relevant sociodemographic characteristics and depressive symptoms prior to pregnancy. RESULTS Respondents with disabilities experienced a higher prevalence of depressive symptoms in both the antenatal period and postpartum period as compared to those without disabilities. In fully adjusted models, respondents with disabilities had 2.4 times the odds of experiencing depressive symptoms during pregnancy and 2.1 times the odds of experiencing postpartum depressive symptoms as compared to respondents without disabilities. CONCLUSION Respondents with disabilities experience a higher prevalence of depressive symptoms throughout the perinatal period thereby increasing the risk for adverse maternal, neonatal and infant health outcomes. IMPACT Perinatal depression is a significant public health issue globally, and our findings suggest that persons with disability are at an increased risk for depressive symptoms both during pregnancy and in the postpartum period. Our findings represent a call to action to improve clinical and supportive services for women with disabilities during the perinatal period to improve their mental health and the consequent health of their offspring. PATIENT OR PUBLIC CONTRIBUTION We thank our Community Advisory Board members who have been instrumental in the conception of this study.
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Affiliation(s)
- Jeanne L. Alhusen
- University of Virginia School of Nursing, Charlottesville, Virginia, USA
| | - Rosemary B. Hughes
- University of Montana Rural Institute for Inclusive Communities, Missoula, Montana, USA
| | - Genevieve Lyons
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Kathryn Laughon
- University of Virginia School of Nursing, Charlottesville, Virginia, USA
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15
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Morgan K, Smith A, Blitshteyn S. POTS and Pregnancy: A Review of Literature and Recommendations for Evaluation and Treatment. Int J Womens Health 2022; 14:1831-1847. [PMID: 36590760 PMCID: PMC9795856 DOI: 10.2147/ijwh.s366667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/06/2022] [Indexed: 12/25/2022] Open
Abstract
Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder of the autonomic nervous system most commonly affecting women of reproductive age. Studies on POTS and pregnancy are limited, and there is a lack of clinical guidelines regarding assessment and management of pregnant women with POTS. The purpose of this review is to summarize data from the available studies on the topic of pregnancy in POTS and common comorbid conditions and to provide the clinical recommendations regarding evaluation and treatment of POTS in pregnant women, based on the available studies and clinical experience. We conclude that pregnancy appears to be safe for women with POTS and is best managed by a multi-disciplinary team with knowledge of POTS and its various comorbidities. Importantly, large, prospective studies are needed to better delineate the course and outcomes of pregnancy, as well as possible pregnancy-related complications in women with POTS. Clinicians should be aware of the clinical presentation, diagnostic criteria, and treatment options in pregnant women with POTS to optimize outcomes and improve medical care during pregnancy and post-partum period.
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Affiliation(s)
- Kate Morgan
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Angela Smith
- HNE Health Libraries, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Svetlana Blitshteyn
- Department of Neurology, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA,Dysautonomia Clinic, Williamsville, NY, USA,Correspondence: Svetlana Blitshteyn, 300 International Drive, Suite 100, Williamsville, NY, 14221, USA, Tel +1-716-531-4598, Fax +1-716-478-6917, Email
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16
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Guo L, Ni Z, Wei G, Cheng W, Huang X, Yue W. Epigenome-wide DNA methylation analysis of whole blood cells derived from patients with GAD and OCD in the Chinese Han population. Transl Psychiatry 2022; 12:465. [PMID: 36344488 PMCID: PMC9640561 DOI: 10.1038/s41398-022-02236-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/14/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022] Open
Abstract
Generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) had high comorbidity and affected more than 44 million people around the world leading to a huge burden on health and economy. Here, we conducted an epigenome-wide DNA methylation study employing 93 patients with GAD, 65 patients with OCD, and 302 health controls, to explore epigenetic alterations associated with the onset and differences of GAD and OCD. We identified multiple differentially methylated positions (DMPs) and regions (DMRs): three DMP genes included RIOK3 (cg21515243, p = 8.00 × 10-10), DNASE2 (cg09379601, p = 1.10 × 10-9), and PSMB4 (cg01334186, p = 3.70 × 10-7) and two DMR genes USP6NL (p = 4.50 × 10-4) and CPLX1 (p = 6.95 × 10-4) were associated with the onset of GAD and OCD; three DMPs genes included LDLRAP1 (cg21400344, p = 4.40 × 10-12), ACIN1 (cg23712970, p = 2.98×10-11), and SCRT1 (cg25472897, p = 5.60 × 10-11) and three DMR genes WDR19 (p = 3.39 × 10-3), SYCP1 (p = 6.41 × 10-3), and FAM172A (p = 5.74 × 10-3) were associated with the differences between GAD and OCD. Investigation of epigenetic age and chronological age revealed a different epigenetic development trajectory of GAD and OCD. Conclusively, our findings which yielded robust models may aid in distinguishing patients from healthy controls (AUC = 0.90-0.99) or classifying patients with GAD and OCD (AUC = 0.89-0.99), and may power the precision medicine for them.
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Affiliation(s)
- Liangkun Guo
- grid.459847.30000 0004 1798 0615Institute of Mental Health, Peking University Sixth Hospital, Beijing, 100191 China ,grid.459847.30000 0004 1798 0615National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China ,grid.506261.60000 0001 0706 7839NHC Key Laboratory of Mental Health, & Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences, Beijing, 100191 China
| | - Zhaojun Ni
- grid.459847.30000 0004 1798 0615Institute of Mental Health, Peking University Sixth Hospital, Beijing, 100191 China ,grid.459847.30000 0004 1798 0615National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China ,grid.506261.60000 0001 0706 7839NHC Key Laboratory of Mental Health, & Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences, Beijing, 100191 China
| | - Guiming Wei
- Department of Neurology, Shandong Daizhuang Hospital, 272051 Jining, Shandong China
| | - Weiqiu Cheng
- grid.5510.10000 0004 1936 8921NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Xuebing Huang
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, 100191, China. .,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China. .,NHC Key Laboratory of Mental Health, & Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences, Beijing, 100191, China.
| | - Weihua Yue
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, 100191, China. .,National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, China. .,NHC Key Laboratory of Mental Health, & Research Unit of Diagnosis and Treatment of Mood Cognitive Disorder, Chinese Academy of Medical Sciences, Beijing, 100191, China. .,PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100871, China. .,Chinese Institute for Brain Research, Beijing, 102206, China.
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Branjerdporn G, Hussain B, Roberts S, Creedy D. Uncovering the Model and Philosophy of Care of a Psychiatric Inpatient Mother-Baby Unit in a Qualitative Study with Staff. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9717. [PMID: 35955073 PMCID: PMC9367725 DOI: 10.3390/ijerph19159717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
The postnatal period is high-risk time for the first onset and recurrence of maternal mental health disorders. Untreated maternal mental illness can have significant adverse impacts on a woman, her baby, and the wider family unit. For women with mental illnesses that cannot be managed in the community, psychiatric inpatient mother-baby units are the gold standard treatment whereby mothers are co-admitted with their infant for specialist perinatal and infant mental health assessment and treatment. The study explores the model of care and examines the philosophies of care that are used within a psychiatric mother-baby unit. Purposive sampling was used to conduct semi-structured focus group and individual interviews with multidisciplinary staff members at a single mother-baby unit. Themes derived from these interviews were coded into two primary themes and a range of sub-themes. The first primary theme focused on the Model of Care consisting of the following sub-themes: mental health care, physical health care, babies' care, building mother-baby relationship, fostering relationships with supports, and facilitating community support. The second primary theme centered around the Philosophy of Care comprising of: person-centered care, trauma-informed care, compassion-centered care, recovery-oriented care, attachment-informed care, non-judgmental care, strengths-based care and interdisciplinary care. The model can be used to provide consistency across mother-baby units and to support core capabilities of staff in providing an optimal level of care.
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Affiliation(s)
- Grace Branjerdporn
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia
- Mater Young Adult Health Centre, Mater Hospital, South Brisbane, QLD 4101, Australia
| | - Besalat Hussain
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia
| | - Susan Roberts
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast, QLD 4215, Australia
| | - Debra Creedy
- School of Nursing & Midwifery, Griffith University, Logan, QLD 4114, Australia
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Personalized exploration of mindfulness-based intervention on antenatal depression: Moderated mediation analyses of a randomized controlled trial. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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To Be Active or to Stop? A Cross-Sectional Retrospective Study Exploring Provider Advice and Patient Fears Surrounding Physical Activity in Pregnancies Complicated by Fetal Growth Restriction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106076. [PMID: 35627613 PMCID: PMC9141534 DOI: 10.3390/ijerph19106076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 12/04/2022]
Abstract
Exercise guidance for women with pregnancies complicated by fetal growth restriction (FGR) is vague, despite the fact that physical activity during pregnancy improves placental development, placental blood flow, and encourages healthy fetal growth. The goal of this study is to test the hypothesis that women with pregnancies complicated by FGR are fearful of physical activity and are being given unclear or limited advice from healthcare providers. Participants (N = 78) (women who delivered an infant diagnosed with FGR within the past 5 years) took an electronic survey including demographic information, pregnancy information, provider advice recall, and other health-related information relevant to growth-restricted pregnancies. Quantitative and qualitative (post-positivism paradigm) methods were employed to analyze the data. When asked specifically about how the FGR diagnosis impacted their activity levels, nearly 50% of participants said the diagnosis led them to decrease their activity levels. Participants reported that healthcare providers who do discuss activity with pregnant patients with FGR suggest low-intensity activities or ceasing activity, although the majority of providers did not discuss activity at all. More fears surrounding physical activity were reported post-FGR diagnosis, including worrying about fetal growth and development and causing fetal harm when engaging in physical activity.
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Dayan N, Velez MP, Vigod S, Pudwell J, Djerboua M, Fell DB, Basso O, Nguyen TV, Joseph KS, Ray JG. Infertility treatment and postpartum mental illness: a population-based cohort study. CMAJ Open 2022; 10:E430-E438. [PMID: 35580889 PMCID: PMC9196066 DOI: 10.9778/cmajo.20210269] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Subfertility and infertility treatment can be stressful experiences, but it is unknown whether each predisposes to postpartum mental illness. We sought to evaluate associations between subfertility or infertility treatment and postpartum mental illness. METHODS We conducted a population-based cohort study of individuals without pre-existing mental illness who gave birth in Ontario, Canada, from 2006 to 2014, stratified by fertility exposure: subfertility without infertility treatment; noninvasive infertility treatment (intrauterine insemination); invasive infertility treatment (in vitro fertilization); and no reproductive assistance. The primary outcome was mental illness occurring 365 days or sooner after birth (defined as ≥ 2 outpatient visits, an emergency department visit or a hospital admission with a mood, anxiety, psychotic, or substance use disorder, self-harm event or other mental illness). We used multivariable Poisson regression with robust error variance to assess associations between fertility exposure and postpartum mental illness. RESULTS The study cohort comprised 786 064 births (mean age 30.42 yr, standard deviation 5.30 yr), including 78 283 with subfertility without treatment, 9178 with noninvasive infertility treatment, 9633 with invasive infertility treatment and 688 970 without reproductive assistance. Postpartum mental illness occurred in 60.8 per 1000 births among individuals without reproductive assistance. Relative to individuals without reproductive assistance, those with subfertility had a higher adjusted relative risk of postpartum mental illness (1.14, 95% confidence interval 1.10-1.17), which was similar in noninvasive and invasive infertility treatment groups. INTERPRETATION Subfertility or infertility treatment conferred a slightly higher risk of postpartum mental illness compared with no reproductive assistance. Further research should elucidate whether the stress of infertility, its treatment or physician selection contributes to this association.
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Affiliation(s)
- Natalie Dayan
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont.
| | - Maria P Velez
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - Simone Vigod
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - Jessica Pudwell
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - Maya Djerboua
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - Deshayne B Fell
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - Olga Basso
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - Tuong Vi Nguyen
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - K S Joseph
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
| | - Joel G Ray
- Departments of Medicine, and of Obstetrics and Gynaecology (Dayan, Basso, Nguyen), McGill University Health Centre; Research Institute (Dayan, Basso, Nguyen), McGill University Health Centre; Departments of Epidemiology, Biostatistics and Occupational Health (Dayan, Basso), McGill University, Montréal, Que.; Department of Obstetrics and Gynaecology (Velez, Pudwell), Queen's University, Kingston Health Sciences Centre; ICES Queen's (Velez, Djerboua), Kingston, Ont.; ICES Central (Vigod, Ray), Toronto, Ont.; Department of Psychiatry (Vigod), University of Toronto, Toronto, Ont.; ICES uOttawa (Fell); Children's Hospital of Eastern Ontario Research Institute (Fell); School of Epidemiology and Public Health (Fell), University of Ottawa; Better Outcomes Registry & Network (BORN Ontario) (Fell), Ottawa, Ont.; Department of Obstetrics and Gynecology (Joseph), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Medicine and Obstetrics and Gynaecology (Ray), University of Toronto, St. Michael's Hospital, Toronto, Ont
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Prevalence and Risk Factors Associated with Postpartum Depression during the COVID-19 Pandemic: A Literature Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042219. [PMID: 35206407 PMCID: PMC8872263 DOI: 10.3390/ijerph19042219] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 01/06/2023]
Abstract
Background: Owing to the high prevalence and detrimental consequences, postpartum depression (PPD) has been identified as one of the severe global public health issues in the last decade. Prior research found that during disasters or events, the prevalence rates of mental disorders among postpartum women are significantly high. However, the effect of the coronavirus disease 2019 (COVID-19) pandemic on PPD and its risk factors remained unclear for postpartum women. Therefore, the present systematic review and meta-analysis aimed to estimate the influence of the COVID-19 pandemic on the prevalence of PPD and to summarize risk factors for PPD during the COVID-19 pandemic. Methods: Three electronic databases of MEDLINE, EMBASE, and Cochrane library databases were systematically searched for articles from their commencements until 1 November 2021. Quality assessment of included studies, random-effects meta-analysis, and sensitivity analysis were performed. Results: A total of eight studies with 6480 postpartum women during the COVID-19 pandemic were included, and most studies were conducted in developed countries. The pooled prevalence of PPD was 34% (95% CI: 21–46%) during the COVID-19 pandemic, much higher than the incident of previous research during the non-pandemic period. Risk factors for PPD during the COVID-19 pandemic were defined as socio-demographic and clinical characteristics, stress and anxiety, lack of various supports, and the COVID-19 related factors. Conclusion: The research findings indicated that the COVID-19 pandemic could make detrimental effects on maternal mental wellbeing among women after childbirth. Investigating the prevalence and risk factors of PPD among postpartum women could shed some light on their mental and emotional states; so that support measures and tailored interventions from health professionals and policymakers could be offered to improve the maternal and infant outcomes, especially during the COVID-19 pandemic. Much more research on maternal psychological wellbeing during the COVID-19 pandemic was strongly recommended to undertake in the middle and low-income countries.
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22
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Riazuelo H. Becoming a mother when suffering from a chronic illness. Front Psychiatry 2022; 13:1059648. [PMID: 36756636 PMCID: PMC9900098 DOI: 10.3389/fpsyt.2022.1059648] [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: 10/01/2022] [Accepted: 12/31/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The critical period of early motherhood when facing serious health problems constitutes a major public health issue. The disease may interfere with, influence, and compound the difficulties experienced over the course of pregnancy and during the parenthood processes. These processes are to be understood as a passage involving so many changes and fraught with difficulties leading to a series of psychological mobilizations. Illness also needs to be considered as a moment of transition, sometimes of severance, marking the lives of the people concerned in a more or less lasting way. Various developments are possible, some of which can be envisaged as leading to more positive outcomes, while others appear as if blocked or doomed to failure. CLINICAL DATA AND METHOD This clinical study is the result of twelve analytically oriented psychotherapeutic follow-ups. The sessions took place weekly over periods ranging from 1 to 6 years. Some of the patients we met had become pregnant while they had a declared but not yet chronic nephropathy. The other patients were already on dialysis and had become mother before starting dialysis. There is also one instance of a pregnant patient on dialysis. In the background, there are also many women who talked about giving up fertility and motherhood. After an in-depth study of each follow-up, a cross-sectional study was conducted to identify the main themes. RESULTS AND DISCUSSION Main considerations on the psychotherapeutic treatment: We regularly observe people who find it impossible to muster the internal resources that would enable them to deal with the trials they undergo in such situations. For the psychologist, there is a need to listen to archaic remnants. Gradually, in the space of psychotherapeutic work, possibilities of "reanimation" of the psyche emerge, an internal space that renews fantasmatic activity as it begins to be able to project into the external space and into the space of the sessions.
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Affiliation(s)
- Hélène Riazuelo
- UFR Sciences Psychologiques et Sciences de l'Éducation (UFR SPSE), Université Paris Nanterre, Nanterre, France.,Nephrology Psychosomatic Unit, Aura Paris Plaisance (APP), Paris, France
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23
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Wyatt S, Ostbye T, De Silva V, Lakmali P, Long Q. Predictors and occurrence of antenatal depressive symptoms in Galle, Sri Lanka: a mixed-methods cross-sectional study. BMC Pregnancy Childbirth 2021; 21:758. [PMID: 34758774 PMCID: PMC8578523 DOI: 10.1186/s12884-021-04239-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/28/2021] [Indexed: 01/21/2023] Open
Abstract
Background There is a high prevalence of antenatal depression in low-or-middle-income countries, but information about risk factors in these settings is still lacking. The purpose of this study is to measure the prevalence of and explore risk factors associated with antenatal depressive symptoms in Galle, Sri Lanka. Methods This study used a mixed-method approach. The quantitative portion included 505 pregnant women from Galle, Sri Lanka, with health record data, responses to psychometric questionnaires (MSPSS and PRAQ-R2), and antenatal depression screening (EPDS). The qualitative portion included interviews with public health midwives about their experiences and routine clinical practices with women with antenatal depressive symptoms. Results Prevalence of antenatal depressive symptoms was 7.5%, highest in women over the age of 30 (13.0%, OR = 3.88, 95%CI = 1.71 – 9.97), with diabetes (21.9%, OR = 3.99, 95%CI = 1.50 – 9.56), or pre-eclampsia in a previous pregnancy (19.4%, OR = 3.32, 95%CI = 1.17 – 8.21). Lower prevalence was observed in the primiparous (3.3%, OR = 0.29, 95%CI = 0.12 – 0.64) employed outside the home (3.6%, OR = 0.33, 95%CI = 0.13 – 0.72), or upper-middle class (2.3%, OR = 0.17, 95%CI = 0.04 – 0.56). Anxiety levels were elevated in depressed women (OR = 1.13, 95%CI = 1.07 – 1.20), while perceived social support was lower (OR = 0.91, 95%CI = 0.89 – 0.93). After multivariable adjustment, only parity (OR = 0.20, 95%CI 0.05 – 0.74) and social support from a “special person” (OR = 0.94, 95%CI = 0.77 – 0.95) remained significantly associated with depressive symptoms. Qualitative findings also identified antenatal health problems and poor social support as risk factors for depressive symptoms. They also identified different contributing factors to poor mental health based on ethnicity, higher stress levels among women working outside the home, and misinformation about health conditions as a cause of poor mental health. Conclusions Prevalence of antenatal depressive symptoms in Galle is lower than the recorded prevalence in other regions of Sri Lanka. Risk factors for antenatal depressive symptoms were identified on biological, psychological, and social axes. These variables should be considered when developing future guidelines for mental health and obstetric treatment in this context.
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Affiliation(s)
- Sage Wyatt
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China
| | - Truls Ostbye
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Vijitha De Silva
- Faculty of Medicine, University of Ruhuna, Matara, Southern Province, Sri Lanka
| | - Prabodha Lakmali
- Faculty of Medicine, University of Ruhuna, Matara, Southern Province, Sri Lanka
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China.
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24
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Aker AM, Vigod SN, Dennis CL, Kaster T, Brown HK. The association between asthma and perinatal mental illness: a population-based cohort study. Int J Epidemiol 2021; 51:964-973. [PMID: 34379748 DOI: 10.1093/ije/dyab160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Asthma is a risk factor for mental illness, but few studies have explored this association around the time of pregnancy. We studied the association between asthma and perinatal mental illness and explored the modifying effects of social and medical complexities. METHODS In a population-based cohort of 846 155 women in Ontario, Canada, with a singleton live birth in 2005-2015 and no recent history of mental illness, modified Poisson regression models were constructed to examine the association between asthma diagnosed before pregnancy and perinatal mental illness, controlling for socio-demographics and medical history. We explored the modifying effects of social and medical complexities using relative excess risk due to interaction. Additional analyses examined the association between asthma and perinatal mental illness by timing and type of mental illness. RESULTS Women with asthma were more likely than those without asthma to have perinatal mental illness [adjusted relative risk (aRR) 1.14; 95% (confidence interval) CI: 1.13, 1.16]. Asthma was associated with increased risk of diagnosis of mental illness prenatally (aRR 1.11; 95% CI: 1.08, 1.13) and post-partum (aRR 1.17; 95% CI: 1.15, 1.19) and specifically diagnoses of mood and anxiety disorders (aRR 1.14; 95% CI: 1.13, 1.16), psychotic disorders (aRR 1.20; 95% CI: 1.10, 1.31) and substance- or alcohol-use disorders (aRR 1.24; 95% CI: 1.14, 1.36). There was no effect modification related to social or medical complexity for these outcomes. CONCLUSIONS Women with asthma predating pregnancy are at slightly increased risk of mental illness in pregnancy and post-partum. A multidisciplinary management strategy may be required to ensure timely identification and treatment.
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Affiliation(s)
- Amira M Aker
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.,ICES, Toronto, Canada
| | - Simone N Vigod
- ICES, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tyler Kaster
- ICES, Toronto, Canada.,Centre for Addiction & Mental Health, Toronto, Canada
| | - Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.,ICES, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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25
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de Wolff MG, Midtgaard J, Johansen M, Rom AL, Rosthøj S, Tabor A, Hegaard HK. Effects of a Midwife-Coordinated Maternity Care Intervention (ChroPreg) vs. Standard Care in Pregnant Women with Chronic Medical Conditions: Results from a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157875. [PMID: 34360168 PMCID: PMC8345548 DOI: 10.3390/ijerph18157875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/30/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
The proportion of childbearing women with pre-existing chronic medical conditions (CMC) is rising. In a randomized controlled trial, we aimed to evaluate the effects of a midwife-coordinated maternity care intervention (ChroPreg) in pregnant women with CMC. The intervention consisted of three main components: (1) Midwife-coordinated and individualized care, (2) Additional ante-and postpartum consultations, and (3) Specialized known midwives. The primary outcome was the total length of hospital stay (LOS). Secondary outcomes were patient-reported outcomes measuring psychological well-being and satisfaction with maternity care, health utilization, and maternal and infant outcomes. A total of 362 women were randomized to the ChroPreg intervention (n = 131) or Standard Care (n = 131). No differences in LOS were found between groups (median 3.0 days, ChroPreg group 0.1% lower LOS, 95% CI −7.8 to 7%, p = 0.97). Women in the ChroPreg group reported being more satisfied with maternity care measured by the Pregnancy and Childbirth Questionnaire (PCQ) compared with the Standard Care group (mean PCQ 104.5 vs. 98.2, mean difference 6.3, 95% CI 3.0–10.0, p < 0.0001). In conclusion, the ChroPreg intervention did not reduce LOS. However, women in the ChroPreg group were more satisfied with maternity care.
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Affiliation(s)
- Mie G. de Wolff
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.J.); (A.L.R.); (H.K.H.)
- The Research Unit for Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Correspondence: ; Tel.: +45-23306414
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
- Mental Health Centre Glostrup, University of Copenhagen, 2600 Glostrup, Denmark
| | - Marianne Johansen
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.J.); (A.L.R.); (H.K.H.)
- Unit for Pregnancy and Heart Disease, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Ane L. Rom
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.J.); (A.L.R.); (H.K.H.)
- The Research Unit for Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Research Unit of Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Susanne Rosthøj
- Section of Biostatistics, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark;
| | - Ann Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Hanne K. Hegaard
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.J.); (A.L.R.); (H.K.H.)
- The Research Unit for Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark;
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Zipursky JS, Thiruchelvam D, Redelmeier DA. Prenatal electrocardiogram testing and postpartum depression: A population-based cohort study. Obstet Med 2021; 15:31-39. [PMID: 35444726 PMCID: PMC9014547 DOI: 10.1177/1753495x211012502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 11/22/2022] Open
Abstract
Background Cardiovascular symptoms in pregnancy may be a clue to psychological distress.
We examined whether electrocardiogram testing in pregnant women is
associated with an increased risk of subsequent postpartum depression. Methods We conducted a population-based cohort study of pregnant women who delivered
in Ontario, Canada comparing women who received a prenatal ECG to women who
did not. Results In total, 3,238,218 women gave birth during the 25-year study period of whom
157,352 (5%) received an electrocardiogram during prenatal care. Receiving
an electrocardiogram test was associated with a one-third relative increase
in the odds of postpartum depression (odds ratio 1.34; 95% confidence
interval 1.29–1.39, p < 0.001). Conclusion The association between prenatal electrocardiogram testing and postpartum
depression suggests a possible link of organic disease with mental illness,
and emphasizes that cardiovascular symptoms may be a clinical clue to the
presence of an underlying mood disorder.
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Affiliation(s)
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Donald A Redelmeier
- Department of Medicine, University of Toronto, Toronto, Canada
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Center for Leading Injury Prevention Practice Education & Research, Toronto, Canada
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Aker AM, Vigod SN, Dennis CL, Brown HK. Perinatal Complications as a Mediator of the Association Between Chronic Disease and Postpartum Mental Illness. J Womens Health (Larchmt) 2021; 31:564-572. [PMID: 34077689 DOI: 10.1089/jwh.2021.0014] [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] [Indexed: 12/11/2022] Open
Abstract
Background: Chronic disease is associated with increased risk of postpartum mental illness, but the mechanisms underlying this association are unclear. Our aim was to explore the mediating role of perinatal complications in the association between chronic disease and postpartum mental illness. Materials and Methods: This was a population-based retrospective cohort study of all women in Ontario, Canada, from 2005 to 2015 with a singleton live birth and no recent history of mental illness during or 2 years before pregnancy. The outcome was mental illness diagnosis between delivery and 365 days postpartum, with perinatal complications, including pregnancy, delivery, and neonatal complications. Modified Poisson regression models were used to examine the association between chronic disease and perinatal mental illness, with generalized estimating equations for the calculation of total, direct, and indirect effects. All models were adjusted for sociodemographic characteristics and remote history of mental health care. Results: Of the 792,972 women, 21.1% had a chronic disease. Chronic disease was associated with an increased risk of postpartum mental illness (adjusted relative risk [aRR] 1.15 [95% confidence interval, CI 1.14-1.16]). There was no evidence of an indirect effect of chronic disease on postpartum mental illness via perinatal complications (aRR 1.003, 95% CI 1.002-1.003). Perinatal complications explained only 1.5% of the association between chronic disease and postpartum mental illness. Results were consistent by type of perinatal complication and chronic disease diagnosis. Conclusion: We observed no clinically meaningful mediating effect of perinatal complications in the association between chronic disease and postpartum mental illness. Future research should investigate alternative mechanisms explaining this association.
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Affiliation(s)
- Amira M Aker
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.,ICES, Toronto, Canada
| | - Simone N Vigod
- ICES, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.,ICES, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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28
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de Wolff MG, Rom AL, Johansen M, Broberg L, Midtgaard J, Tabor A, Hegaard HK. Worries among pregnant Danish women with chronic medical conditions - A cross sectional study with data from the Copenhagen pregnancy cohort. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100623. [PMID: 33984666 DOI: 10.1016/j.srhc.2021.100623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/16/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Pregnancy is a time of uncertainty and worries are common. Pregnant women with somatic chronic medical conditions (SCMC) are at higher risk of adverse pregnancy outcomes and perinatal mental illness than women without SCMC. We aimed to describe the degree and content of worries in early pregnancy among Danish women with SCMC compared with women without SCMC. STUDY DESIGN We conducted a cross-sectional study with self-reported questionnaires answered by 28,794 women from 2012─2019 during 1st trimester at a large university hospital in Denmark. MAIN OUTCOME MEASURES We used the Cambridge Worry Scale (CWS). The outcomes of interest were the prevalence of major worry at item level (n/%) and the total CWS score (mean/SEM) as expression of the degree and content of worries. Univariate and multivariable regression analysis were performed. RESULTS Women with SCMC reported a significantly higher total CWS score (aMD 1.50, 95% CI: 1.20-1.80). Women with SCMC were significantly more likely to report major worry in relation to own health (aOR 2.72, 95% CI: 2.43-3.08), the baby's health (aOR 1.40 95% CI 1.31-1.52), the process of giving birth (aOR 1.12, 95% CI: 1.04-1.21), the possibility of preterm labor (aOR 1.44, 95% CI: 1.28-1.63), and miscarriage (aOR 1.34, 95% CI: 1.24-1.43). CONCLUSION Women with SCMC reported higher overall degree of worry during early pregnancy and an increased risk of major worry in relation to own health, pregnancy complications and giving birth. In antenatal care, these worries should be addressed by clinicians.
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Affiliation(s)
- Mie Gaarskjaer de Wolff
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; The Research Unit for Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Blegdamsvej 3, 2200 Copenhagen N, Denmark.
| | - Ane Lilleøre Rom
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; The Research Unit for Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3, 5000 Odense, Denmark.
| | - Marianne Johansen
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; Center for Pregnancy and Heart Disease, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Lotte Broberg
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; The Research Unit for Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Blegdamsvej 3, 2200 Copenhagen N, Denmark.
| | - Julie Midtgaard
- The University Hospitals Center for Health Research, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, P.O.B 2099, 1014 Copenhagen K, Denmark.
| | - Ann Tabor
- University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Blegdamsvej 3, 2200 Copenhagen N, Denmark; Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Hanne Kristine Hegaard
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; The Research Unit for Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Blegdamsvej 3, 2200 Copenhagen N, Denmark.
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29
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Ceulemans M, Foulon V, Ngo E, Panchaud A, Winterfeld U, Pomar L, Lambelet V, Cleary B, O'Shaughnessy F, Passier A, Richardson JL, Hompes T, Nordeng H. Mental health status of pregnant and breastfeeding women during the COVID-19 pandemic-A multinational cross-sectional study. Acta Obstet Gynecol Scand 2021; 100:1219-1229. [PMID: 33475148 PMCID: PMC8014496 DOI: 10.1111/aogs.14092] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 12/21/2022]
Abstract
Introduction Evidence on perinatal mental health during the coronavirus disease 2019 (COVID‐19) pandemic and its potential determinants is limited. Therefore, this multinational study aimed to assess the mental health status of pregnant and breastfeeding women during the pandemic, and to explore potential associations between depressive symptoms, anxiety, and stress and women's sociodemographic, health, and reproductive characteristics. Material and methods A cross‐sectional, web‐based study was performed in Ireland, Norway, Switzerland, the Netherlands, and the UK between 16 June and 14 July 2020. Pregnant and breastfeeding women up to 3 months postpartum who were older than 18 years of age were eligible. The online, anonymous survey was promoted through social media and hospital websites. The Edinburgh Depression Scale (EDS), the Generalized Anxiety Disorder seven‐item scale (GAD‐7), and the Perceived Stress Scale (PSS) were used to assess mental health status. Regression model analysis was used to identify factors associated with poor mental health status. Results In total, 9041 women participated (including 3907 pregnant and 5134 breastfeeding women). The prevalence of major depressive symptoms (EDS ≥ 13) was 15% in the pregnancy cohort and and 13% the breastfeeding cohort. Moderate to severe generalized anxiety symptoms (GAD ≥ 10) were found among 11% and 10% of the pregnant and breastfeeding women. The mean (±SD) PSS scores for pregnant and breastfeeding women were 14.1 ± 6.6 and 13.7 ± 6.6, respectively. Risk factors associated with poor mental health included having a chronic mental illness, a chronic somatic illness in the postpartum period, smoking, having an unplanned pregnancy, professional status, and living in the UK or Ireland. Conclusions This multinational study found high levels of depressive symptoms and generalized anxiety among pregnant and breastfeeding women during the COVID‐19 outbreak. The study findings underline the importance of monitoring perinatal mental health during pandemics and other societal crises to safeguard maternal and infant mental health.
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Affiliation(s)
- Michael Ceulemans
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Teratology Information Service, Pharmacovigilance center Lareb, 's-Hertogenbosch, the Netherlands
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Elin Ngo
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Alice Panchaud
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Ursula Winterfeld
- Swiss Teratogen Information Service, Service de Pharmacologie Clinique, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Léo Pomar
- Materno-Fetal and Obstetrics Research Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Valentine Lambelet
- Materno-Fetal and Obstetrics Research Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Brian Cleary
- Rotunda Hospital, Dublin, Ireland.,School of Pharmacy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Fergal O'Shaughnessy
- Rotunda Hospital, Dublin, Ireland.,School of Pharmacy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Anneke Passier
- Teratology Information Service, Pharmacovigilance center Lareb, 's-Hertogenbosch, the Netherlands
| | - Jonathan L Richardson
- UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust and Public Health England, Newcastle upon Tyne, UK
| | - Titia Hompes
- Department of Neurosciences, KU Leuven, Leuven, Belgium.,Adult Psychiatry, UPC KU Leuven, Leuven, Belgium
| | - Hedvig Nordeng
- Pharmacoepidemiology and Drug Safety Research Group, Department of Pharmacy, PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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30
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Raghavan V, Khan HA, Seshu U, Rai SP, Durairaj J, Aarthi G, Sangeetha C, John S, Thara R. Prevalence and risk factors of perinatal depression among women in rural Bihar: A community-based cross-sectional study. Asian J Psychiatr 2021; 56:102552. [PMID: 33454561 PMCID: PMC7896100 DOI: 10.1016/j.ajp.2021.102552] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/05/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Perinatal depression (PND) is one of the most common mental disorders occurring during the perinatal period among women. Few studies examined prevalence and risk factors of PND from rural settings in India. This study aimed to estimate the prevalence of perinatal depression and identify social risk factors for it among women from rural Bihar. MATERIALS AND METHODS A cross sectional study was conducted in a community setting in rural areas of Bihar. All perinatal women were screened through a door to door survey and recruited after obtaining informed consent. A semi-structured proforma was used to collect sociodemographic characteristics and family related variables. Edinburgh postnatal depression scale (EPDS) was used to screen for perinatal depression. RESULTS A total of 564 perinatal women were recruited into the study. The estimated prevalence of PND was 23.9 % (95 % CI: 20.6,27.6). Multivariate analysis showed perinatal depression was associated with physical illness in the mother, previous history of abortion, poor financial status and ill-treatment by in-laws. CONCLUSION Prevalence of perinatal depression among women is high in rural settings of North India. A multitude of factors ranging from physical, obstetric, economic and family related confer a high risk for PND. Comprehensive interventions are needed to address these risk factors of perinatal depression.
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Affiliation(s)
- Vijaya Raghavan
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India.
| | - Homam A Khan
- Innovators In Health (India) Nagar Panchayat, Ward 02, Thana: Dalsinghsarai, Distt: Samastipur, Bihar, 848114, India
| | - Uttara Seshu
- Innovators In Health (India) Nagar Panchayat, Ward 02, Thana: Dalsinghsarai, Distt: Samastipur, Bihar, 848114, India
| | - Surya Prakash Rai
- Innovators In Health (India) Nagar Panchayat, Ward 02, Thana: Dalsinghsarai, Distt: Samastipur, Bihar, 848114, India
| | - Jothilakshmai Durairaj
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India
| | - G Aarthi
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India
| | - C Sangeetha
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India
| | - Sujit John
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India
| | - R Thara
- Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai, 600101, Tamil Nadu, India
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31
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Sakalli Kani A, Esim Buyukbayrak E, Dural U, Oguz S, Yavuzer Ö, Yanartas Ö, Topcuoglu V. Impact of expectant mother's knowledge level about fetal anomaly scan on their state anxiety prior to antenatal ultrasound screening. J Matern Fetal Neonatal Med 2021; 35:5025-5030. [PMID: 33461355 DOI: 10.1080/14767058.2021.1874905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aimed to investigate the role of expectant mothers' background antenatal ultrasound knowledge on their state anxiety when they apply for the ultrasound examination. MATERIALS AND METHODS A cross-sectional study was conducted in perinatology outpatient clinic of a university hospital. Expectant mothers who applied for the first trimester ultrasound scan and second trimester anomaly scan were recruited to the study. A self-report form was applied to participants to assess the sociodemographic characteristics, obstetric history, knowledge and attitudes toward antenatal ultrasound. Expectant mothers' state anxiety prior to ultrasound scan was measured with the state sub-scale of State-Trait Anxiety Inventory. RESULTS A total of 500 expectant mothers (220 in the first trimester and 280 in the second trimester) were included to the study. We found a negative correlation between the participants' age and state anxiety level (r = -0.118, p < .01). Also, participants' education level had a significant effect on their state anxiety level (F (2, 497)=5.91, p < .01). Participant's age significantly predicted lower state anxiety level (β = -0.10, t = -2.09, p < .05). We did not find any significant relationship between the mean knowledge level of mothers and state anxiety levels of mothers (r = -0.07, p > .05). CONCLUSION Age was the only affecting factor on anxiety levels before ultrasound scan in pregnant participants. There was no significant effect of background knowledge on state anxiety.
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Affiliation(s)
- Ayse Sakalli Kani
- Department of Psychiatry, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Esra Esim Buyukbayrak
- Department of Obstetrics and Gynecology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Uzay Dural
- Department of Psychology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Seren Oguz
- School of Medicine, Marmara University, Istanbul, Turkey
| | - Özlem Yavuzer
- Department of Obstetrics and Gynecology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Ömer Yanartas
- Department of Psychiatry, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
| | - Volkan Topcuoglu
- Department of Psychiatry, Pendik Research and Training Hospital, Marmara University, Istanbul, Turkey
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