Longitudinal mediation analysis of the factors associated with trajectories of posttraumatic stress disorder symptoms among postpartum women in Northwest Ethiopia: Application of the Karlson-Holm-Breen (KHB) method

Prevalence of postpartum post-traumatic stress disorder and associated factors among postnatal mothers in West Arsi zone, South West Ethiopia, 2024: a community-based cross-sectional study

Background

Up to one-third of women globally experience giving birth as traumatic, which can lead to postpartum post-traumatic stress disorder. Postpartum post-traumatic stress disorders have significant health consequences for the mother, child, and other family members. Although it has tragic health impacts, little is known about this problem in the study area.

Objectives

The study aimed to assess the prevalence of postpartum posttraumatic stress disorder and associated factors among postnatal mothers.

Methods

A community-based cross-sectional study was employed among 635 mothers in the first year after childbirth by using simple random sampling techniques from March 20 to April 20, 2024 in West Arsi zone, Ethiopia. Face-to-face interviewers administered structured questionnaires that were used to collect the data. The collected data were cleaned, coded, and entered into Epidata and exported to Statistical Package for Social Sciences for further analysis. Both bivariate and multivariable analyses were done by using binary logistic regression.

Result

Out of 635, 624 postnatal mothers participated in the study, for a response rate of 98.27%. The prevalence of postpartum post-traumatic stress disorder was 21.60% (95% CI: 18.40%, 24.87%). Primiparous mothers (AOR = 2.26, 95% CI: 1.38, 3.70), have no antenatal care follow-up (AOR = 2.48, 95% CI: 1.47, 4.20), cesarean section delivery (AOR = 2.86, 95% CI: 1.50, 5.61), instrumental delivery (AOR = 3.06, 95% CI: 1.75, 5.34), maternal morbidity (AOR = 2.94, 95% CI: 1.71, 5.05), and postpartum intimate partner violence (AOR = 7.43, 95% CI: 4.53, 12.20) were the identified factors.

Conclusion and recommendation

As identified, one out of five mothers had postpartum posttraumatic stress disorder. Thus, healthcare providers should focus on identified factors like cesarean section and instrumental deliveries while counseling, as this enhances the mothers' psychological readiness. In addition, the West Arsi Zonal Health Office should develop effective strategies to alleviate the problem by focusing on the identified factors.

A nomogram for predicting postpartum post-traumatic stress disorder: a prospective cohort study

BACKGROUND

Postpartumpost-traumatic stress disorder (PTSD), as a psychological stress disorder, has long-term and widespread harm. Still, compared with other postpartum psychiatric disorders, postpartum PTSD has received relatively littleattention in China. This study aims to investigate the risk factors of postpartum PTSD and to develop a convenient and rapid nomogram screening tool to help clinical staff identify high-risk pregnant womenin time and take preventative and management measures.

METHODS

Recruited pregnant women hospitalized for delivery in Qingdao Municipal Hospital and Jinzhou Maternal and Child Health Hospital from November 2022 to October 2023 as convenient samples for the questionnaire survey. Telephone follow-up was conducted 42 days after delivery. After univariate analysis, multicollinearity analysis, and logistic regression analysis, the risk factors of postnatal PTSD were obtained, a prediction model was established, and a nomogram was drawn by R software. G*power3.1.9.7 calculated the effectiveness of the test. The model was validated internally using the Bootstrap approach, and external validation was carried out using a verification group. The accuracy of the model's predictions and its clinical application value were evaluated by the area under the curve, calibration plot, and decision curve analysis.

RESULTS

A total of 602 women were recruited in this study, and the incidence of postpartum PTSD was 11.1% (67/602). Multifactorial logistic regression analysis showed that poor self-assessment of sleep status in late pregnancy (OR = 5.336), cesarean section (OR = 2.825), instrumental delivery (OR = 5.994), having fear of labor (OR = 4.857), and a high score of Five Factors Inventory Neuroticism subscale (OR = 1.244) were independent risk factors for developing postpartum PTSD. A high Quality of Relationship Index score (OR = 0.891) was a protective factor for postpartum PTSD. In the training and validation sets, the nomogram model's area under the ROC curve was 0.928 and 0.907, respectively. The calibration curves showed that the nomogram model was well-fitted, and the Decision Curve Analysis indicated that the nomogram model had good value for clinical application.

CONCLUSIONS

With its strong predictive capacity, the prediction model built using postpartum PTSD risk factors can help clinical caregivers identify high-risk pregnant women early on and implement timely preventive intervention strategies.

Family concerns and relationship problems in anxious pregnant women and their associations with postnatal functional disability in Pakistan

OBJECTIVE

Expanding on existing research suggesting that strategies to reduce prenatal anxiety can decrease functional disability (e.g., difficulties in performing everyday activities and social participation), we examined if this effect varied by type of anxiety-producing problem (i.e., having family concerns and relationship problems versus other problems) reported during pregnancy. Further, we explored if perceived social support mediated this relationship.

METHODS

We used longitudinal data on 310 anxious Pakistani women who received any psychosocial intervention sessions as part of a program that was based on Cognitive Behavioral Therapy. The Psychological Outcome Profiles (PSYCHLOPS) was used to assess whether women had 'family concerns and relationship problems' or 'other problems.' The WHO Disability Assessment Schedule 2.0 assessed functional disability at six-weeks after delivery. Lack of support was measured using a 12-item Multi-dimensional Scale of Perceived Social Support. We employed linear regression to examine associations between types of problems reported during pregnancy and postnatal functional disability. Causal mediation analysis was used to assess whether postnatal social support mediated this relationship.

RESULTS

Of anxious pregnant women, 34% reported family concerns or relationship problems as primary problems in pregnancy. They were more likely to report higher functional disability at six-weeks after delivery than women who reported other problems (adjusted B = 2.40, 95% CI: 0.83-3.97). Lack of overall social support (Estimateindirect = 0.69, 95% CI: 0.04-1.38) and lack of support from friends (Estimateindirect = 0.62, 95% CI: 0.01-1.29) significantly mediated the relationship.

CONCLUSIONS

Findings suggest that complementing pre- and post-natal care with support programs and services that address family concerns and relationship problems, as well as enhancing social support is important to functional disability.

A structural equation modelling of the direct and indirect factors associated with functional status over time as measured by WHODAS-32 items among postpartum women in Northwest Ethiopia

INTRODUCTION

Full functional status recovery which is a multidimensional concept, that includes personal care, infant and family care, social and occupational activities and adjusting to the role of motherhood may require several months to achieve. However, most study designs on postpartum maternal functional status were cross-sectional, providing limited insights into functional status patterns over time and the mediating relationships among variables associated with it during the postpartum period.

OBJECTIVE

To investigate the patterns of functional status over time and the mediating relationships among variables associated with functional status after childbirth.

METHODS

From October 2020 to March 2021, 775 women in Northwest Ethiopia participated in a community-based follow-up study that was linked to a health institution. Functional status was measured by the Amharic version of WHODAS 2.0 instrument. Structural equation modelling was used to determine the direct and indirect effects of predictor variables on individual domains of functional status as measured by WHODAS 2.0 instrument.

RESULTS

Higher fear of childbirth score, anxiety and PTSD score had a direct deleterious effect (increased risk of functional disability) on the overall functional status and six domains of WHODAS 2.0 (cognition, mobility, self-care, getting along with people, household life activities and community participation) at the first, second and third follow up periods. Higher social support had a direct protective effect (decreased risk of functional disability) on all domains of WHODAS 2.0 and the overall functional status at the three follow up periods. Higher social support had also an indirect protective effect through fear of birth on the six domains of WHODAS 2.0 and the overall functional status throughout the follow up period. Higher PTSD symptom score had also an indirect deleterious effect (increased risk of functional disability) through fear of birth on the overall functional status and six domains of WHODAS 2.0 (higher disability) throughout the follow up period. Complications of delivery management had a direct deleterious effect (increased disability score) on the domains of getting along with people, household life activities, mobility, self-care and community participation and on the overall functional status disability score.

CONCLUSION

Maternal functioning in the postpartum period is initially impaired, but improves over time. Despite improvement, maternal morbidities are correlated with worse functioning scores compared to women without these morbidities. Interventions should target on the mediating role of fear of child birth, life threatening event of health risk and PTSD with the deleterious effects of complications of delivery management, poor social support, vaginal mode of delivery, anxiety, poor physical and mental quality of life on functional status of postpartum women.

Longitudinal patterns of the relation between anxiety, depression and posttraumatic stress disorder among postpartum women with and without maternal morbidities in Northwest Ethiopia: a cross-lagged autoregressive structural equation modelling

BACKGROUND

The postpartum period is a time where mothers can undergo significant changes that increase vulnerability for depression, anxiety and posttraumatic stress disorder symptoms. However, the direct and indirect factors of depression, anxiety and posttraumatic stress disorder symptoms and their direction of relationships following childbirth is not well investigated in Ethiopia. The aim of this study was to determine the direct and indirect factors of depression, anxiety and posttraumatic stress disorder symptoms and their direction of relationships following childbirth.

METHODS

A total of 775 women consented to participate at the first, second and third follow-up of the study (6th, 12th and 18th week of postpartum period) during October, 2020 - March, 2021. Women were recruited after childbirth and before discharge using the World Health Organization maternal morbidity working group criteria to identify exposed and non-exposed groups. A cross-lagged autoregressive path analysis and linear structural equation modelling were carried out using Stata version 16 software.

RESULTS

Prevalence rates of anxiety were 18.5%, 15.5% and 8.5% at the 6th, 12th and 18th week of postpartum respectively. The prevalence rates for depression were also found to be 15.5%, 12.9% and 8.6% respectively during the same follow up period and for posttraumatic stress disorder it was found to be 9.7%, 6.8% and 3.5% at the 6th, 12th and 18th week of postpartum respectively. Moreover, anxiety and depression were found to be a causal risk factors for posttraumatic stress disorder in the postpartum period. Direct maternal morbidity, fear of childbirth, higher gravidity, perceived traumatic childbirth and indirect maternal morbidity were found to have a direct and indirect positive association with depression, anxiety and posttraumatic stress disorder. In contrast, higher parity, higher family size and higher social support have a direct and indirect negative association.

CONCLUSION

Postnatal mental health screening, early diagnosis and treatment of maternal morbidities, developing encouraging strategies for social support and providing adequate information about birth procedures and response to mothers' needs during childbirth are essential to improve maternal mental health in the postpartum period.

Adverse Childhood Experiences and Cardiovascular Risk among Young Adults: Findings from the 2019 Behavioral Risk Factor Surveillance System

Background: Heart disease is the fourth leading cause of death for young adults aged 18-34 in the United States. Recent research suggests that adverse childhood experiences (ACEs) may shape cardiovascular health and its proximate antecedents. In the current study, we draw on a contemporary, national sample to examine the association between ACEs and cardiovascular health among young adults in the United States, as well as potential mediating pathways. Methods: The present study uses data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) to examine associations between ACEs and cardiovascular risk, as well as the role of cumulative disadvantage and poor mental health in these associations. Results: Findings indicate that young adults who have experienced a greater number of ACEs have a higher likelihood of having moderate to high cardiovascular risk compared to those who have zero or few reported ACEs. Moreover, both poor mental health and cumulative disadvantage explain a significant proportion of this association. Conclusions: The present findings suggest that young adulthood is an appropriate age for deploying prevention efforts related to cardiovascular risk, particularly for young adults reporting high levels of ACEs.

BMI mediates the association of family medical history with self-reported hypertension and diabetes among older adults: Evidence from baseline wave of the longitudinal aging study in India

Background

This study explored the association between family history of hypertension and diabetes with their diagnosis among older Indian adults. The study further examined the role of body mass index (BMI) as a potential mediator in these associations.

Methods

Data from the Longitudinal Ageing Study in India (LASI, 2017-18), wave-1 were used. The sample for the study included 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis has been conducted to assess the prevalence of self-reported hypertension and diabetes. Further, multivariable logistic regression models were used to test the research hypotheses of this study. The Karlson-Holm-Breen (KHB) mediation analysis was conducted to recover the direct and indirect effects of BMI in the association of family medical history and diagnosis of hypertension and diabetes.

Results

A proportion of 32.70% of older adults were diagnosed with hypertension and 14.23% of older adults were diagnosed with diabetes. A proportion of 19.48% and 14.69% of older adults had a family history of hypertension and diabetes, respectively. Also, 16.57% and 5.53% of older adults were overweight and obese, respectively in the current study. Older adults who had family history of hypertension had higher odds of being diagnosed with hypertension [aOR: 2.23, CI: 2.07-2.39] than those who had no such family history. This association was mediated by BMI (percent mediated: 6.31%). Similarly, older adults who had family history of diabetes had higher odds of being diagnosed with diabetes [aOR: 2.63, CI: 2.41-2.88] than those who had no such family history. This association was mediated by BMI (percent effect mediated: 6.66%).

Conclusion

The study highlights the relevance of using family medical history data along with information on BMI as potential source for the control and management of hypertension and diabetes among older population.