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Bastain TM, Chavez T, Habre R, Hernandez-Castro I, Grubbs B, Toledo-Corral CM, Farzan SF, Lurvey N, Lerner D, Eckel SP, Lurmann F, Lagomasino I, Breton C. Prenatal ambient air pollution and maternal depression at 12 months postpartum in the MADRES pregnancy cohort. Environ Health 2021; 20:121. [PMID: 34838014 PMCID: PMC8626870 DOI: 10.1186/s12940-021-00807-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 11/15/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND Depression is the leading cause of mental health-related morbidity and affects twice as many women as men. Hispanic/Latina women in the US have unique risk factors for depression and they have lower utilization of mental health care services. Identifying modifiable risk factors for maternal depression, such as ambient air pollution, is an urgent public health priority. We aimed to determine whether prenatal exposure to ambient air pollutants was associated with maternal depression at 12 months after childbirth. METHODS One hundred eighty predominantly low-income Hispanic/Latina women participating in the ongoing MADRES cohort study in Los Angeles, CA were followed from early pregnancy through 12 months postpartum through a series of phone questionnaires and in-person study visits. Daily prenatal ambient pollutant estimates of nitrogen dioxide (NO2), ozone (O3), and particulate matter (PM10 and PM2.5) were assigned to participant residences using inverse-distance squared spatial interpolation from ambient monitoring data. Exposures were averaged for each trimester and across pregnancy. The primary outcome measure was maternal depression at 12 months postpartum, as reported on the 20-item Center for Epidemiologic Studies-Depression (CES-D) scale. We classified each participant as depressed (n = 29) or not depressed (n = 151) based on the suggested cutoff of 16 or above (possible scores range from 0 to 60) and fitted logistic regression models, adjusting for potential confounders. RESULTS We found over a two-fold increased odds of depression at 12 months postpartum associated with second trimester NO2 exposure (OR = 2.63, 95% CI: 1.41-4.89) and pregnancy average NO2 (OR = 2.04, 95% CI: 1.13-3.69). Higher second trimester PM2.5 exposure also was associated with increased depression at 12 months postpartum (OR = 1.56, 95% CI: 1.01-2.42). The effect for second trimester PM10 was similar and was borderline significant (OR = 1.58, 95% CI: 0.97-2.56). CONCLUSIONS In a low-income cohort consisting of primarily Hispanic/Latina women in urban Los Angeles, we found that prenatal ambient air pollution, especially mid-pregnancy NO2 and PM2.5, increased the risk of depression at 12 months after childbirth. These results underscore the need to better understand the contribution of modifiable environmental risk factors during potentially critical exposure periods.
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Affiliation(s)
- Theresa M. Bastain
- Department of Population and Public Health Sciences, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Thomas Chavez
- Department of Population and Public Health Sciences, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Rima Habre
- Department of Population and Public Health Sciences, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Ixel Hernandez-Castro
- Department of Population and Public Health Sciences, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | - Brendan Grubbs
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
| | - Claudia M. Toledo-Corral
- Department of Population and Public Health Sciences, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
- Department of Health Sciences, California State University, Northridge, USA
| | - Shohreh F. Farzan
- Department of Population and Public Health Sciences, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | | | | | - Sandrah P. Eckel
- Department of Population and Public Health Sciences, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
| | | | - Isabel Lagomasino
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, USA
| | - Carrie Breton
- Department of Population and Public Health Sciences, USC Keck School of Medicine, University of Southern California, 2001 N. Soto Street, M/C 9237, Los Angeles, CA 90032 USA
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Wensu Z, Xidi Z, Shaojie L, Baohua Z, Yunhan Y, Huilan X, Zhao H, Xiyue X. Does the Presence of Anxiety and Depression Symptoms Mediate the Association Between Family Functions and Self-Efficacy in Pregnant Women in the Third Trimester?: A Community-Based Cross-Sectional Survey. Front Psychiatry 2021; 12:726093. [PMID: 34803756 PMCID: PMC8599816 DOI: 10.3389/fpsyt.2021.726093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Pregnant women in the third trimester can be more vulnerable to adverse mental health outcomes, but there is limited research on the association between family function and self-efficacy and potential mediation by symptoms of anxiety and depression. Methods: The cross-sectional study enrolled 813 pregnant women in the third trimester from 14 communities of Hengyang city, Hunan province of China. All of the participants completed a battery of self-report measures of family function (Family Adaptation Partnership Growth and Resolve Index, APGAR-family), self-efficacy (General Self-Efficacy Scale, GSES), anxiety (measured by Generalized Anxiety Disorder scale with seven items, GAD-7), and depression symptoms (Patient Health Questionnaire with nine items, PHQ-9). The correlation analysis was performed using Spearman's correlation coefficient. Baron and Kenny's method and multiple mediation models with bootstrapping were used to determine whether the symptoms of anxiety and depression mediated the association between family functions and self-efficacy. Results: There were 22.6% pregnant women in the low level of self-efficacy, with 60.9% in the moderate level and 16.5% of respondents in the high level. Self-efficacy had significant correlations with both anxiety symptoms (r = -0.19, p < 0.05), depression symptoms (r = -0.22, p < 0.05), and family function (r = 0.31, p < 0.05). Anxiety symptoms were significantly associated with self-efficacy (β = -0.016, p < 0.05). Depression symptoms were significantly associated with self-efficacy (β = -0.024, p < 0.05). Anxiety and depression symptoms partly mediated the association between family function and self-efficacy, accounting for 11.4 and 16.4% of total effect, respectively. It was indicated that pregnant women with a high degree of family function are less likely to have emotional symptoms and predicted to have higher levels of self-efficacy. Conclusions: Anxiety and depression show mediating effects in the association between family function and self-efficacy. Improved family function can have a positive impact on pregnant women in the third trimester.
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Affiliation(s)
- Zhou Wensu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhu Xidi
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Li Shaojie
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zheng Baohua
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yu Yunhan
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xu Huilan
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Hu Zhao
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xiong Xiyue
- NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China.,Department of Child Rehabilitation, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
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Moore Simas TA, Huang MY, Packnett ER, Zimmerman NM, Moynihan M, Eldar-Lissai A. Matched cohort study of healthcare resource utilization and costs in young children of mothers with postpartum depression in the United States. J Med Econ 2020; 23:174-183. [PMID: 31597499 DOI: 10.1080/13696998.2019.1679157] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: To assess healthcare resource utilization (HRU) and costs in children of mothers with and without postpartum depression (PPD).Methods: Administrative claims data from the IBM Watson Health MarketScan Databases (2010-2016) were used. Women with live births (index date = delivery date) were identified and linked to their newborns. The mother-child pairs were divided into PPD and non-PPD exposure cohorts based on claims for depression, mood or adjustment disorders, or anxiety identified in the mother between 15 and 365 days after delivery. Mother-child pairs with PPD exposure were propensity score matched 1:3 to mother-child pairs without PPD exposure. Children were required to have 24 months of continuous health plan enrolment following delivery. Additional comparisons were performed between mother-child pairs with and without preterm delivery.Results: Overall, 33,314 mother-child pairs with PPD exposure were propensity score matched to 102,364 mother-child pairs without PPD exposure. During the 24-month follow-up period, HRU across most service categories was significantly higher among children in the PPD exposure cohort than non-PPD exposure cohort. Among outpatient services, the percentages of children with a physician specialist service (68% versus 64%), early-intervention screening (40% versus 37%), and an emergency room visit (48% versus 42%) were greater in children of mothers with PPD (all p < .001). Furthermore, children of mothers with PPD incurred 12% higher total healthcare costs in the first 24 months of life compared to children of mothers without PPD ($24,572 versus $21,946; p < .001). After excluding mothers with preterm delivery, the proportion of children with ER visits, physician specialist services, and outpatient pharmacy claims was significantly higher in the PPD exposure cohort than non-PPD exposure cohort (all p < .001).Conclusion: The results of this analysis suggest that HRU and costs over the first 24 months of life in children of mothers with PPD exceeded that of children of mothers without evidence of PPD.
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Affiliation(s)
- Tiffany A Moore Simas
- Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry and Population & Quantitative Health Sciences, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, USA
| | - Ming-Yi Huang
- Health Economics Outcomes Research, Sage Therapeutics, Inc, Cambridge, MA, USA
| | | | | | | | - Adi Eldar-Lissai
- Health Economics Outcomes Research, Sage Therapeutics, Inc, Cambridge, MA, USA
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Alzboon G, Vural G. Factors Influencing the Quality of Life of Healthy Pregnant Women in North Jordan. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E278. [PMID: 31208100 PMCID: PMC6631935 DOI: 10.3390/medicina55060278] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023]
Abstract
Background and Objectives: Quality of life (QOL) assessment during pregnancy contributes to determining women's unmet needs and preventing negative health outcomes. In this study, we aimed to identify the effects of participants' characteristics, perceived stress, and perceived social support on their QOL. We also aimed to determine the differences in QOL according to these factors. Materials and Methods: A cross-sectional study was carried out in a city in Jordan. Purposive sampling was used to select 218 participants. Data was collected by the quality of life Short Form- 36(SF-36) survey, perceived stress scale (PSS), and The Multidimensional perceived Social Support Scale (MSPSS). Results: We found that only parity had a significant effect on the QOL. High-parity women had lower QOL scores than low-parity women. The participants reported high social support, specifically from their families and significant others. The 36-Item Short-Form Health Survey was a reliable tool for measuring the QOL in pregnancy. Conclusions: Parity factor and social support should be recognized in any health promotion intervention and during providing antenatal care. Further research is needed toassess the QOL during pregnancy.
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Affiliation(s)
- Ghadeer Alzboon
- Department of Birth and Women's Health Nursing, Near East University, 99138 Nicosia, Cyprus, via Mersin 10, Turkey.
| | - Gülşen Vural
- Department of Birth and Women's Health Nursing, Near East University, 99138 Nicosia, Cyprus, via Mersin 10, Turkey.
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Fairthorne JC, Hanley GE, Brant R, Oberlander TF. Risk factors for hospitalizations associated with depression among women during the years around a birth: a retrospective cohort study. Int J Popul Data Sci 2019; 4:453. [PMID: 34095525 PMCID: PMC8142953 DOI: 10.23889/ijpds.v4i1.453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction Socio-economic status (SES) is an important determinant of health. Low SES is associated with higher rates of prenatal and post-partum depression, and prenatal and post-partum depression are associated with sub-optimal maternal and infant health. Furthermore, increased negative effects of post-partum depression have been reported in children from low SES backgrounds. Objective To assess whether SES was related to the risk of a medical or psychiatric hospitalization associated with depression (HAWD) and the risk of a HAWD by anti-depressant (AD) use during the years around a birth. Methods This retrospective cohort study used linked birth, hospitalization, prescription and tax-file records of the study cohort. We linked registry data of 243,933 women delivering 348,273 live infants in British Columbia (1999-2009). The outcomes of interest were a HAWD and a HAWD with the associated patient AD use. Ranked area-based measures of equivalised, family disposable income were used to create income deciles, our proxy for SES. Decile-1 represented the lowest income areas, and mothers from Decile-6 (middle-income) were the comparator group. Anti-depressant use was defined as having a prescription for a selective serotonin reuptake inhibitor (SSRI) or other AD during the years around a birth, defined as the period beginning 12 months before conception and ending 12 months after the birth. We analysed by pregnancy using mixed effects logistic regression whilst adjusting for maternal age and parity. Results Compared to mothers from middle-income areas (Decile-6), mothers from low income areas (Decile-1, Decile-2) had increased odds of a HAWD [adjusted OR=1.77 (CI: 1.43, 2.19); adjusted OR=1.56 (CI: 1.26, 1.94)]. Mothers from low income areas with depression and no AD use had even higher odds of a HAWD [adjusted OR=1.83 (CI: 1.33, 2.20); adjusted OR=1.71(CI: 1.33, 2.20)]. Conclusions This study provides preliminary evidence to suggest that barriers to treating depression with ADs in mothers from low income areas during the years around a birth might contribute to their increased risk of a HAWD associated with non-pharmacologically treated depression. Further research is needed to understand the reasons for this increased risk. Disclaimer All inferences, opinions, and conclusions drawn in this manuscript are those of the authors and do not reflect the opinions or policies of the Data Stewards of Population Data BC.
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Affiliation(s)
- Jennifer Christine Fairthorne
- British Columbia Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC Canada V5Z 4H4.,Telethon Kids Institute, University of Western Australia
| | - Gillian E Hanley
- British Columbia Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC Canada V5Z 4H4.,Department of Obstetrics and Gynaecology, University of British Columbia, Faculty of Medicine, 1125 Howe Street, Vancouver, BC Canada V6Z 2K8
| | - Rollin Brant
- British Columbia Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC Canada V5Z 4H4.,Department of Statistics, University of British Columbia
| | - Tim F Oberlander
- British Columbia Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC Canada V5Z 4H4
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