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Mathew A, Akpotu IC, Lockwood MB, Tirkey AJ, Patil CL, Doorenbos AZ. Critical Realism in Symptom Science - A Scoping Review. ANS Adv Nurs Sci 2024:00012272-990000000-00091. [PMID: 38864677 DOI: 10.1097/ans.0000000000000534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
There has been an increasing interest in research positioned within critical realism (CR). This analysis aimed to determine how CR has been applied in symptom science through a scoping review of the literature. Fifty-two articles were identified through searches in seven databases and search engines, and grey literature. Quantitative and qualitative analyses were performed using Excel and ATLAS.ti 8.0. Review findings indicate that CR has been used to examine two key aspects of symptoms - symptom experiences and symptom interventions. The details of how CR was operationalized are presented. This first scoping review highlights how a critical realist lens would help examine individual and contextual factors that influence symptom experiences, response to interventions, and outcomes.
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Affiliation(s)
- Asha Mathew
- Author Affiliations: Department of Surgical Nursing, College of Nursing, Christian Medical College Vellore, The Tamil Nadu Dr M.G.R. Medical University, Chennai, India (Dr. Mathew); Head and Neck Surgery Unit II, Christian Medical College Vellore, India (Dr. Tirkey); Department of Biobehavioral Sciences, College of Nursing, University of Illinois, Chicago, USA (Ms Akpotu and Drs. Lockwood and Doorenbos); Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan (Dr. Patil); and University of Illinois Cancer Center, Chicago, USA (Dr. Doorenbos)
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Sim CSM, Chen H, Chong SL, Xia OJ, Chew E, Guo X, Ng LP, Ch'ng YC, Ong JLH, Tan J, Ng DCC, Tan NC, Chan YH. Primary health level screening for postpartum depression during well-child visits: Prevalence, associated risk factors, and breastfeeding. Asian J Psychiatr 2023; 87:103701. [PMID: 37517174 DOI: 10.1016/j.ajp.2023.103701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
Postpartum depression (PPD) is a public health problem that is associated with detrimental effects on the wellbeing of the mother, child and family. Early detection for PPD at the primary health level provides an opportunity for intervention. We aim to examine: (1) the prevalence rate of PPD in the primary care population, (2) acceptance and attendance rates of intervention for women who screened positive for PPD, (3) sociodemographic and maternal risk factors of PPD, and (4) the impact of PPD on breastfeeding. We implemented a mother-child dyadic screening program using the modified Patient Health Questionnaire-2 during routine well-child visits at 2 or 3 months postpartum between July 2019 and December 2021. We performed multivariable logistic regression to identify independent risk factors for PPD and described using adjusted odds ratio (OR) with corresponding 95 % confidence intervals. Among 5561 mothers, the prevalence rate of probable PPD was 2.4 %. About half (54.4 %) of mothers who screened positive accepted intervention and of these, about two-thirds accepted onward referrals to tertiary care and community mental health service, with higher attendance at the latter. In the final adjusted model, mothers who had probable PPD were more likely to be older than age 35 years (OR 1.88, 95 % CI 1.05-3.45; p < 0.05) and not breastfeeding (OR 1.9, 95 % CI 1.06-3.38; p < 0.05). Overall, our findings highlight the importance of early PPD screening and management in primary care. These findings can help inform maternal mental health service development and utilization, thereby optimizing maternal and infant outcomes.
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Affiliation(s)
- Cherie Sze Min Sim
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
| | - Helen Chen
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore; SingHeatlth-Duke NUS Paediatric Medicine Academic Clinical Programme, Singapore.
| | - Shu-Ling Chong
- SingHeatlth-Duke NUS Paediatric Medicine Academic Clinical Programme, Singapore; Paediatric Emergency Medicine Department, KK Women's and Children's Hospital, Singapore
| | | | - Elaine Chew
- SingHeatlth-Duke NUS Paediatric Medicine Academic Clinical Programme, Singapore; Adolescent Medicine Service, KK Women's and Children's Hospital, Singapore
| | - Xiaoxuan Guo
- SingHealth Polyclinics, Singapore; SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
| | - Lai Peng Ng
- SingHealth Polyclinics, Singapore; SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
| | - Ying Chia Ch'ng
- Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore
| | | | | | - David Chee Chin Ng
- SingHealth Polyclinics, Singapore; SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore; SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
| | - Yoke Hwee Chan
- SingHeatlth-Duke NUS Paediatric Medicine Academic Clinical Programme, Singapore; Division of Medicine, KK Women's and Children's Hospital, Singapore
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Rencken G, Govender P, Uys CJE. Neurobehavioural challenges experienced by HIV exposed infants: a study in South Africa. BMC Pediatr 2022; 22:479. [PMID: 35933329 PMCID: PMC9356445 DOI: 10.1186/s12887-022-03526-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 07/22/2022] [Indexed: 12/01/2022] Open
Abstract
Background The newborn infant is a complexly organized, competent being, who plays an active role in shaping their environment through their increasing skills in autonomic regulation, motor control, regulation of state and social interaction. Infants born to HIV positive mothers, are exposed to HIV and antiretroviral therapy inutero, and may experience adverse effects from this. Methods A cross-sectional study of 132 mother-infant dyads from a large public health hospital in South Africa. Infants were assessed using the Neonatal Behavioural Assessment Scale on day two of life, and mothers mental health assessed using the Edinburugh Postnatal Depression Scale. Medical and demographic data on mothers and infants was collected, including maternal age, HIV status, length of time on antiretrovirals, relationship status, employment status, gravid status, mode of delivery, infant anthropometrics and infant gender. Data was input into IBM SPSS statistics 21, where frequencies and percentages for descriptive analysis, and Chi-square and student’s two sample t-tests were run to compare data from HIV infected-exposed and HIV uninfected-unexposed mothers and infants. Results HIV exposed infants were smaller than HIV unexposed infants, even though low birth weight was an exclusion criteria. Statistically significant differences were found between HIV exposed and unexposed infants in neurobehavioiral items of social interaction (p = 0.00), motor system (p = 0.00) and state organization (p = 0.01), with HIV exposed infants performing less optimally in these domains. HIV exposed infants also presented with more abnormal reflexes. Infants born to depressed mothers showed superior motor skills, state organization and state regulation than infants born to mothers who did not score in the possibly depressed range. Conclusions HIV exposed infants have inferior neurobehavioural functioning, which may affect their quality of life and ability to develop a reciprocal relationship with a primary caregiver. This may have an effect on development, behaviour and mental health in later childhood. HIV exposed infants shoud be monitored closely and their functioning in autonomic stability, motor control, resualtion of state and social interaction assessed regularly. Guidance for caregivers in incorporating strategies into the care of these infants is essential to buffer the possible long term negative effects on development.
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Affiliation(s)
- Gina Rencken
- Department of Occupational Therapy, University of Kwazulu Natal (South Africa), Durban, South Africa. .,Department of Occupational Therapy, University of KwaZulu-Natal, Durban, South Africa.
| | - Pragashnie Govender
- Department of Occupational Therapy, University of Kwazulu Natal (South Africa), Durban, South Africa.,Department of Occupational Therapy, University of KwaZulu-Natal, Durban, South Africa
| | - Catharina J E Uys
- Department of Occupational Therapy, University of Pretoria (South Africa), HW Snyman South Building 5-19, Prinshof Campus, ), Durban, South Africa
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Maternal mental health and caregiver competence of HIV-positive and negative women caring for their singleton newborns in KwaZulu-Natal Province, South Africa. S Afr Med J 2022. [DOI: 10.7196/samj.2022.v112i7.15833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. Maternal mental health during the perinatal period has been of interest to many researchers, with antenatal depression and postnatal depression (PND) being a leading cause of morbidity. The adverse effects of maternal depression on the offspring throughout infancy, childhood and adolescence are well documented. Studies on the mental health of persons living with HIV have also reported a high prevalence of depression.
Objectives. To describe the prevalence of PND in a sample of HIV-positive and HIV-negative mothers delivering healthy singleton infants at one obstetric unit in KwaZulu-Natal (KZN) Province, South Africa, and the subsequent factors influencing neonatal behaviour and perceptions of caregiver competence. Correlations between the presence of PND and perceptions of caregiver competence (with the mother as caregiver), and between infant behaviour, the mother’s confidence in her competence as caregiver, and demographic and medical variables, were also examined.
Methods. Demographic and clinical data were collected from 132 mothers at initial contact and from 32 mothers at the 6-week follow-up appointment. Mothers independently completed the Edinburgh Postnatal Depression Scale at each time point, and the Mother and Baby Scales (MABS) at the 6-week follow-up appointment.Results. The prevalence of depression among all mothers at initial contact was 72.0%, remaining high (68.8%) among the mothers who returned for follow-up. There was a statistically significant correlation between depression and employment at follow-up (p=0.013), and between depression and delivery method (p=0.030). The majority of mothers reported being ‘able to laugh and see the funny side of things’ and ‘looking forward with enjoyment to things’ at initial contact and follow-up. Thoughts of self-harm were reported by 44.7% of mothers at baseline, and by 53.1% at follow-up. Although most infants scored in the average clinical band for neonatal behavioural factors in the MABS, mothers reported lack of confidence, globally and in caring for their infant.
Conclusion. This study of maternal mental health of a sample of HIV-positive and HIV-negative mothers of infants in KZN revealed a higher prevalence of PND than reported in other studies. This population of mothers and infants is at risk of adverse outcomes of maternal depression, in addition to other possible risk factors.
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Elrassas H, Taha GR, Soliman AEDM, Madbole SAEK, Mahmoud DAM. Prevalence and related factors of perinatal depression in Egyptian mothers. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00203-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Early detection of perinatal depression and its cultural determinants could reduce its sequalae on mothers and their babies. This study investigated the prevalence of perinatal depression in Egyptian mothers and compare women with and without perinatal depression regarding the psychosocial factors.
Three-hundred one women were recruited (166 were pregnant and 135 were in postpartum period) from a primary healthcare unit. Full sociodemographic data, Social Classification Scale, Dyadic Adjustment Scale (DAS), and the Edinburgh Postnatal Depression Scale (EPDS) were completed. Subjects with EPDS score > 9 answered the structured clinical interview (SCID-I) for diagnosis of depression and Hamilton Rating Scale for Depression (HRSD) for depression severity.
Results
Depression with mild to moderate severity was reported in 5.4% and 3.7% of women during pregnancy and postpartum period, respectively. There was a statistically significant association between depression and employment (p = 0.031), mother-in-law disputes (p = 0.002), stigma of being the second wife (p = 0.047), and having financial burdens (p = 0.001). Marital satisfaction was a protective factor for depression (p < 0.001).
Conclusions
Prevalence of perinatal depression was comparable to other developing countries. It was strongly linked to culturally related factors including marital women’s employment, mother-in-law disputes, being the second wife, and socioeconomic burdens. Early detection of perinatal depression and its culturally related factors is important for its management.
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Yuen M, Hall OJ, Masters GA, Nephew BC, Carr C, Leung K, Griffen A, McIntyre L, Byatt N, Moore Simas TA. The Effects of Breastfeeding on Maternal Mental Health: A Systematic Review. J Womens Health (Larchmt) 2022; 31:787-807. [PMID: 35442804 DOI: 10.1089/jwh.2021.0504] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Breastfeeding has many positive effects on the health of infants and mothers, however, the effect of breastfeeding on maternal mental health is largely unknown. The goal of this systematic review was to (1) synthesize the existing literature on the effects of breastfeeding on maternal mental health, and (2) inform breastfeeding recommendations. Materials and Methods: A literature search was conducted in electronic databases using search terms related to breastfeeding (e.g., breastfeeding, infant feeding practices) and mental health conditions (e.g., mental illness, anxiety, depression), resulting in 1,110 records. After reviewing article titles and abstracts, 339 articles were advanced to full-text review. Fifty-five articles were included in the final analysis. Results: Thirty-six studies reported significant relationships between breastfeeding and maternal mental health outcomes, namely symptoms of postpartum depression and anxiety: 29 found that breastfeeding is associated with fewer mental health symptoms, one found it was associated with more, and six reported a mixed association between breastfeeding and mental health. Five studies found that breastfeeding challenges were associated with a higher risk of negative mental health symptoms. Conclusions: Overall, breastfeeding was associated with improved maternal mental health outcomes. However, with challenges or a discordance between breastfeeding expectations and actual experience, breastfeeding was associated with negative mental health outcomes. Breastfeeding recommendations should be individualized to take this into account. Further research, specifically examining the breastfeeding experiences of women who experienced mental health conditions, is warranted to help clinicians better personalize breastfeeding and mental health counseling.
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Affiliation(s)
- Megan Yuen
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Olivia J Hall
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Grace A Masters
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | - Catherine Carr
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Katherine Leung
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Adrienne Griffen
- Maternal Mental Health Leadership Alliance, Arlington, Virginia, USA
| | | | - Nancy Byatt
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,UMass Memorial Health, Worcester, Massachusetts, USA
| | - Tiffany A Moore Simas
- T.H. Chan School of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,UMass Memorial Health, Worcester, Massachusetts, USA
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Kariuki EW, Kuria MW, Were FN, Ndetei DM. Predictors of postnatal depression in the slums Nairobi, Kenya: a cross-sectional study. BMC Psychiatry 2022; 22:242. [PMID: 35382788 PMCID: PMC8981836 DOI: 10.1186/s12888-022-03885-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postnatal depression (PND) is a universal mental health problem that prevents mothers' optimal existence and mothering. Although research has shown high PND prevalence rates in Africa, including Kenya, little research has been conducted to determine the contributing factors, especially in low-resource communities. OBJECTIVE This study aimed to investigate the PND risk factors among mothers attending Lang'ata and Riruta Maternal and Child Health Clinics (MCH) in the slums, Nairobi. METHODS This study was cross-sectional. It is part of a large study that investigated the effectiveness of a brief psychoeducational intervention on PND. Postnatal mothers (567) of 6-10 weeks postanatal formed the study population. Depression rate was measured using the original 1961 Beck's Depression Inventory (BDI). In addition, a sociodemographic questionnaire (SDQ) was used to collect hypothesized risk variables. Multivariable logistic regression analysis was used to explore predictors of PND. RESULTS The overall prevalence of PND in the sample of women was 27.1%. Women aged 18-24 (β = 2.04 95% C.I.[0.02; 4.05], p = 0.047), dissatisfied with body image (β = 4.33 95% C.I.[2.26; 6.41], p < 0.001), had an unplanned pregnancy (β = 2.31 95% C.I.[0.81; 3.80], p = 0.003 and felt fatigued (β = - 1.85 95% C.I.[- 3.50; 0.20], p = 0.028) had higher odds of developing PND. Participants who had no stressful life events had significantly lower depression scores as compared to those who had stressful life events (β = - 1.71 95% C.I.[- 3.30; - 0.11], p = 0.036) when depression was treated as a continuous outcome. Sensitivity analysis showed that mothers who had secondary and tertiary level of education had 51 and 73% had lower likelihood of having depression as compared to those with a primary level of education (A.O.R = 0.49 95% C.I.[0.31-0.78], p = 0.002) and (A.O.R = 0.27 95% C.I.[0.09-0.75], p = 0.013) respectively. CONCLUSION This study reveals key predictors/risk factors for PND in low-income settings building upon the scanty data. Identifying risk factors for PND may help in devising focused preventive and treatment strategies.
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Affiliation(s)
- Esther W. Kariuki
- grid.10604.330000 0001 2019 0495Department of Psychiatry, School of Medicine, The University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
| | - Mary W. Kuria
- grid.10604.330000 0001 2019 0495Department of Psychiatry, School of Medicine, The University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
| | - Fredrick N. Were
- grid.10604.330000 0001 2019 0495Department of Psychiatry, School of Medicine, The University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
| | - David M. Ndetei
- grid.10604.330000 0001 2019 0495Department of Psychiatry, School of Medicine, The University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
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Multidomain Social Determinants of Depressive Symptoms for the Elderly with Chronic Diseases: Evidence from the China Health and Retirement Longitudinal Study. Healthcare (Basel) 2021; 9:healthcare9121765. [PMID: 34946491 PMCID: PMC8701898 DOI: 10.3390/healthcare9121765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
Elderly individuals with chronic diseases (CDs) have a much higher risk of mental disorders, especially depression. This study aimed to identify the multidomain social determinants of occurrence and degree of depressive symptoms for the Chinese elderly with CDs. Data of 3438 elderly individuals (aged over 60 years) with CDs were drawn from the fourth wave of the China Health and Retirement Longitudinal Study implemented in 2018. Logistic regression was used to describe associations with the occurrence of depressive symptoms within and across multidomain social determinants (demographic, economic, neighborhood, environmental, and social and cultural). The Shapley value decomposition method was used to measure the relative importance of variables of the five domains. A quantile regression model was used to test how the effects of social factors vary across different points of depression score distributions. Approximately 40.1% of Chinese elderly individuals with CDs reported depressive symptoms. Respondents who were female, had a low income, experienced a disability, lived in rural areas, and were not engaged in work had a higher probability of suffering from depressive symptoms. Conversely, increased age, being covered by social security and being well-educated had a protective effect. Data also showed that the effects of these associated factors varied across different points of depression score distributions. The fact that socially disadvantaged people are more vulnerable to severe depressive symptoms implies that psychological health services and intervention strategies should target this population.
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Jannati N, Farokhzadian J, Ahmadian L. The Experience of Healthcare Professionals Providing Mental Health Services to Mothers with Postpartum Depression: A qualitative study. Sultan Qaboos Univ Med J 2021; 21:554-562. [PMID: 34888074 PMCID: PMC8631231 DOI: 10.18295/squmj.4.2021.031] [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: 04/28/2020] [Revised: 07/02/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022] Open
Abstract
Objectives This study aimed to describe the experience of healthcare professionals in
providing mental health services to women with postpartum depression
(PPD). Methods In this qualitative study, data were collected through semi-structured
interviews with five physicians, five midwives and five psychologists from
14 urban healthcare centres in Kerman, Iran, from April 2019 to September
2019. Purposeful sampling was used to select the participants. Data were
qualitatively analysed using a content analysis approach. Results Data analysis revealed the main theme of the study: ‘the long way
ahead for comprehensive, integrated and responsive mental health
services’. This theme included four categories: ‘postpartum
depression challenges’, ‘social and personal
factors’, ‘structural challenges’ and ‘need
for change in mental health services’. The participants described
that depression diagnosis is difficult due to insufficient knowledge among
healthcare providers and the hidden signs of PPD. They also described how
different factors such as economic and cultural factors, personality traits,
a community’s lack of knowledge, negative attitude towards
depression and limited family support might cause depression. Moreover,
providing mental health services involves certain challenges, such as
limited human resources, insufficient financial resources and incomplete or
inefficient policy-making. Conclusion Although measures have been taken to provide mental health services, there
are many challenges regarding providing mental health services to mothers.
Therefore, serious measures should be taken to improve mental health
services and re-define the existing measures. Informing the community,
empowering the healthcare providers and attempting to change the
community’s attitudes and beliefs can affect the mental healthcare
of women with depression.
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Affiliation(s)
| | - Jamileh Farokhzadian
- Nursing Research Center, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Ahmadian
- Neuroscience Research Center, Institute of Neuropharmacology
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Loughman A, Hedley J, Olsson CA, Berk M, Moylan S, Saffery R, Sly PD, Tang ML, Ponsonby AL, Vuillermin P. Increased maternal mental health burden in a representative longitudinal community cohort coinciding with COVID-19 lockdown. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1080/00049530.2021.1956286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Amy Loughman
- IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - James Hedley
- Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Parkville, Australia
| | - Craig A. Olsson
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Burwood, Australia
| | - Michael Berk
- IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
- Orygen, the National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Parkville, Australia
- Florey Institute for Neuroscience and Mental Health, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Barwon Health, Geelong, Australia
| | - Steven Moylan
- IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
| | - Richard Saffery
- Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Parkville, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Peter D. Sly
- Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Parkville, Australia
- Child Health Research Centre, The University of Queensland, Saint Lucia, Australia
| | - Mimi L.K. Tang
- Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Parkville, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Parkville, Australia
- Florey Institute for Neuroscience and Mental Health, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Peter Vuillermin
- IMPACT – the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
- Barwon Health, Geelong, Australia
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Baldassarre ME, Antonucci LA, Castoro G, Di Mauro A, Fanelli M, Grosso FM, Cassibba R, Laforgia N. Maternal Psychological Factors and Onset of Functional Gastrointestinal Disorders in Offspring: A Prospective Study. J Pediatr Gastroenterol Nutr 2021; 73:30-36. [PMID: 33633078 DOI: 10.1097/mpg.0000000000003107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES Functional gastrointestinal disorders (FGIDs) are a heterogeneous group of conditions of unclear etiology. The biopsychosocial model approach to FGIDs posits that early-life stressors may trigger a cascade of complex interactions between genetic predisposition and risk factors eventually leading to the occurrence of FGIDs. The relationship between the psychological disposition of the mother and FGIDs occurrence is poorly understood. We conducted a study to investigate if parental psychological factors may contribute to the onset of FGIDs in offspring. METHODS We performed a prospective cohort study of parent-infant pairs who completed a battery of self-reported psychological questionnaires and a validated Rome III questionnaire for the diagnosis of infant and toddler FGIDs. The Edinburgh Postpartum Depression Scale (EPDS) was used to examine postpartum depression (PPD) symptoms; the Maternity Blues Questionnaire (MBQ) was applied to measure maternity blues severity; the Symptoms Checklist-Revised (SCL90-R) was used to assess the presence of relevant psychiatric symptoms; adult attachment style in mothers was assessed in a continuous way through the five dimensions of the Attachment Style Questionnaire (ASQ). RESULTS Out of the 360 eligible mothers, 200 were enrolled, 113 completed the 3-month follow-up and were included in the final analysis. PPD symptoms prevalence was 20.4%, 20%, 13.2%, and 13.1% respectively at 3 days, 1 week, 1 month, and 3 months after delivery. 40.4% of mothers suffered from severe blues according to the MBQ. Relevant psychiatric symptoms (SCL90-R) were present in 7.8% and 10.9% of mothers, respectively at 1 week and 3 months after delivery. 48.7% of mothers showed a secure attachment pattern measured through the RQ. At 1-month follow-up, infant regurgitation was diagnosed in 26 (23%) of infants, infantile colic in 31 (27.4%), dyschezia in 17 (15%), and functional constipation in 9 (8%). At 3-month follow-up, FGIDs prevalence was respectively 16 (19.3%), 11 (13.3%), 4 (4.8%), and 11 (13.3%). A significant positive association between PPD symptoms starting 3 days after delivery and the presence of infantile colic on setting 1 month after birth was found (P = 0.028), as well as between PPD symptoms occurrence 7 days after delivery and infantile regurgitation beginning 1 month after birth (P = 0.042). A higher prevalence of infantile colic was found in the offspring of mothers suffering from PPD symptoms from 3 days after delivery (54.5 vs 19.8; P = 0.001). No significant association was found between FGIDs and psychiatric symptoms and maternity blues at any timepoint. On the other hand, mothers of infants with regurgitation with an onset 1 month after birth have higher insecurity score in avoidant and fearful ASQ-related attachment dimensions (respectively, P = 0.03, P = 0.042, P = 0.03). CONCLUSIONS Maternal psychological factors might contribute to the onset of infant FGIDs in offspring. Early screening of postpartum depression symptoms and early implementation of psychological interventions within the postpartum period might promote the health of the mother-infant dyad.
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Affiliation(s)
| | | | | | | | - Margherita Fanelli
- Interdisciplinary Department of Medicine, University "Aldo Moro" of Bari, Aldo Moro University of Bari, Bari
| | - Francesca Maria Grosso
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Hamwi S, Lorthe E, Barros H. Language Proficiency and Migrant-Native Disparities in Postpartum Depressive Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094782. [PMID: 33947149 PMCID: PMC8125143 DOI: 10.3390/ijerph18094782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 01/08/2023]
Abstract
Migrant women have a higher risk of developing postpartum depressive symptoms (PPDS) than do native women. This study aimed to investigate the role of host-country language proficiency in this disparity. We analysed the data of 1475 migrant and 1415 native women who gave birth at a Portuguese public hospital between 2017 and 2019 and were participants in the baMBINO cohort study. Migrants’ language proficiency was self-rated and comprised understanding, speaking, reading, and writing skills. PPDS were assessed using the Edinburgh Postnatal Depression Scale with a cut-off score of ≥10. Multivariable logistic regression models were fitted to estimate the association between language proficiency and PPDS. PPDS were experienced by 7.2% of native women and 12.4% among migrants (p < 0.001). Increasing proportions of PPDS were observed among decreasing Portuguese proficiency levels; 11% among full, 13% among intermediate, and 18% among limited proficiency women (ptrend < 0.001). Full (aOR 1.63 (95% CI 1.21–2.19)), intermediate (aOR 1.68 (95% CI 1.16–2.42)), and limited (aOR 2.55 (95% CI 1.64–3.99)) language proficiencies were associated with increasingly higher odds of PPDS among migrant women, compared to native proficiency. Prevention measures should target migrant women at high risk of PPDS, namely those with limited language skills, and promote awareness, early detection, and help-seeking, in addition to facilitating communication in their perinatal healthcare encounters.
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Affiliation(s)
- Sousan Hamwi
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal;
- Correspondence: ; Tel.: +351-22-206-1820
| | - Elsa Lorthe
- Unit of Population Epidemiology, Department of Primary Care, Geneva University Hospitals, 1205 Geneva, Switzerland;
- Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Université de Paris, F-75004 Paris, France
| | - Henrique Barros
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, 4050-091 Porto, Portugal;
- Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, 4200-450 Porto, Portugal
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13
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Psychosocial stratification of antenatal indicators to guide population-based programs in perinatal depression. BMC Pregnancy Childbirth 2021; 21:277. [PMID: 33823838 PMCID: PMC8025384 DOI: 10.1186/s12884-021-03722-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is increasing awareness that perinatal psychosocial adversity experienced by mothers, children, and their families, may influence health and well-being across the life course. To maximise the impact of population-based interventions for optimising perinatal wellbeing, health services can utilise empirical methods to identify subgroups at highest risk of poor outcomes relative to the overall population. METHODS This study sought to identify sub-groups using latent class analysis within a population of mothers in Sydney, Australia, based on their differing experience of self-reported indicators of psychosocial adversity. This study sought to identify sub-groups using latent class analysis within a population of mothers in Sydney, Australia, based on their differing experience of self-reported indicators of psychosocial adversity. Subgroup differences in antenatal and postnatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. RESULTS Latent class analysis identified four distinct subgroups within the cohort, who were distinguished empirically on the basis of their native language, current smoking status, previous involvement with Family-and-Community Services (FaCS), history of child abuse, presence of a supportive partner, and a history of intimate partner psychological violence. One group consisted of socially supported 'local' women who speak English as their primary language (Group L), another of socially supported 'migrant' women who speak a language other than English as their primary language (Group M), another of socially stressed 'local' women who speak English as their primary language (Group Ls), and socially stressed 'migrant' women who speak a language other than English as their primary language (Group Ms.). Compared to local and not socially stressed residents (L group), the odds of antenatal depression were nearly three times higher for the socially stressed groups (Ls OR: 2.87 95%CI 2.10-3.94) and nearly nine times more in the Ms. group (Ms OR: 8.78, 95%CI 5.13-15.03). Antenatal symptoms of depression were also higher in the not socially stressed migrant group (M OR: 1.70 95%CI 1.47-1.97) compared to non-migrants. In the postnatal period, Group M was 1.5 times more likely, while the Ms. group was over five times more likely to experience suboptimal mental health compared to Group L (OR 1.50, 95%CI 1.22-1.84; and OR 5.28, 95%CI 2.63-10.63, for M and Ms. respectively). CONCLUSIONS The application of empirical subgrouping analysis permits an informed approach to targeted interventions and resource allocation for optimising perinatal maternal wellbeing.
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14
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Miyake Y, Tanaka K, Arakawa M. Associations of job type, income, and education with postpartum depressive symptoms: The Kyushu Okinawa Maternal and Child Health Study. Psychiatry Res 2020; 291:113224. [PMID: 32562937 DOI: 10.1016/j.psychres.2020.113224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/28/2022]
Abstract
Epidemiological evidence on the role of socioeconomic status on postpartum depressive symptoms has been inconsistent. The present prospective study investigated the relationship between employment, job type, income, and education and postpartum depressive symptoms. Subjects were 1316 Japanese women. The subjects were asked to complete an Edinburgh Postnatal Depression Scale (EPDS) between three and four months postpartum. Postpartum depressive symptoms were defined as EPDS score ≥ 9. The prevalence of postpartum depressive symptoms was 8.2%. Compared with unemployment, holding a sales job was independently related to a reduced risk of postpartum depressive symptoms: the adjusted odds ratio (OR) was 0.13 (95% CI: 0.01-0.66). Compared with a household income under four million yen per year, a household income of six million yen or more per year was independently inversely associated with postpartum depressive symptoms: the adjusted OR was 0.33 (95% CI: 0.16-0.63). Compared with less than 13 years of education, both 13 or 14 years and 15 years or more were independently inversely related to postpartum depressive symptoms: the adjusted ORs were 0.40 (95% CI: 0.23-0.69) and 0.48 (95% CI: 0.28-0.82), respectively. Holding a sales job, higher household income and higher educational levels may be inversely associated with postpartum depressive symptoms.
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Affiliation(s)
- Yoshihiro Miyake
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Ehime, Japan; Research Promotion Unit, Translational Research Center, Ehime University Hospital, Ehime, Japan; Center for Data Science, Ehime University, Ehime, Japan.
| | - Keiko Tanaka
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Ehime, Japan; Research Promotion Unit, Translational Research Center, Ehime University Hospital, Ehime, Japan; Center for Data Science, Ehime University, Ehime, Japan
| | - Masashi Arakawa
- Wellness Research Fields, Faculty of Global and Regional Studies, University of the Ryukyus, Okinawa, Japan; The Department of Cross Cultural Studies, Osaka University of Tourism, Okinawa, Japan
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15
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Seidler Y, Seiler-Ramadas R, Kundi M. 'No Austrian Mother Does This to Sleep Without a Baby!' Postnatal Acculturative Stress and 'Doing the Month' Among East Asian Women in Austria: Revisiting Acculturation Theories From a Qualitative Perspective. Front Psychol 2020; 11:977. [PMID: 32477230 PMCID: PMC7240129 DOI: 10.3389/fpsyg.2020.00977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/20/2020] [Indexed: 11/15/2022] Open
Abstract
Acculturative stress is a phenomenon describing negative emotions experienced by immigrants in their socio-cultural and psychological adaptation process to the host society’s dominant culture and its population. Acculturative stress is assumed to be one the reasons for higher prevalence of postnatal depression among immigrant women compared to non-immigrant women. Theories and models of acculturation and coping strategies suggest that certain cultural orientations or behaviors could mitigate acculturative stress and postnatal depression. Nevertheless, quantitative studies applying these theories have so far revealed inconsistent results. Given this background, we ask: what can a qualitative study of immigrant women’s postnatal experiences tell us about the interrelationships between immigrant mothers’ acculturation behaviors or cultural orientations, and maternal psychological health? Particularly, we explore the postnatal experiences of Chinese and Japanese women who gave birth in Austria, focusing on their experiences and behaviors influenced by their heritage culture’s postnatal practices (zuò yuè zi and satogaeri). Theoretically, we apply Berry’s acculturation model through a focus on what we call ‘Postnatal Acculturative Stress’ (PAS). By doing so, we identify factors that prevent or mitigate PAS. Another aim of this article is to critically reassess Berry’s model in the context of postnatal care and maternal psychological health. Data were analyzed using a combination of deductive and inductive method through the application of directed content analysis and phenomenological approach. Women’s postnatal experiences were summarized as an ‘unexpected solitary struggle in the midst of dual identity change’ in four specific domains: postnatal rest and diet, social support, feelings toward significant others and identity. Preventive and mitigating factors against PAS included trust (in self and one’s health beliefs) and mutual respectful relationships with and between the significant others. The application of Berry’s acculturation model provided a useful framework of analysis. Nevertheless, the multifarious complexity involved in the process of acculturation as well as different power dynamics in the family and healthcare settings makes it difficult to draw causal relationships between certain acculturation behaviors or cultural orientations with specific health outcomes. Health professionals should be aware of the complex psychosocial processes, contexts as well as social environment that shape immigrants’ acculturative behaviors.
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Affiliation(s)
- Yuki Seidler
- Center for Public Health, Medical University of Vienna, Vienna, Austria.,Department of Development Studies, University of Vienna, Vienna, Austria.,Center for Health and Migration, Vienna, Austria
| | | | - Michael Kundi
- Center for Public Health, Medical University of Vienna, Vienna, Austria
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16
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Shorey S, Ying L, Yobas P. Parenting Outcomes and Predictors of Parenting Satisfaction in the Early Postpartum Period. West J Nurs Res 2020; 43:13-24. [PMID: 32389069 DOI: 10.1177/0193945920914593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined the relationships among parenting self-efficacy (PSE), social support, postnatal depression (PND), and predictors of parenting satisfaction in the early postpartum period using a cross-sectional exploratory quantitative design. The hypothetical model was tested among interrelated concepts of outcome variables among 250 parents (125 couples). The structural equation model revealed an adequate fit between the hypothesized model and the data. PSE and spousal support were found to be predictors of parenting satisfaction. PSE was also found to be a predictor of social support. PND was not found to be a predictor of parenting satisfaction. None of the obstetric and demographic factors predicted parenting satisfaction. This is the first study that tested interrelations among crucial parenting outcome variables among fathers and mothers in the early postpartum period. It is important to assess interrelated parenting outcomes among both parents so that support can be provided to ultimately influence parenting satisfaction.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National University Health System, Singapore
| | - Lau Ying
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National University Health System, Singapore
| | - Piyanee Yobas
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,National University Health System, Singapore
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17
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Khanlari S, Eastwood J, Barnett B, Naz S, Ogbo FA. Psychosocial and obstetric determinants of women signalling distress during Edinburgh Postnatal Depression Scale (EPDS) screening in Sydney, Australia. BMC Pregnancy Childbirth 2019; 19:407. [PMID: 31699040 PMCID: PMC6836342 DOI: 10.1186/s12884-019-2565-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/21/2019] [Indexed: 12/20/2022] Open
Abstract
Background and objectives The perinatal period presents a high-risk time for development of mood disorders. Australia-wide universal perinatal care, including depression screening, make this stage amenable to population-level preventative approaches. In a large cohort of women receiving public perinatal care in Sydney, Australia, we examined: (1) the psychosocial and obstetric determinants of women who signal distress on EPDS screening (scoring 10–12) compared with women with probable depression (scoring 13 or more on EPDS screening); and (2) the predictive ability of identifying women experiencing distress during pregnancy in classifying women at higher risk of probable postnatal depression. Methods We analysed routinely collected perinatal data from all live-births within public health facilities from two health districts in Sydney, Australia (N = 53,032). Perinatal distress was measured using the EPDS (scores of 10–12) and probable perinatal depression was measured using the EPDS (scores of 13 or more). Logistic regression models that adjusted for confounding variables were used to investigate a range of psychosocial and obstetric determinants and perinatal distress and depression. Results Eight percent of this cohort experienced antenatal distress and about 5 % experienced postnatal distress. Approximately 6 % experienced probable antenatal depression and 3 % experienced probable postnatal depression. Being from a culturally and linguistically diverse background (AOR = 2.0, 95% CI 1.8–2.3, P < 0.001), a lack of partner support (AOR = 2.9, 95% CI 2.3–3.7) and a maternal history of childhood abuse (AOR = 1.9, 95% CI 1.6–2.3) were associated with antenatal distress. These associations were similar in women with probable antenatal depression. Women who scored 10 to12 on antenatal EPDS assessment had a 4.5 times higher odds (95% CI 3.4–5.9, P < 0.001) of experiencing probable postnatal depression compared with women scoring 9 or less. Conclusion Antenatal distress is more common than antenatal depressive symptoms and postnatal distress or depression. Antenatal maternal distress was associated with probable postnatal depression. Scale properties of the EPDS allows risk-stratification of women in the antenatal period, and earlier intervention with preventively focused programs. Prevention of postnatal depression could address a growing burden of illness and long-term complications for mothers and their infants.
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Affiliation(s)
- Sarah Khanlari
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Street, Croydon, NSW, 2132, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan Campus, University Drive, Callaghan, NSW, 2308, Australia.,Sydney Institute for Women Children and their Families, Sydney Local Health District, 18 Marsden Street, Level 1, Camperdown, NSW, 2050, Australia
| | - John Eastwood
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Street, Croydon, NSW, 2132, Australia.,Sydney Institute for Women Children and their Families, Sydney Local Health District, 18 Marsden Street, Level 1, Camperdown, NSW, 2050, Australia.,Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, 2170, Australia.,School of Women's and Children's Health, Faculty of Medicine, The University of New South Wales, Kensington, NSW, 2052, Australia.,Menzies Centre for Health Policy, Charles Perkins Centre, School of Public Health, Sydney University, Sydney, NSW, 2006, Australia
| | - Bryanne Barnett
- Sydney Institute for Women Children and their Families, Sydney Local Health District, 18 Marsden Street, Level 1, Camperdown, NSW, 2050, Australia.,School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Sabrina Naz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2571, Australia.
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18
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Black KA, MacDonald I, Chambers T, Ospina MB. Postpartum Mental Health Disorders in Indigenous Women: A Systematic Review and Meta-Analysis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41:1470-1478. [DOI: 10.1016/j.jogc.2019.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/07/2019] [Accepted: 02/07/2019] [Indexed: 11/26/2022]
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19
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Pollak MJ, Milte CM, van der Pligt P, Teychenne M. Total physical activity but not diet quality associated with postnatal depressive symptoms amongst women living in socioeconomically disadvantaged neighborhoods. Nutr Res 2019; 68:54-61. [PMID: 31421393 DOI: 10.1016/j.nutres.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/02/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
Lifestyle behaviors such as healthy diet and some forms of physical activity have been linked to lower risk of depressive symptoms in the general population. However, little is known regarding their associations with postnatal depressive symptoms. Given that postnatal women (particularly those living in socioeconomically disadvantaged neighborhoods) are more likely to have poorer diet quality, lower physical activity levels and greater risk of depressive symptoms, this study sought to determine the associations between diet quality, total and domain specific physical activity and depressive symptoms amongst postnatal women from socioeconomically disadvantaged neighborhoods. It was hypothesized that higher diet quality and levels of leisure-time physical activity would be associated with lower depressive symptoms. In 2007-2008, cross-sectional data were collected from 246 women living in socioeconomically disadvantaged neighborhoods in Victoria, Australia. Participants completed self-report measures of diet (using a 17 item dietary questionnaire), domain specific physical activity (International Physical Activity Questionnaire), and depressive symptoms (Centre for Epidemiologic Studies Depression Scale). Linear regression analyses were used to determine the associations between diet quality, physical activity and postnatal depressive symptoms. There was a significant inverse association between total physical activity (B, -0.009; 95% CI, -0.016 to -0.001; P = .023) and postnatal depressive symptoms. No association was found between other domain-specific physical activity (i.e. leisure-time, domestic or transport-related physical activity), or diet quality and postnatal depressive symptoms. Acknowledging the cross-sectional nature of this study, these findings suggest that total physical activity may play a more important role than diet quality in the relationship with postnatal depressive symptoms.
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Affiliation(s)
- Miriam J Pollak
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia.
| | - Catherine M Milte
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences.
| | - Paige van der Pligt
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences.
| | - Megan Teychenne
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences.
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20
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Ogbo FA, Kingsley Ezeh O, Dhami MV, Naz S, Khanlari S, McKenzie A, Agho K, Page A, Ussher J, Perz J, Eastwood J. Perinatal Distress and Depression in Culturally and Linguistically Diverse (CALD) Australian Women: The Role of Psychosocial and Obstetric Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2945. [PMID: 31426304 PMCID: PMC6720521 DOI: 10.3390/ijerph16162945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 01/24/2023]
Abstract
Perinatal distress and depression can have significant impacts on both the mother and baby. The present study investigated psychosocial and obstetric factors associated with perinatal distress and depressive symptoms among culturally and linguistically diverse (CALD) Australian women in Sydney, New South Wales. The study used retrospectively linked maternal and child health data from two Local Health Districts in Australia (N = 25,407). Perinatal distress was measured using the Edinburgh Postnatal Depression Scale (EPDS, scores of 10-12) and depressive symptoms, with EPDS scores of 13 or more. Multivariate multinomial logistic regression models were used to investigate the association between psychosocial and obstetric factors with perinatal distress and depressive symptoms. The prevalence of perinatal distress and depressive symptoms among CALD Australian women was 10.1% for antenatal distress; 7.3% for antenatal depressive symptoms; 6.2% for postnatal distress and 3.7% for postnatal depressive symptoms. Antenatal distress and depressive symptoms were associated with a lack of partner support, intimate partner violence, maternal history of childhood abuse and being known to child protection services. Antenatal distress and depressive symptoms were strongly associated with postnatal distress and depressive symptoms. Higher socioeconomic status had a protective effect on antenatal and postnatal depressive symptoms. Our study suggests that current perinatal mental health screening and referral for clinical assessment is essential, and also supports a re-examination of perinatal mental health policy to ensure access to culturally responsive mental health care that meets patients' needs.
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Affiliation(s)
- Felix Akpojene Ogbo
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia.
- General Practice Unit, Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State 972261, Nigeria.
| | - Osita Kingsley Ezeh
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
| | - Mansi Vijaybhai Dhami
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
| | - Sabrina Naz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
| | - Sarah Khanlari
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Street, Croydon, NSW 2132, Australia
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Anne McKenzie
- Primary & Community Health, Child and Family, South Western Sydney Local Health District, Narellan CHC, NSW 2567, Australia
| | - Kingsley Agho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
| | - Andrew Page
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
| | - Jane Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571, Australia
| | - John Eastwood
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Street, Croydon, NSW 2132, Australia
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW 2170, Australia
- School of Women's and Children's Health, The University of New South Wales, Kensington, Sydney, NSW 2052, Australia
- Menzies Centre for Health Policy, Charles Perkins Centre, School of Public Health, Sydney University, Sydney, NSW 2006, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Camperdown, NSW 2050, Australia
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21
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Whalen OM, Campbell LE, Murphy VE, Lane AE, Gibson PG, Mattes J, Collison A, Mallise CA, Woolard A, Karayanidis F. Observational study of mental health in asthmatic women during the prenatal and postnatal periods. J Asthma 2019; 57:829-841. [PMID: 31148493 DOI: 10.1080/02770903.2019.1621888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective: We aimed to examine the prevalence and severity of psychological distress of women with asthma in both the prenatal and postnatal periods, and to determine whether asthmatic women with and without mental health problems differ in self-management, medications knowledge, and asthma symptoms.Methods: We assessed spirometry performance and asthma symptoms in 120 women (mean age 29.8 years) before 23 weeks gestation, as part of the Breathing for Life Trial (Trial ID: ACTRN12613000202763). Prenatal depression data was obtained from medical records. At 6 weeks postpartum, we assessed general health, self-reported asthma control, depression symptoms (with the Edinburgh Postnatal Depression Scale) and adaptive functioning (with the Achenbach System of Empirically Based Assessment scales).Results: Twenty percent of our sample reported having a current mental health diagnosis, 14% reported currently receiving mental health care, while 47% reported having received mental health care in the past (and may/may not have received a diagnosis). The sample scored high on the Aggressive Behavior, Avoidant Personality, and Attention Deficit/Hyperactivity scales. Poorer self-reported postnatal asthma control was strongly correlated with elevated somatic complaints, externalizing problems, antisocial personality problems, and greater withdrawal. Prenatal spirometry or asthma severity and control were largely not associated with measures of psychopathology.Conclusions: These findings indicate that pregnant women with asthma frequently report issues with psychopathology during the prenatal and postnatal periods, and that the subjective perception of asthma control may be more related to psychopathology than objective asthma measures. However, due to sample bias, these findings are likely to be understated.
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Affiliation(s)
- Olivia M Whalen
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Linda E Campbell
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa E Murphy
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Alison E Lane
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Peter G Gibson
- Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia.,Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia
| | - Joerg Mattes
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Adam Collison
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Carly A Mallise
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Alix Woolard
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, NSW, Australia
| | - Frini Karayanidis
- School of Psychology, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia
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22
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Kimmel MC, Bauer A, Meltzer-Brody S. Toward a framework for best practices and research guidelines for perinatal depression research. J Neurosci Res 2019; 98:1255-1267. [PMID: 30924191 PMCID: PMC10127524 DOI: 10.1002/jnr.24425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/09/2018] [Accepted: 10/26/2018] [Indexed: 02/06/2023]
Abstract
This review article highlights the current state of perinatal depression (PND) research including established standards of care and innovative research in progress. PND can have a significant adverse impact on mother, child, and family; however, to date, wide-scale identification, prevention, and treatment have been limited. PND is heterogenous in presentation with likely multifactorial etiologies for each woman. Challenges in PND research are discussed including a need for universal tools, standardized measures, benchmarks, and best practices. Current examples are reviewed that highlight approaches to novel treatment paradigms and interventions. This includes reviewing epidemiologic studies in PND research, examining the biological underpinnings of PND, and discussing examples from this field and other fields currently developing translational research that spans from bench to bedside. Current and future challenges and opportunities in developing best practices for the treatment of PND are outlined. We also discuss the use of the NIMH Research Domain Criteria approach for PND research and provide recommendations for future directions in PND research collaboration. In conclusion, greater precision in perinatal psychiatry can be possible in the future with the development of guidelines and best practices that build on current work and apply innovative and collaborative approaches of scientists, providers, patients, community members, and government officials.
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Affiliation(s)
- Mary C Kimmel
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Anna Bauer
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Samantha Meltzer-Brody
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Predictors of Postpartum Depression: A Comprehensive Review of the Last Decade of Evidence. Clin Obstet Gynecol 2019; 61:591-603. [PMID: 29596076 DOI: 10.1097/grf.0000000000000368] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Postpartum depression (PPD) is one of the most frequent complications of childbirth affecting ~500,000 women annually (prevalence 10% to 15%). Despite the documented adverse outcomes for mother and child, there remains a great need to develop prospective approaches to identify women at risk. This review examines some of the best-characterized molecular and clinical risk factors for PPD. We illustrate that this is a growing literature but there remains a lack of reliable molecular predictors for PPD. Current best predictors are clinical assessments for psychiatric history and adverse life events, highlighting the need for increased depression screening across the perinatal period.
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Navodani T, Gartland D, Brown SJ, Riggs E, Yelland J. Common maternal health problems among Australian-born and migrant women: A prospective cohort study. PLoS One 2019; 14:e0211685. [PMID: 30742634 PMCID: PMC6370277 DOI: 10.1371/journal.pone.0211685] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Migrant women of non-English speaking background make up an increasing proportion of women giving birth in high income countries, such as Australia, Canada and the United Kingdom. The aim of this study was to assess the prevalence of common physical and psychosocial health problems during pregnancy and up to 18 months postpartum among migrant women of non-English speaking background compared to Australian-born women. METHODS Prospective pregnancy cohort study of 1507 nulliparous women. Women completed self-administered questionnaires or telephone interviews in early and late pregnancy and at 3, 6, 9, 12 and 18 months postpartum. Standardised instruments were used to assess incontinence, depressive symptoms and intimate partner violence. FINDINGS Migrant women of non-English speaking background (n = 243) and Australian-born mothers (n = 1115) reported a similar pattern of physical health problems during pregnancy and postpartum. The most common physical health problems were: exhaustion, back pain, constipation and urinary incontinence. Around one in six Australian-born women (16.9%) and more than one in four migrant women (22.5%) experienced intimate partner abuse in the first 12 months postpartum. Compared to Australian-born women, migrant women were more likely to report depressive symptoms at 12 and 18 months postpartum. CONCLUSION Physical and mental health problems are common among women of non-English speaking background and Australian-born women, and frequently persist up to 18 months postpartum. Migrant women experience a higher burden of postpartum depressive symptoms and intimate partner violence, and may face additional challenges accessing appropriate care and support.
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Affiliation(s)
- Tharanga Navodani
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Ministry of Health, Colombo, Sri Lanka
| | - Deirdre Gartland
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Stephanie J. Brown
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Elisha Riggs
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Jane Yelland
- Intergenerational Health Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
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Postpartum depression and social support in a racially and ethnically diverse population of women. Arch Womens Ment Health 2019; 22:105-114. [PMID: 29968129 PMCID: PMC6800248 DOI: 10.1007/s00737-018-0882-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 06/22/2018] [Indexed: 01/07/2023]
Abstract
Lack of social support is an important risk factor for postpartum depression (PPD), whereas the presence of social support can buffer against PPD. However, the relationship between social support and PPD in racial/ethnic minority women is still largely unknown. Our purpose was to examine the role of social support in a large, diverse population of PPD cases and controls. Participants (N = 1517) were recruited at the routine 6-week postpartum visit (± 1-2 weeks) from four different outpatient clinics in North Carolina. Case status was determined using the MINI International Neuropsychiatric Interview. Social support was measured using the Medical Outcomes Social (MOS) Support survey and the Baby's Father Support Scale (DAD). We found that higher levels of social support had a strong protective association against PPD (MOS total score OR, 0.23; 95% CI, 0.19-0.27; p = 6.92E-90; DAD total score OR, 0.89; 95% CI, 0.88-0.92; p = 1.69E-29), and the effects of social support did not differ when accounting for race/ethnicity. Additionally, PPD symptom severity is significantly and negatively correlated with the degree of social support. Our findings suggest that multi-dimensional aspects of social support may be protective for racial/ethnic minority women. We believe this study is currently the largest and most robust characterizing PPD case status and its association with social support in a diverse cohort of mothers. Future work is required to understand how best to implement culturally sensitive interventions to increase social support in minority perinatal women.
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James-Hawkins L, Shaltout E, Nur AA, Nasrallah C, Qutteina Y, Abdul Rahim HF, Hennink M, Yount KM. Human and economic resources for empowerment and pregnancy-related mental health in the Arab Middle East: a systematic review. Arch Womens Ment Health 2019; 22:1-14. [PMID: 29721624 PMCID: PMC6373230 DOI: 10.1007/s00737-018-0843-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/02/2018] [Indexed: 01/15/2023]
Abstract
This systematic review synthesizes research on the influence of human and economic resources for women's empowerment on their pre- and postnatal mental health, understudied in the Arab world. We include articles using quantitative methods from PubMed and Web of Science. Two researchers reviewed databases and selected articles, double reviewing 5% of articles designated for inclusion. Twenty-four articles met inclusion criteria. All 24 articles measured depression as an outcome, and three included additional mental health outcomes. Nine of 17 studies found an inverse association between education and depression; two of 12 studies found contradictory associations between employment and depression, and four of six studies found a positive association between financial stress and depression. These results suggest that there is a negative association between education and depression and a positive association between financial stress and depression among women in the Arab world. Firm conclusions warrant caution due to limited studies meeting inclusion criteria and large heterogeneity in mental health scales used, assessment measures, and definitions of human and economic resources for women's empowerment. It is likely that education reduces depression among postpartum women and that financial stress increases their depression. These findings can be used to aid in the design of interventions to improve mother and child outcomes. However, more research in the Arab world is needed on the relationship between human and economic resources for women's empowerment and perinatal mental health, and more consistency is needed in how resources and mental health are measured.
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Affiliation(s)
| | | | - Aasli Abdi Nur
- Emory University, 1518 Clifton Rd., Atlanta, GA 30329 USA
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Hollins Martin CJ, Anderson L, Martin CR. A scoping review to determine themes that represent perceptions of self as mother ('ideal mother' vs 'real mother'). J Reprod Infant Psychol 2018; 37:224-241. [PMID: 30554526 DOI: 10.1080/02646838.2018.1556786] [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: 10/27/2022]
Abstract
Background: Postnatal depression (PND) is a key cause of maternal morbidity, with current systems of initial recognition in the UK detecting only 50% of cases. In attempts to predict those potentially at risk, this review suggests a novel approach. Aim: Implementing the concept of 'ideal mother' versus 'real mother', and asking the woman to compare their 'ideal self' against 'existent self', the aim of this instrument development review was to determine themes from the literature that relate to women's perceptions of self as a mother, and from this identification develop questions for inclusion within a proposed new measure entitled the Self-Image as Mother Scale (SIMS). Method: A scoping review of the literature was carried out to identify themes considered to affect perception of self as mother, and from this identification, evidence-based questions for inclusion in the SIMS were developed. Findings: Themes identified included (1) marital dissatisfaction, (2) inadequate partner support, (3) lack of family support, (4) socioeconomic status and associated poverty, (5) concern about infant, (6) antenatal/postnatal complications, (7) acceptance of infant gender, (8) history of mental health problems, (9) unplanned pregnancy. Conclusions: From this scoping review 18 questions were developed for inclusion in the SIMS, which will then be evaluated for psychometric properties, scale refinement and validation.
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Affiliation(s)
- Caroline J Hollins Martin
- a Maternal Health, School of Nursing, Midwifery and Social Care , Edinburgh Napier University (ENU), Sighthill Campus , Edinburgh , UK
| | - Lara Anderson
- b School of Nursing, Midwifery and Social Care , Edinburgh Napier University (ENU), Sighthill Campus , Edinburgh , UK
| | - Colin R Martin
- c Perinatal Mental Health , Institute for Clinical and Applied Health Research (ICAHR), University of Hull , Hull , UK
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Xu F, Roberts L, Binns C, Sullivan E, Homer CSE. Anaemia and depression before and after birth: a cohort study based on linked population data. BMC Psychiatry 2018; 18:224. [PMID: 30005598 PMCID: PMC6044006 DOI: 10.1186/s12888-018-1796-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/20/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To investigate the rates of hospitalisation for anaemia and depression in women in the six-year period (3 years before and after birth). To compare hospital admissions for depression in women with and without anaemia. METHODS This is a population-based cohort study. Women's birth records (New South Wales (NSW) Perinatal Data Collection) were linked with NSW Admitted Patients Data Collection records between 1 January 2001 and 31 December 2010, so that hospital admissions for mothers could be traced back for 3 years before birth and followed up 3 years after birth. SETTING NSW Australia. SUBJECTS all women who gave birth to their first child in NSW between 1 January 2004 and 31 December 2008. RESULTS Hospital admissions for both anaemia and depression were increased significantly in the year just before and after birth compared with the years before and after. Women with anaemia were more likely to be admitted to hospital for depression than those without (for principal diagnosis of depression, adjusted OR = 1.62, 95% CI = 1.25-2.11; for all diagnosis of depression, adjusted OR = 2.01, 95% CI = 1.70-2.38). CONCLUSIONS Depression was associated with anaemia in women before and after birth. This finding highlight the important role of primary care providers in assessing for both anaemia and depressive symptomatology together, given the relationship between the two. Treating or preventing anaemia may help to prevent postnatal depression.
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Affiliation(s)
- Fenglian Xu
- Faculty of Health, University of Technology Sydney, Ultimo, 2007, Australia.
| | - Lynette Roberts
- 0000 0004 1936 7611grid.117476.2Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, 2007 Australia
| | - Colin Binns
- 0000 0004 0375 4078grid.1032.0School of Public Health, Curtin University, Perth, Australia
| | - Elizabeth Sullivan
- 0000 0004 1936 7611grid.117476.2Faculty of Health, University of Technology Sydney, Ultimo, 2007 Australia
| | - Caroline S. E. Homer
- 0000 0004 1936 7611grid.117476.2Faculty of Health, University of Technology Sydney, Ultimo, 2007 Australia
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Engberg E, Stach-Lempinen B, Rönö K, Kautiainen H, Eriksson JG, Koivusalo SB. A randomized lifestyle intervention preventing gestational diabetes: effects on self-rated health from pregnancy to postpartum. J Psychosom Obstet Gynaecol 2018. [PMID: 28635526 DOI: 10.1080/0167482x.2017.1286642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION The purpose was to examine the effects of a randomized lifestyle intervention on self-rated health from pregnancy to postpartum in participants at high risk for gestational diabetes mellitus. METHODS We included 266 women with a history of gestational diabetes and/or prepregnancy BMI ≥30 kg/m2. The intervention group (n = 144) received individualized counseling on diet, physical activity, and weight management from trained nurses at six timepoints between the first trimester of pregnancy and 12 months postpartum, and met three times with a dietitian. The control group (n = 122) received standard antenatal care. We assessed self-rated health at the six timepoints by means of a single question with five response options ranging from good (1) to poor (5). Baseline-adjusted mean changes in self-rated health level were assessed with a mixed model for repeated measure methods. RESULTS The mean (SD) for self-rated health at baseline was 1.8 (0.8) in the intervention group and 2.1 (0.9) in the control group (p = 0.006). Self-rated health varied over time (time effect p < 0.001) and was the poorest in the third trimester. The sample indicated that self-rated health improved in the intervention group and deteriorated in the control group from the first trimester to 12 months postpartum, but the difference between the groups did not reach statistical significance (group effect p = 0.064). DISCUSSION The self-rated health level varied over time from the first trimester of pregnancy to 12 months postpartum in women at risk for gestational diabetes. Improving self-rated health among high-risk pregnant women through lifestyle intervention calls for further research.
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Affiliation(s)
- Elina Engberg
- a Department of Sports and Exercise Medicine, Clinicum , University of Helsinki , Helsinki , Finland.,b Foundation for Sports and Exercise Medicine , Clinic for Sports and Exercise Medicine , Helsinki , Finland
| | - Beata Stach-Lempinen
- c Department of Obstetrics and Gynecology , South-Karelia Central Hospital , Lappeenranta , Finland
| | - Kristiina Rönö
- d Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Hannu Kautiainen
- e Department of General Practice and Primary Health Care , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,f Department of General Practice and Primary Health Care , University of Eastern Finland , Joensuu , Finland
| | - Johan G Eriksson
- e Department of General Practice and Primary Health Care , University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,g Department of Chronic Disease Prevention , National Institute for Health and Welfare , Helsinki , Finland.,h Folkhälsan Research Center , Helsinki , Finland
| | - Saila B Koivusalo
- d Department of Obstetrics and Gynecology , University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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30
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Ogbo FA, Eastwood J, Hendry A, Jalaludin B, Agho KE, Barnett B, Page A. Determinants of antenatal depression and postnatal depression in Australia. BMC Psychiatry 2018; 18:49. [PMID: 29463221 PMCID: PMC5819705 DOI: 10.1186/s12888-018-1598-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/08/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Depression is a leading source of morbidity and health loss in Australian women. This study investigates the determinants of antenatal depressive symptoms and postnatal depressive symptoms in an Australian population, including people from culturally and linguistically diverse (CALD) backgrounds. METHOD The study used a retrospective cohort of mothers of all live births in public health facilities in 2014 (N = 17,564) within South Western Sydney Local Health District and Sydney Local Health District in New South Wales, Australia. Prevalence of antenatal and postnatal depressive symptoms were estimated for the cohort. Multivariate logistic regression models were conducted to investigate the sociodemographic, psychological and health service determinants of antenatal and postnatal depressive symptoms, measured using the Edinburgh Postnatal Depression Scale (EPDS). RESULTS The prevalence of antenatal and postnatal depressive symptoms was 6.2% and 3.3% of the cohort, respectively. Significant risk factors for maternal depressive symptoms during pregnancy were, a lack of partner support, history of intimate partner violence, being from the CALD population and low socioeconomic status. Self-reported antenatal depressive symptoms were strongly associated with postnatal depressive symptoms. Risk factors for postnatal depressive symptoms were similar to those for antenatal depressive symptoms, as well as assisted delivery. CONCLUSION Factors relating to demographic and psychosocial disadvantage were associated with subsequent antenatal and postnatal depressive symptoms in New South Wales, Australia. Our study suggests that screening for probable depression and timely referral for expert assessment of at-risk mothers may be an effective strategy to improve maternal mental health outcomes.
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Affiliation(s)
- Felix Akpojene Ogbo
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
- Ingham Institute for Applied Medical Research, University of New South Wales, 1 Campbell Street, Liverpool, NSW 2170 Australia
| | - John Eastwood
- Ingham Institute for Applied Medical Research, University of New South Wales, 1 Campbell Street, Liverpool, NSW 2170 Australia
- School of Women’s and Children’s Health, University of New South Wales, Kensington, Sydney, NSW 2052 Australia
- Menzies Centre for Health Policy, Charles Perkins Centre, School of Public Health, Sydney University, Sydney, NSW 2006 Australia
- School of Public Health, Griffith University, Gold Coast, QLD 4222 Australia
- Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Rd, Croydon, NSW 2132 Australia
| | - Alexandra Hendry
- Ingham Institute for Applied Medical Research, University of New South Wales, 1 Campbell Street, Liverpool, NSW 2170 Australia
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145 Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research, University of New South Wales, 1 Campbell Street, Liverpool, NSW 2170 Australia
- Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, NSW Australia
| | - Kingsley E. Agho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | | | - Andrew Page
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
- Ingham Institute for Applied Medical Research, University of New South Wales, 1 Campbell Street, Liverpool, NSW 2170 Australia
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Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries. Front Psychiatry 2018; 8:248. [PMID: 29449816 PMCID: PMC5799244 DOI: 10.3389/fpsyt.2017.00248] [Citation(s) in RCA: 300] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/07/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD and a meta-regression to identify economic, health, social, or policy factors associated with national PPD prevalence. METHODS We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence. FINDINGS 291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7% (95% confidence interval: 16.6-18.8%), with significant heterogeneity across nations (Q = 16,823, p = 0.000, I2 = 98%), ranging from 3% (2-5%) in Singapore to 38% (35-41%) in Chile. Nations with significantly higher rates of income inequality (R2 = 41%), maternal mortality (R2 = 19%), infant mortality (R2 = 16%), or women of childbearing age working ≥40 h a week (R2 = 31%) have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence. INTERPRETATION The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.
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Affiliation(s)
- Jennifer Hahn-Holbrook
- Department of Psychology, University of California, Merced, Merced, CA, United States
- Center for Excellence in Biopsychosocial Approaches to Health, Chapman University, Orange, CA, United States
| | | | - Itzel Anaya
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
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Carlberg M, Edhborg M, Lindberg L. Paternal Perinatal Depression Assessed by the Edinburgh Postnatal Depression Scale and the Gotland Male Depression Scale: Prevalence and Possible Risk Factors. Am J Mens Health 2018; 12:720-729. [PMID: 29350097 PMCID: PMC6131440 DOI: 10.1177/1557988317749071] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Several studies have used the Edinburgh Postnatal Depression Scale (EPDS),
developed to screen new mothers, also for new fathers. This study aimed to
further contribute to this knowledge by comparing assessment of possible
depression in fathers and associated demographic factors by the EPDS and the
Gotland Male Depression Scale (GMDS), developed for “male” depression screening.
The study compared EPDS score ≥10 and ≥12, corresponding to minor and major
depression, respectively, in relation to GMDS score ≥13. At 3–6 months after
child birth, a questionnaire was sent to 8,011 fathers of whom 3,656 (46%)
responded. The detection of possibly depressed fathers by EPDS was 8.1% at score
≥12, comparable to the 8.6% detected by the GMDS. At score ≥10, the proportion
detected by EPDS increased to 13.3%. Associations with possible risk factors
were analyzed for fathers detected by one or both scales. A low income was
associated with depression in all groups. Fathers detected by EPDS alone were at
higher risk if they had three or more children, or lower education. Fathers
detected by EPDS alone at score ≥10, or by both scales at EPDS score ≥12, more
often were born in a foreign country. Seemingly, the EPDS and the GMDS are
associated with different demographic risk factors. The EPDS score appears
critical since 5% of possibly depressed fathers are excluded at EPDS cutoff 12.
These results suggest that neither scale alone is sufficient for depression
screening in new fathers, and that the decision of EPDS cutoff is crucial.
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Affiliation(s)
- Magdalena Carlberg
- 1 Health and Medical Care Administration, Stockholm County Council, Stockholm, Sweden
| | - Maigun Edhborg
- 2 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lene Lindberg
- 3 Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden.,4 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Investigation of the association between quality of life and depressive symptoms during postpartum period: a correlational study. BMC WOMENS HEALTH 2017; 17:115. [PMID: 29162087 PMCID: PMC5698934 DOI: 10.1186/s12905-017-0473-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 11/15/2017] [Indexed: 11/17/2022]
Abstract
Background The onset of a major depressive episode is experienced by a large number of women in the weeks or months following delivery. Postpartum depression may deem those women experiencing it incapable of taking care for themselves, their family and their infants, while at the same time it could negatively affect their quality of life. The present study assessed the quality of life of a sample of mothers in Greece, in order to investigate the association between postpartum depression and quality of life (QoL). Methods 145 women in a Private-General Obstetrics and Pediatric Clinic in Greece completed the Edinburgh Postnatal Depression scale (EPDS) and SF-36 questionnaire on the third and fourth day after delivery (caesarean or normal childbirth). The data were analyzed using SPSS version 17.0. Linear and logistic regression analysis was performed in order to find the independent factors related to the quality of life and postpartum depression symptoms. Results 9.9% of the participants experienced postpartum depression symptoms. Significant associations were found between the place of residence and symptoms of postpartum depression, and more specifically, women outside of Attica indicated higher levels of postpartum depression symptoms (p = 0.008) than women living in Attica. The level of education was also found to be significantly associated with postpartum depression symptoms, since women with Primary and Secondary education experienced higher levels of postpartum depression symptoms (p = 0.005) than those with a tertiary education. Concerning quality of life, women with postpartum depression symptoms scored 24.27 lower in «Role-Physical», 15.60 lower in «Bodily pain», 11.45 lower in «General Health», 14.18 lower in dimension of «Vitality», 38.25 lower in Role – Emotional and 16.82 lower in dimension of mental health, compared to those without depression symptoms. Conclusion Postpartum depression symptoms are associated with the quality of life of women after pregnancy, and therefore constitute a powerful predictor of the quality of life. Health care professionals should provide individualized care for the prevention and treatment of Postpartum Depression symptoms in order to help women improve their quality of life.
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A longitudinal investigation of perfectionism and repetitive negative thinking in perinatal depression. Behav Res Ther 2017; 97:26-32. [DOI: 10.1016/j.brat.2017.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 05/31/2017] [Accepted: 06/26/2017] [Indexed: 11/17/2022]
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Anderson FM, Hatch SL, Comacchio C, Howard LM. Prevalence and risk of mental disorders in the perinatal period among migrant women: a systematic review and meta-analysis. Arch Womens Ment Health 2017; 20:449-462. [PMID: 28389934 PMCID: PMC5423996 DOI: 10.1007/s00737-017-0723-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/28/2017] [Indexed: 11/16/2022]
Abstract
This study was conducted in order to evaluate the prevalence and risk of mental disorders in the perinatal period among migrant women. Six databases (including MEDLINE) were searched from inception to October 19th, 2015, in addition to citation tracking. Studies were eligible if mental disorders were assessed with validated tools during pregnancy and up to 1 year postpartum among women born outside of the study country. Of 3241 abstracts screened, 53 met the inclusion criteria for the review. Only three studies investigated a mental disorder other than depression. Unadjusted odds ratios were pooled using random effects meta-analysis for elevated depression symptoms during pregnancy (n = 12) and the postpartum (n = 24), stratified by study country due to heterogeneity. Studies from Canada found an increased risk for antenatal (OR = 1.86, 95% CIs 1.32-2.62) and postnatal elevated depression symptoms (OR = 1.98, 95% CIs 1.57-2.49) associated with migrant status. Studies from the USA found a decreased risk of antenatal elevated depression symptoms (OR = 0.71, 95% CIs 0.51-0.99), and studies from the USA and Australia found no association between migrant status and postnatal elevated depression symptoms. Low social support, minority ethnicity, low socioeconomic status, lack of proficiency in host country language and refugee or asylum-seeking status all put migrant populations at increased risk of perinatal mental disorders.
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Affiliation(s)
- Fraser M Anderson
- Section of Women's Mental Health, IOPPN, King's College London, Box P031, David Goldberg Centre, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Stephani L Hatch
- Department of Psychological Medicine, IOPPN, King's College London, London, UK
| | - Carla Comacchio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Louise M Howard
- Section of Women's Mental Health, IOPPN, King's College London, Box P031, David Goldberg Centre, 16 De Crespigny Park, London, SE5 8AF, UK
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Ceri V, Özlü-Erkilic Z, Özer Ü, Kadak T, Winkler D, Dogangün B, Akkaya-Kalayci T. Mental health problems of second generation children and adolescents with migration background. Int J Psychiatry Clin Pract 2017; 21:142-147. [PMID: 28498088 DOI: 10.1080/13651501.2017.1291820] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Despite the growing number of young second-generation immigrant (SGI) children and adolescents, studies about their mental health are rare. The objective of this study was to investigate the mental health problems of SGI children and adolescents in Istanbul, Turkey. METHODS In a clinical sample the mental health of 54 SGIs and 50 native children and adolescents were examined using the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) and Children's Global Assessment Scale. The assessments were carried out by a blinded rater. RESULTS SGI children had higher rates of psychiatric disorders such as depression (p = 0.001), post-traumatic stress disorder (PTSD) (p = 0.011) and anxiety disorders (p = 0.013), more comorbid disorders and lower functionality scores compared to their native counterparts (p = 0.001). CONCLUSIONS SGI children seem to have higher rates of psychiatric disorders most probably due to migration-induced burdens. The professionals treating SGI children should have more awareness for these problems to be able to approach them in a culture and language sensitive way.
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Affiliation(s)
- Veysi Ceri
- a Department of Child and Adolescent Psychiatry , Marmara University Pendik Training and Research Hospital , Istanbul , Turkey
| | - Zeliha Özlü-Erkilic
- b Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
| | - Ürün Özer
- c Department of Neurology, Neurosurgery , Mazhar Osman Training and Research Hospital for Psychiatry , Istanbul , Turkey
| | - Tayyib Kadak
- d Department of Child and Adolescent , Istanbul University, Cerrahpasa Medical Faculty Psychiatry , Istanbul , Turkey
| | - Dietmar Winkler
- e Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria
| | - Burak Dogangün
- d Department of Child and Adolescent , Istanbul University, Cerrahpasa Medical Faculty Psychiatry , Istanbul , Turkey
| | - Türkan Akkaya-Kalayci
- b Outpatient Clinic of Transcultural Psychiatry and Migration Induced Disorders in Childhood and Adolescence, Department of Child and Adolescent Psychiatry , Medical University of Vienna , Vienna , Austria
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Almeida LM, Costa-Santos C, Caldas JP, Dias S, Ayres-de-Campos D. The impact of migration on women's mental health in the postpartum period. Rev Saude Publica 2017; 50:S0034-89102016000100220. [PMID: 27355463 PMCID: PMC4917335 DOI: 10.1590/s1518-8787.2016050005617] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/10/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the influence of I mmigration on the psychological health of women after childbirth. METHODS In this cross-sectional study, immigrant and Portuguese-native women delivering in the four public hospitals of the metropolitan area of Porto, Portugal, were contacted by telephone between February and December 2012 during the first postpartum month to schedule a home visit and fill in a questionnaire. Most immigrant (76.1%) and Portuguese mothers (80.0%) agreed to participate and with the visits, thus a total of 89 immigrants and 188 Portuguese women were included in the study. The questionnaire included the application of four validated scales: Mental Health Inventory-5, Edinburgh Postpartum Depression Scale, Perceived Stress Scale, and Scale of Satisfaction with Social Support. Statistical analysis included t-test and Chi-square or Fisher's test, and logistic regression models. RESULTS Immigrants had an increased risk of postpartum depression (OR = 6.444, 95%CI 1.858-22.344), and of low satisfaction with social support (OR = 6.118, 95%CI 1.991-18.798). We did not perceive any associations between migrant state, perceived stress, and impoverished mental health. CONCLUSIONS Immigrant mothers have increased vulnerabilities in the postpartum period, resulting in an increased risk of postpartum depression and lesser satisfaction with the received social support.
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Affiliation(s)
- Lígia Moreira Almeida
- Instituto de Saúde Pública. Faculdade de Medicina da Universidade do Porto. Porto, Portugal
| | - Cristina Costa-Santos
- Centro de Investigação em Tecnologias e Serviços de Saúde. Faculdade de Medicina da Universidade do Porto. Porto, Portugal
| | | | - Sónia Dias
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa. Lisboa, Portugal
| | - Diogo Ayres-de-Campos
- Departamento de Obstetrícia e Ginecologia. Centro Hospitalar de São João. Faculdade de Medicina. Universidade do Porto. Porto, Portugal
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Schmied V, Langdon R, Matthey S, Kemp L, Austin MP, Johnson M. Antenatal psychosocial risk status and Australian women's use of primary care and specialist mental health services in the year after birth: a prospective study. BMC Womens Health 2016; 16:69. [PMID: 27782825 PMCID: PMC5078921 DOI: 10.1186/s12905-016-0344-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 09/16/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Poor mental health in the perinatal period can impact negatively on women, their infants and families. Australian State and Territory governments are investing in routine psychosocial assessment and depression screening with referral to services and support, however, little is known about how well these services are used. The aim of this paper is to report on the health services used by women for their physical and mental health needs from pregnancy to 12 months after birth and to compare service use for women who have been identified in pregnancy as having moderate-high psychosocial risk with those with low psychosocial risk. METHODS One hundred and six women were recruited to a prospective longitudinal study with five points of data collection (2-4 weeks after prenatal booking, 36 weeks gestation, 6 weeks postpartum, 6 months postpartum and 12 months postpartum) was undertaken. Data were collected via face-to-face and telephone interviews, relating to psychosocial risk factors, mental health and service use. The prenatal psychosocial risk status of women (data available for 83 of 106 women) was determined using the Antenatal Risk Questionnaire (ANRQ) and was used to compare socio-demographic characteristics and service use of women with 'low' and 'moderate to high' risk of perinatal mental health problems. RESULTS The findings indicate high use of postnatal universal health services (child and family health nurses, general practitioners) by both groups of women, with limited use of specialist mental health services by women identified with moderate to high risk of mental health problems. While almost all respondents indicated that they would seek help for mental health concerns most had a preference to seek help from partners and family before accessing health professionals. CONCLUSION These preliminary data support local and international studies that highlight the poor uptake of specialist services for mental health problems in postnatal women, where this may be required. Further research comparing larger samples of women (with low and psychosocial high risk) are needed to explore the extent of any differences and the reasons why women do not access these specialist services.
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Affiliation(s)
- Virginia Schmied
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia.
| | - Rachel Langdon
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia
- Centre for Applied Nursing Research (a joint facility of the South Western Sydney Local Health District and Western Sydney University, Liverpool, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, Sydney, NSW, Australia
| | - Stephen Matthey
- School of Psychology, University of Sydney and Research Director, Infant, Child & Adolescent Mental Health Service, South West Sydney Local Health District, Sydney, Australia
| | - Lynn Kemp
- School of Nursing & Midwifery, Western Sydney University, Locked Bag 1797 Penrith, Sydney, 2751, NSW, Australia
| | - Marie-Paule Austin
- Chair, Perinatal Mental Health Unit University of New South Wales & St John of God Health Care, Burwood , Sydney, Australia
- The Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW, Australia
- The Ingham Institute for Applied Medical Research, Liverpool, Sydney, NSW, Australia
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Eastwood JG, Kemp LA, Jalaludin BB. Realist theory construction for a mixed method multilevel study of neighbourhood context and postnatal depression. SPRINGERPLUS 2016; 5:1081. [PMID: 27468381 PMCID: PMC4945545 DOI: 10.1186/s40064-016-2729-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 06/30/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND We have recently described a protocol for a study that aims to build a theory of neighbourhood context and postnatal depression. That protocol proposed a critical realist Explanatory Theory Building Method comprising of an: (1) emergent phase, (2) construction phase, and (3) confirmatory phase. A concurrent triangulated mixed method multilevel cross-sectional study design was described. The protocol also described in detail the Theory Construction Phase which will be presented here. METHODS The Theory Construction Phase will include: (1) defining stratified levels; (2) analytic resolution; (3) abductive reasoning; (4) comparative analysis (triangulation); (5) retroduction; (6) postulate and proposition development; (7) comparison and assessment of theories; and (8) conceptual frameworks and model development. THEORY CONSTRUCTION The stratified levels of analysis in this study were predominantly social and psychological. The abductive analysis used the theoretical frames of: Stress Process; Social Isolation; Social Exclusion; Social Services; Social Capital, Acculturation Theory and Global-economic level mechanisms. Realist propositions are presented for each analysis of triangulated data. Inference to best explanation is used to assess and compare theories. A conceptual framework of maternal depression, stress and context is presented that includes examples of mechanisms at psychological, social, cultural and global-economic levels. Stress was identified as a necessary mechanism that has the tendency to cause several outcomes including depression, anxiety, and health harming behaviours. The conceptual framework subsequently included conditional mechanisms identified through the retroduction including the stressors of isolation and expectations and buffers of social support and trust. CONCLUSION The meta-theory of critical realism is used here to generate and construct social epidemiological theory using stratified ontology and both abductive and retroductive analysis. The findings will be applied to the development of a middle range theory and subsequent programme theory for local perinatal child and family interventions.
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Affiliation(s)
- John G. Eastwood
- />Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Road, Croydon, NSW 2132 Australia
- />School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- />School of Women’s and Children’s Health, The University of New South Wales, Sydney, NSW 2052 Australia
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
- />School of Public Health, The University of Sydney, Sydney, NSW 2006 Australia
- />School of Medicine, Griffith University, Gold Coast, QLD 4222 Australia
| | - Lynn A. Kemp
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
- />School of Nursing and Midwifery, Western Sydney University, Campbelltown, NSW 2560 Australia
| | - Bin B. Jalaludin
- />School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
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Enatescu VR, Bernad E, Gluhovschi A, Papava I, Romosan R, Palicsak A, Munteanu R, Craina M, Enatescu I. Perinatal characteristics and mother's personality profile associated with increased likelihood of postpartum depression occurrence in a Romanian outpatient sample. J Ment Health 2016; 26:212-219. [PMID: 26925764 DOI: 10.3109/09638237.2016.1149802] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Postpartum depression represents an increasingly recognized psychiatric condition in new mothers, and even more so in recent years as its detection has improved. AIMS This study aimed to reveal those maternal and perinatal parameters that are significantly associated with increased likelihood of postpartum depression in delivering mothers from our region. METHODS A cross-sectional survey was conducted in 163 women between 6 and 8 weeks after delivery. Postnatal depression was assessed by the Edinburgh Postnatal Depression Scale (EPDS) using a cut-off of >12. RESULTS Postnatal depression was detected in 39 (23.93%) new mothers. The preterm delivery [odds ratio (OR) 7.233; 95% confidence interval (CI) 1.631-32.078; p = 0.009], presence of complications during pregnancy (OR 4.579; 95% CI 1.314-15.953; p = 0.017) and being primiparous (OR 3.388; 95% CI 1.430-8.025; p = 0.006) have been associated with an increased likelihood of subsequent postpartum depression. Anxiety traits of personality were the most represented in depressive mothers. CONCLUSIONS Postpartum depression is a frequent psychiatric condition in new mothers from our region. These results outline the critical role of mother's profile of personality which in a particular context of perinatal events could result in an increased likelihood of postpartum depression requiring a multidisciplinary approach.
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Affiliation(s)
| | - Elena Bernad
- b Department of Obstetrics, Gynecology and Neonatology , Victor Babes University of Medicine and Pharmacy , Timisoara , Romania , and
| | - Adrian Gluhovschi
- b Department of Obstetrics, Gynecology and Neonatology , Victor Babes University of Medicine and Pharmacy , Timisoara , Romania , and
| | | | | | | | - Rosana Munteanu
- c Eduard Pamfil Psychiatric Clinic, Timisoara County Emergency Clinical Hospital , Timisoara , Romania
| | - Marius Craina
- b Department of Obstetrics, Gynecology and Neonatology , Victor Babes University of Medicine and Pharmacy , Timisoara , Romania , and
| | - Ileana Enatescu
- b Department of Obstetrics, Gynecology and Neonatology , Victor Babes University of Medicine and Pharmacy , Timisoara , Romania , and
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Chojenta CL, Lucke JC, Forder PM, Loxton DJ. Maternal Health Factors as Risks for Postnatal Depression: A Prospective Longitudinal Study. PLoS One 2016; 11:e0147246. [PMID: 26785131 PMCID: PMC4718697 DOI: 10.1371/journal.pone.0147246] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/03/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE While previous studies have identified a range of potential risk factors for postnatal depression (PND), none have examined a comprehensive set of risk factors at a population-level using data collected prospectively. The aim of this study was to explore the relationship between a range of factors and PND and to construct a model of the predictors of PND. METHODS Data came from 5219 women who completed Survey 5 of the Australian Longitudinal Study on Women's Health in 2009 and reported giving birth to a child. RESULTS Over 15% of women reported experiencing PND with at least one of their children. The strongest positive associations were for postnatal anxiety (OR = 13.79,95%CI = 10.48,18.13) and antenatal depression (OR = 9.23,95%CI = 6.10,13.97). Positive associations were also found for history of depression and PND, low SF-36 Mental Health Index, emotional distress during labour, and breastfeeding for less than six months. CONCLUSIONS Results indicate that understanding a woman's mental health history plays an important role in the detection of those who are most vulnerable to PND. Treatment and management of depression and anxiety earlier in life and during pregnancy may have a positive impact on the incidence of PND.
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Affiliation(s)
- Catherine L. Chojenta
- Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia
| | - Jayne C. Lucke
- Australian Research Centre in Sex, Health and Society, Faculty of Health Sciences, La Trobe University, Melbourne, Australia
| | - Peta M. Forder
- Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia
| | - Deborah J. Loxton
- Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia
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Safadi RR, Abushaikha LA, Ahmad MM. Demographic, maternal, and infant health correlates of post-partum depression in Jordan. Nurs Health Sci 2015; 18:306-13. [DOI: 10.1111/nhs.12268] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 11/14/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Reema R. Safadi
- Maternal and Child Health Nursing Department; The University of Jordan; Amman Jordan
| | - Lubna A. Abushaikha
- Maternal and Child Health Nursing Department; The University of Jordan; Amman Jordan
| | - Muayyad M. Ahmad
- The University of Jordan; Clinical Nursing Department; Amman Jordan
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Eastwood JG, Kemp LA, Jalaludin BB. Being alone and expectations lost: a critical realist study of maternal depression in South Western Sydney. SPRINGERPLUS 2015; 4:700. [PMID: 26609502 PMCID: PMC4646882 DOI: 10.1186/s40064-015-1492-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 10/30/2015] [Indexed: 11/29/2022]
Abstract
The study reported here is part of a critical realist multilevel study. It seeks to identify and explain complex perinatal contextual social and psychosocial mechanisms that may influence the developmental origins of health and disease, with a focus on the role of postnatal depression. The aims of the greater study are to: (1) describe the phenomenon of postnatal depression in South Western Sydney; and (2) identify mechanisms that would add to our understanding of the psycho-social causes of maternal depression. This paper will move beyond our previous quantitative descriptions of individual-level predictors of depressive symptoms by seeking the views of local mothers and practitioners, to explain the mechanisms that might be involved. The study was set in South Western Sydney, New South Wales, Australia. An Explanatory Theory Building Method was used. The previously reported quantitative study was a non-linear principal component analysis and logistic regression study of 15,389 months delivering in 2002 and 2003. This intensive qualitative study used open coding of interviews, of seven practitioners and three naturally occurring mothers groups, to enable maximum emergence. The theoretical concepts identified were: attachment and nurturing, infant temperament, unplanned pregnancy and sole parenthood, support for mothers, access to services, stress, financial hardship, isolation and marginalisation, mothers' "loss of control" and "power", and expectations and dreams. Being alone and expectations lost emerged as possible triggers of stress and depression for mothers. These findings might also apply to others who have their dreams shattered during life's transitions. In these situations social and cultural context can either nurture and support or marginalise and isolate. The challenge for policy and practice is to support mothers and their partners during the transition to parenthood within a challenging social and material context.
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Affiliation(s)
- John G. Eastwood
- />Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Road, Croydon, NSW 2132 Australia
- />School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- />School of Women’s and Children’s Health, The University of New South Wales, Sydney, NSW 2052 Australia
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
- />School of Public Health, The University of Sydney, Sydney, NSW 2006 Australia
- />School of Medicine, Griffith University, Gold Coast, QLD 4222 Australia
| | - Lynn A. Kemp
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
- />School of Nursing and Midwifery, Western Sydney University, Campbelltown, NSW 2560 Australia
| | - Bin B. Jalaludin
- />School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
- />Ingham Institute of Applied Medicine, The University of New South Wales, Liverpool, NSW 2170 Australia
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Falah-Hassani K, Shiri R, Vigod S, Dennis CL. Prevalence of postpartum depression among immigrant women: A systematic review and meta-analysis. J Psychiatr Res 2015; 70:67-82. [PMID: 26424425 DOI: 10.1016/j.jpsychires.2015.08.010] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/03/2015] [Accepted: 08/07/2015] [Indexed: 12/20/2022]
Abstract
The aims of this systematic review and meta-analysis were threefold: to estimate the prevalence of postpartum depressive symptoms in immigrant women, compare this prevalence to non-immigrant women, and determine risk factors for postpartum depressive symptoms in immigrant women. Literature searches were conducted in PubMed, Embase, PsycINFO, Web of Science, Scopus, ResearchGate and Google Scholar databases from 1950 until October 2014. Twenty-four studies met the inclusion criteria of which 22 (12 cross-sectional and 10 prospective cohort) contributed data for meta-analyses. Heterogeneity and publication bias were assessed. The prevalence of postpartum depressive symptoms in immigrant women was 20% (95% confidence interval [CI] 17-23%, 18 studies, N = 13,749 women). Immigrant women were twice more likely to experience depressive symptoms in the postpartum period than non-immigrant women (pooled unadjusted odds ratio [OR] = 2.10 [95% CI 1.62-2.73, 15 studies, N = 50,519 women] and adjusted OR = 2.18 [95% CI 1.60-2.96, 7 studies, N = 35,557 women]). There was, however, evidence of publication bias with the pooled adjusted OR reduced to 1.63 (95% CI 1.22-2.17) after adjustment for bias. Risk factors associated with postpartum depressive symptoms among immigrant women included shorter length of residence in the destination country, lower levels of social support, poorer marital adjustment, and perceived insufficient household income. This study suggests that postpartum depression is a common condition among immigrant women. Moreover, immigrant women are at higher risk of postpartum depression than non-immigrant women. Further prospective studies on the risk factors of postpartum depression among immigrant women verified by a clinical diagnosis are needed.
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Affiliation(s)
| | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Simone Vigod
- Women's College Hospital and Research Institute, Toronto, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
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Pilkington PD, Whelan TA, Milne LC. Maternal crying and postpartum distress: the moderating role of partner support. J Reprod Infant Psychol 2015. [DOI: 10.1080/02646838.2015.1067884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Lisa C. Milne
- Australian Catholic University, Fitzroy, Victoria, Australia
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Reilly N, Yin C, Monterosso L, Bradshaw S, Neale K, Harrison B, Austin MP. Identifying psychosocial risk among mothers in an Australian private maternity setting: A pilot study. Aust N Z J Obstet Gynaecol 2015. [DOI: 10.1111/ajo.12370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nicole Reilly
- Perinatal & Women's Mental Health Unit; St John of God Health Care; University of New South Wales; Burwood New South Wales Australia
| | - Carolyn Yin
- Perinatal & Women's Mental Health Unit; St John of God Health Care; University of New South Wales; Burwood New South Wales Australia
| | - Leanne Monterosso
- St John of God Murdoch Hospital; Murdoch Western Australia Australia
- University of Notre Dame Australia; Murdoch Western Australia Australia
- School of Nursing and Midwifery; Edith Cowan University of Western Australia; Joondalup Western Australia Australia
| | - Sue Bradshaw
- St John of God Murdoch Hospital; Murdoch Western Australia Australia
| | - Kizzi Neale
- St John of God Murdoch Hospital; Murdoch Western Australia Australia
| | - Beate Harrison
- Murdoch Raphael Centre; St John of God Murdoch Hospital; Murdoch Western Australia Australia
| | - Marie-Paule Austin
- Perinatal & Women's Mental Health Unit; St John of God Health Care; University of New South Wales; Burwood New South Wales Australia
- The Black Dog Institute; Prince of Wales Hospital; Burwood New South Wales Australia
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Khajehei M. Mental health of perinatal women. World J Obstet Gynecol 2015; 4:46-51. [DOI: 10.5317/wjog.v4.i2.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/06/2015] [Accepted: 03/18/2015] [Indexed: 02/05/2023] Open
Abstract
Pregnancy and childbirth are major stressors for some women. They can be followed by deterioration in mental health status and cause mental illnesses during perinatal period. Undetected and untreated perinatal mental illnesses can have negative unexpected impacts on parenting skills of the women and children’s development. Mentally ill mothers may not effectively attend their children’s needs in a timely manner and may experience an unfavourable mother-child attachment affecting the child’s language, social, emotional and cognitive development. The rate of pregnancy and postnatal health complications and interventions is higher among mentally ill women with some certain risk factors. The mentally ill mothers along with their partners need comprehensive support and counselling to be able to care for their infants and establish strong parent-child bond and attachment. Mental health campaigns across the world have endeavoured to increase the knowledge and awareness of the public towards perinatal mental health illnesses. To this aim, a routine screening is recommended in order to identify the women who are at risk of mood or anxiety disorder during perinatal period. The development of knowledge on perinatal mental illnesses among public and the health professionals has resulted in timely recognition and treatment of perinatal mental illnesses. Although great volumes of research show high prevalence of perinatal mental illnesses and their impacts on parenting confidence and competence as well as child’s developmental process, there is still lack of research on various aspects of perinatal mental illnesses. To enable early prevention, diagnosis and intervention, it is crucial to identify families who are at an increased risk of perinatal mental illnesses and provide support and intervention to minimise the adverse outcomes. The children’s needs may not be met by providing treatment to parental mental illnesses alone. It is also important to understand the impact of specific parenting behaviours on child outcomes which is modified by the quality of parenting.
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Lee CT, Stroo M, Fuemmeler B, Malhotra R, Østbye T. Trajectories of depressive symptoms over 2 years postpartum among overweight or obese women. Womens Health Issues 2015; 24:559-66. [PMID: 25213748 DOI: 10.1016/j.whi.2014.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 05/28/2014] [Accepted: 05/29/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although depressive symptoms are common postpartum, few studies have followed women beyond 12 months postpartum to investigate changes in the number and severity of these symptoms over time, especially in overweight and obese women. Using two complementary analytical methods, this study aims to identify trajectories of depressive symptoms over 2 years postpartum among overweight or obese mothers, and assess the demographic, socioeconomic, and health covariates for these trajectories. METHODS Using longitudinal data from two behavioral intervention studies (Kids and Adults Now!-Defeat Obesity [KAN-DO] and Active Mothers Postpartum (AMP); n = 844), we used latent growth modeling to identify the overall trajectory of depressive symptoms and how it was related to key covariates. Next, we used latent class growth analysis to assess the heterogeneity in the depressive symptom trajectories over time, and thereby, identify subgroups of women with distinct trajectories. FINDINGS The overall trajectory of depressive symptoms over 2 years postpartum was relatively stable in our sample. However, the presence of three distinct latent class trajectories (stable-low [82.5%], decreasing symptoms [7.3%], and increasing symptoms [10.2%]), identified based on trajectory shape and mean depressive symptom score, supported heterogeneity in depressive symptom trajectories over time. Lower maternal education was related to a higher symptom score, and poorer subjective health status at baseline predicted inclusion in the increasing symptoms trajectory. CONCLUSIONS In some overweight or obese mothers, postpartum depressive symptoms do not resolve quickly. Practitioners should be aware of this phenomenon and continue to screen for depression for longer periods of time postpartum.
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Affiliation(s)
- Chien-Ti Lee
- School of Family Life, Brigham Young University, Provo, Utah.
| | - Marissa Stroo
- Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina
| | - Bernard Fuemmeler
- Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina
| | - Rahul Malhotra
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina; Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
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Eastwood JG, Jalaludin BB, Kemp LA, Phung HN. Realist identification of group-level latent variables for perinatal social epidemiology theory building. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2015; 44:407-33. [PMID: 25618983 DOI: 10.2190/hs.44.3.a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We have previously reported in this journal on an ecological study of perinatal depressive symptoms in South Western Sydney. In that article, we briefly reported on a factor analysis that was utilized to identify empirical indicators for analysis. In this article, we report on the mixed method approach that was used to identify those latent variables. Social epidemiology has been slow to embrace a latent variable approach to the study of social, political, economic, and cultural structures and mechanisms, partly for philosophical reasons. Critical realist ontology and epistemology have been advocated as an appropriate methodological approach to both theory building and theory testing in the health sciences. We describe here an emergent mixed method approach that uses qualitative methods to identify latent constructs followed by factor analysis using empirical indicators chosen to measure identified qualitative codes. Comparative analysis of the findings is reported together with a limited description of realist approaches to abstract reasoning.
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Eastwood JG, Jalaludin BB, Kemp LA, Phung HN. Bayesian hierarchical spatial regression of maternal depressive symptoms in South Western Sydney, Australia. SPRINGERPLUS 2014; 3:55. [PMID: 24555171 PMCID: PMC3921342 DOI: 10.1186/2193-1801-3-55] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 01/20/2014] [Indexed: 11/26/2022]
Abstract
Background There is increasing interest in the role played by maternal depression in mediating the effects of adversity during pregnancy and poor infant outcomes. There is also increasing evidence from multilevel regression studies for an association of area-level economic deprivation and poor individual mental health. The purpose of the study reported here is to explore the spatial distribution of postnatal depressive symptoms in South Western Sydney, Australia, and to identify covariate associations that could inform subsequent multilevel studies. Methods Mothers (n = 15,389) delivering in 2002 and 2003 were assessed at 2–3 weeks after delivery for risk factors for depressive symptoms. The individual-level binary outcome variables were Edinburgh Depression Scale (EDS) >9 and >12. The association between social, demographic and ecological factors and aggregated outcome variables were investigated using exploratory factor analysis and multivariate hierarchical Bayesian spatial regression. Relative risks from the final EDS >12 regression model were mapped to visualise the contribution from explanatory covariates and residual components. Results The exploratory factor analysis identified six factors: neighbourhood adversity, social cohesion, health behaviours, housing quality, social services, and support networks. Variables associated with neighbourhood adversity, social cohesion, social networks, and ethnic diversity were consistently associated with aggregated depressive symptoms. Measures of social disadvantage, lack of social cohesion and lack of social capital were associated with increased depressive symptoms. The association with social disadvantage was not significant when controlling for ethnic diversity and social capital. Conclusions The findings support the theoretical proposition that neighbourhood adversity causes maternal psychological distress and depression within the context of social buffers including social networks, social cohesion, and social services. The finding have implications for the distribution of health services including early nurse home visiting which has recently been confirmed to be effective in preventing postnatal depression. Electronic supplementary material The online version of this article (doi:10.1186/2193-1801-3-55) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John G Eastwood
- Community Paediatrics, South Western Sydney Local Health District, Locked Mail Bag 7008, Liverpool, BC 1871 New South Wales Australia ; School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia ; School of Women's and Children's Health, The University of New South Wales, Sydney, NSW 2052 Australia ; School of Public Health, University of Sydney, Sydney, NSW 2006 Australia ; School of Public Health, Griffith University, Gold Coast, Queensland, 4222 Australia
| | - Bin B Jalaludin
- Community Paediatrics, South Western Sydney Local Health District, Locked Mail Bag 7008, Liverpool, BC 1871 New South Wales Australia ; School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
| | - Lynn A Kemp
- Community Paediatrics, South Western Sydney Local Health District, Locked Mail Bag 7008, Liverpool, BC 1871 New South Wales Australia ; School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia
| | - Hai N Phung
- Community Paediatrics, South Western Sydney Local Health District, Locked Mail Bag 7008, Liverpool, BC 1871 New South Wales Australia ; School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW 2052 Australia ; School of Public Health, Griffith University, Gold Coast, Queensland, 4222 Australia
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