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Giurgescu C, Adaji R, Hyer S, Wheeler J, Misra DP. Neighborhood Environment and Perceived Stress Before and During the COVID-19 Pandemic Among Childbearing Black Women. J Perinat Neonatal Nurs 2024; 38:334-341. [PMID: 39074329 PMCID: PMC11296494 DOI: 10.1097/jpn.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
PURPOSE The purpose of this study among pregnant and postpartum Black women was twofold: (1) to compare levels of perceived stress, depressive symptoms, social support, and neighborhood disorder and crime before the pandemic vs during the pandemic; and (2) to examine the association of perceived stress, depressive symptoms, and social support with neighborhood disorder and crime at both time points. METHODS This was a prospective study as part of the Biosocial Impact on Black Births, a longitudinal study that examined the role of maternal factors on preterm birth among Black women. A sample of 143 women were included who responded to survey questions during pregnancy prior to the pandemic and again after birth, during the pandemic. Women completed the COVID survey between May 21, 2020, and January 28, 2021. RESULTS The levels of perceived stress (70.75 and 76.28, respectively, P < .01) and social support (17.01 and 18.78, respectively, P < .01) were lower during the pandemic than prior to the pandemic. Social support, perceived stress, and depressive symptoms were significantly correlated with the pre-pandemic measures of perceived neighborhood disorder and crime. Perceived stress and depressive symptoms were also significantly correlated with pandemic measures of perceived neighborhood. CONCLUSION Women reported lower levels of perceived stress during the pandemic than prior to the pandemic, but neighborhood characteristics were consistently associated with perceived stress and depressive symptoms both prior to and during the pandemic. Further exploration is warranted to better understand these relationships.
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Affiliation(s)
- Carmen Giurgescu
- Author Affiliations: College of Nursing, University of Central Florida, Orlando, Florida (Drs Giurgescu, Hyer, and Wheeler); and Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan (Drs Adaji and Misra)
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Eldeirawi KM, Persky VW, Zielke C, Goldstein E, Bimbi O, Saenz J, Mustafa Z, Jumah TA, Ramirez XR, Aldirawi A, Quinn L, Hernandez R. Economic, Psychological, and Emotional Well-Being of Pregnant Women During the COVID-19 Pandemic. J Midwifery Womens Health 2024. [PMID: 38923387 DOI: 10.1111/jmwh.13659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/04/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION The intersection between perinatal mental health and the coronavirus disease 2019 (COVID-19) pandemic remains of significant public health importance. The current study examined the emotional and financial well-being and predictors of elevated depressive symptoms among pregnant women during the COVID-19 pandemic. METHODS This online survey was conducted with 2118 women ≥18 years old who were pregnant at the time of the survey and living in the United States or Puerto Rico. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale, with scores ≥10 indicative of elevated depressive symptoms. The final logistic regression model included housing insecurity, financial distress, COVID-19 diagnosis, exposure to COVID-19, and demographic covariates. RESULTS More than half the sample (53.8%) had elevated depressive symptoms. In logistic regression analyses, the odds of having elevated depressive symptoms were significantly higher for participants reporting housing insecurity (adjusted odds ratio [aOR], 1.56; 95% CI, 1.22-2.01), financial distress (aOR, 1.57; 95% CI, 1.17-2.12), COVID-19 diagnosis (aOR, 2.53; 95% CI, 1.53-4.17), and COVID-19 exposure (aOR, 1.41; 95% CI, 1.07-1.86), after adjusting for covariates. The association of elevated depressive symptoms with housing insecurity was especially strong among those who experienced COVID-19 (aOR, 6.04; 95% CI, 2.15-17.0). DISCUSSION Our findings are consistent with previous literature revealing that diagnosis, exposure, concerns about family, and effects on financial stability were related to depressive symptoms during the pandemic. The relationships between financial and housing concerns with elevated depressive symptoms, independent of concerns about infection in family members, suggest that there may be direct and indirect effects of the pandemic on mental health.
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Affiliation(s)
- Kamal M Eldeirawi
- College of Nursing, University of Illinois Chicago, Chicago, Illinois
| | - Victoria W Persky
- School of Public Health, University of Illinois Chicago, Chicago, Illinois
| | - Cameron Zielke
- School of Public Health, University of Illinois Chicago, Chicago, Illinois
| | - Ellen Goldstein
- College of Nursing, University of Illinois Chicago, Chicago, Illinois
| | - Olivia Bimbi
- College of Nursing, University of Illinois Chicago, Chicago, Illinois
| | - Jennifer Saenz
- College of Nursing, University of Illinois Chicago, Chicago, Illinois
| | - Zane Mustafa
- College Liberal Arts, University of Illinois Chicago, Chicago, Illinois
| | - Tamara A Jumah
- College Liberal Arts, University of Illinois Chicago, Chicago, Illinois
| | - Xavier R Ramirez
- School of Social Work, University of Illinois at Urbana Champaign, Urbana, Illinois
| | - Ali Aldirawi
- Neonatal Intensive Care Unit, Al-Shifa Hospital, Gaza, Palestine
| | - Laurie Quinn
- College of Nursing, University of Illinois Chicago, Chicago, Illinois
| | - Rosalba Hernandez
- College of Nursing, University of Illinois Chicago, Chicago, Illinois
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Duchette C, Perera M, Arnett S, White E, Belcher E, Tinius R. Benefits of Resistance Training During Pregnancy for Maternal and Fetal Health: A Brief Overview. Int J Womens Health 2024; 16:1137-1147. [PMID: 38912201 PMCID: PMC11193983 DOI: 10.2147/ijwh.s462591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/11/2024] [Indexed: 06/25/2024] Open
Abstract
Research demonstrates resistance training is not only safe but also beneficial for pregnant women. However, exercise recommendations for pregnant women still minimize the importance of resistance exercise and provide minimal guidance. With a large increase in strength-focused sports among women, it is critical to re-evaluate the risk/benefit ratio of these exercises and ensure the latest recommendations reflect the latest clinical research. The purpose of this review is to highlight the safety and benefits of resistance training for both maternal and fetal health, particularly focusing on recent work. Relevant research involving resistance training during pregnancy was accessed and analyzed via a quasi-systematic search. Results demonstrate that appropriate prenatal resistance training can help alleviate some of the common symptoms of pregnancy, such as fatigue, back pain, and poor mental health. Resistance exercise can assist with glucose control in gestational diabetes mellitus, as well as decrease the risk of infant macrosomia and childhood metabolic dysfunction associated with uncontrolled gestational diabetes. Resistance training can also increase the likelihood of a vaginal delivery, which is beneficial for both mother and baby. Concerning fetal health, resistance training increases uterine blood flow, decreases the risk of neonatal macrosomia, and improves cognitive function and metabolic health in childhood. As with all forms of exercise, pregnant women should avoid resistance exercises that involve the supine position for extended bouts of time, trauma (or risk of trauma) to the abdomen, ballistic movements, movements that rely heavily on balance, and conditions that prohibit appropriate temperature control. With these considerations in mind, resistance training's benefits far surpass the lack of risk to the fetus. Resistance training is a safe and effective way to improve and maintain physical fitness during pregnancy and represents no risk to fetal health and development. Thus, healthcare providers should recommend resistance training for pregnant women.
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Affiliation(s)
| | - Madhawa Perera
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky, USA
| | - Scott Arnett
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky, USA
| | - Erin White
- Health, Exercise, and Rehabilitative Sciences, Winona State University, Winona, Minnesota, USA
| | - Elizabeth Belcher
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky, USA
| | - Rachel Tinius
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, Kentucky, USA
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Wang LY, Tsai HM, Chen YW, Jhang JY, Wu PJ, Huang YT, Lee MY, Chen LC, Yu WP, Chiang MC. A preliminary study of the effectiveness of video visitation on depression and stress in mothers with preterm infants during the pandemic. Pediatr Neonatol 2024:S1875-9572(24)00092-5. [PMID: 38910078 DOI: 10.1016/j.pedneo.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/26/2023] [Accepted: 12/05/2023] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND AND PURPOSE Parents of preterm infants experience anxiety and stress in the neonatal intensive care unit (NICU). Visitation restrictions due to COVID-19 have increased maternal pressure and limited bonding opportunities. Little research exists in Taiwan on using video conferencing as a solution. This study investigates depression and stress levels in mothers of preterm infants and evaluates the effectiveness of video visitation during NICU restrictions. METHODS This study adopts a cross-sectional design and a qualitative survey. Mothers of premature infants were recruited and they participated in the study. Interventions for video visits were scheduled on the third day of admission to the NICU (T1) and during the second week of the study (T2). After each video visit, participants completed an online survey. The study's online survey used structured questionnaires including demographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Parental Stress Scale (PSS): Infant Hospitalization (IH). RESULTS A total of 51 mothers of preterm infants participated in the study. During the T1 and T2 periods, single mothers with lower educational levels and those aged below 30 experienced depression and high levels of stress. Lower birth weight and gestational age were associated with maternal depression. Video visitation intervention led to a significant decrease in depression scores (EPDS, T1: 11.3 ± 5.5 vs. T2: 10.1 ± 5.2, p = 0.039). Positive correlations were observed between EPDS and PSS: IH scores (p < 0 .005). CONCLUSION Video visitation intervention can reduce maternal depression in mothers with preterm infants. Since it is practical, video visitation may be applied even after the pandemic.
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Affiliation(s)
- Ling-Ying Wang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan; MSc Program in Innovation for Smart Medicine, College of Management, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Min Tsai
- College of Nursing, Hungkuang University, Taichung, Taiwan
| | - Yi-Wen Chen
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jing-Yi Jhang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pei-Jhen Wu
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Ting Huang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ming-Ying Lee
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Li-Chen Chen
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Wen-Pin Yu
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
| | - Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Barbosa HJC, Fronza M, Silva RS, Dos Santos TC, Freitas Rocha ARD. Influence of COVID-19 on mental health of postpartum women, breastfeeding time and infant development. Arch Womens Ment Health 2024:10.1007/s00737-024-01478-6. [PMID: 38832981 DOI: 10.1007/s00737-024-01478-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND The COVID-19 pandemic may have affected the mental health of pregnant and postpartum women, influencing the duration of exclusive breastfeeding and the child's neuropsychomotor development. RESEARCH AIM To evaluate the influence of COVID-19 on the mental health of postpartum women, on the protein and antioxidant profile of breast milk, on the duration of exclusive breastfeeding and on the neuropsychomotor development of their infants. METHODS Observational study, prospective cohort, with 180 postpartum women. Psychosocial status was assessed by changes in mood and lifestyle; trait and state anxiety, and postpartum depression. Breastfeeding time and neuropsychomotor development were determined at the three-month well-child consultation based on the child's health record and the WHO Anthro software. 5 ml of mature breast milk were collected from the full breast of the lactating women. RESULTS There was no difference between the prevalence of anxious traits and states and postpartum depression among seropositive and negative postpartum women for COVID-19. There was no difference in the prevalence of time and type of breastfeeding, and of normal and delayed neuropsychomotor development between seropositive and negative postpartum women for COVID-19. The fact that the baby smiles and raises and keeps his head elevated were associated with lower chances of an anxious state among postpartum women (OR: 0.23; OR: 0.28 and OR: 0.20, respectively). CONCLUSIONS The need for more studies to investigate the influence of the COVID-19 pandemic on the mental health of postpartum women, breastfeeding and the neuropsychomotor development of babies is highlighted, given the importance of breast milk for the growth and development of babies.
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Affiliation(s)
| | - Márcio Fronza
- Universidade de Vila Velha, Vila Velha, Espírito Santo, Brazil
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Becker E, Atkinson L, Gonzalez A, Khoury J. Social support buffers the impact of pregnancy stress on perceptions of parent-infant closeness during the COVID-19 pandemic. Infant Ment Health J 2024; 45:328-340. [PMID: 38196240 DOI: 10.1002/imhj.22096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
Pregnant individuals and parents have experienced elevated mental health problems and stress during COVID-19. Stress during pregnancy can be harmful to the fetus and detrimental to the parent-child relationship. However, social support is known to act as a protective factor, buffering against the adverse effects of stress. The present study examined whether (1) prenatal stress during COVID-19 was associated with parent-infant closeness at 6 months postpartum, and (2) social support moderated the effect of prenatal stress on the parent-infant relationship. In total, 181 participants completed questionnaires during pregnancy and at 6 months postpartum. A hierarchical linear regression analysis was conducted to assess whether social support moderated the effect of stress during pregnancy on parent-infant closeness at 6 months postpartum. Results indicated a significant interaction between prenatal stress and social support on parents' perceptions of closeness with their infants at 6 months postpartum (β = .805, p = .029); parents who experienced high prenatal stress with high social support reported greater parent-infant closeness, compared to those who reported high levels of stress and low social support. Findings underscore the importance of social support in protecting the parent-infant relationship, particularly in times of high stress, such as during the COVID-19 pandemic.
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Affiliation(s)
- Emma Becker
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Leslie Atkinson
- Department of Psychology, Metropolitan Toronto University, Toronto, Ontario, Canada
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Khoury
- Department of Psychology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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Obiakor GC, Banta JE, Sinclair RG, Baba Djara M, Mataya R, Wiafe S. The Impact of Social Determinants of Maternal Mental Health in Marginalized Mothers. J Womens Health (Larchmt) 2024; 33:650-661. [PMID: 38662499 DOI: 10.1089/jwh.2022.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Background: A deeper understanding of the key determinants of maternal mental health is important for improving care for women, especially women who are at an economic disadvantage. Objectives: To explore the associations of select social determinants: access, social support, and stress, with the onset of antepartum depression in low-income mothers. Participants: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, population-based surveillance system with selected data from 2016 to 2019, establishing a randomly selected sample of women with a recent live birth at most 4 months postdelivery, between 1,300 and 3,400 women per state (n ∼ 162,558). Methods: In this cross-sectional study, the phase 8 PRAMS was adapted to measure social support, access, stress, and their relationships with the onset of antepartum depression in low-income mothers. To assess low-income marginalization, a threshold was established based on income levels within 130% of the federal poverty level; antepartum (n ∼ 41,289). Results: The defined access, social support, and stress factors showed a statistically significant association with the onset of antepartum depression among low-income mothers. Of women in this sample, 22.6% indicated antepartum depression (p < 0.001; R2 = 0.066). Negative social support indicators were associated with an increased likelihood of antepartum depression; 3.71 increased odds of depression for abuse during pregnancy, and 0.79 decreased odds with positive acknowledgment of paternity. Access indicator terms showed an association with the decreased likelihood of antepartum depression through breastfeeding information support (Info from Baby Doc, odds ratio [OR] = 0.86), prenatal care utilization (12+ visits, OR = 0.82), and specific insurance type (insurance by job, OR = 0.82). All instances of stressful life events showed an increased likelihood of depression during pregnancy (for majority of stressful life events: OR >1.12). Conclusions: Economically marginalized mothers face unmet social and health care needs leading to poorer outcomes during pregnancy. These findings provide additional support for improved policy and public health efforts, such as assessment, education, and interventions, to decrease prevalence and improve treatment for antepartum depression among marginalized mothers.
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Affiliation(s)
- Gina C Obiakor
- Department of Health Policy and Leadership, School of Public Health, Loma Linda University, Loma Linda, California, USA
| | - Jim E Banta
- Department of Health Policy and Leadership, School of Public Health, Loma Linda University, Loma Linda, California, USA
| | - Ryan G Sinclair
- Department of Environmental Health, School of Public Health, Loma Linda University, Loma Linda, California, USA
| | - Monita Baba Djara
- Department of Global Health, School of Public Health, Loma Linda University, Loma Linda, California, USA
| | - Ronald Mataya
- Department of Global Health, School of Public Health, Loma Linda University, Loma Linda, California, USA
| | - Seth Wiafe
- Department of Health Policy and Leadership, School of Public Health, Loma Linda University, Loma Linda, California, USA
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Zivin K, Courant A. Disparities in Utilization and Delivery Outcomes for Women with Perinatal Mood and Anxiety Disorders. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2024; 9:e240003. [PMID: 38817312 PMCID: PMC11138136 DOI: 10.20900/jpbs.20240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Perinatal mood and anxiety disorders (PMAD), which include depression and/or anxiety in the year before and/or after delivery, are common complications of pregnancy, affecting up to one in four perinatal individuals, with costs of over $15 billion per year in the US. In this paper, we provide an overview of the disparities in utilization and delivery outcomes for individuals with perinatal mood and anxiety disorders in the US. In addition, we discuss the current US screening and treatment guidelines as well as the high societal costs of illness of PMAD for both perinatal individuals and children. Finally, we outline opportunities for quality improvement of PMAD care in the US, including leveraging increased engagement with healthcare system during prenatal care, working toward a more cohesive national strategy to address PMAD, leaning into evidence-based policymaking through collaboration with a panel of experts, and generating state-level profiles focused on PMAD.
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Affiliation(s)
- Kara Zivin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Program on Women’s Healthcare Effectiveness Research, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor MI 48109, USA
- VA Ann Arbor Healthcare System, Ann Arbor MI 48105, USA
| | - Anna Courant
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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Hays MJ, Kustes SR, Bjork EL. Metacognitive Management of Attention in Online Learning. J Intell 2024; 12:46. [PMID: 38667713 PMCID: PMC11051084 DOI: 10.3390/jintelligence12040046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 04/02/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Performance during training is a poor predictor of long-term retention. Worse yet, conditions of training that produce rapidly improving performance typically do not produce long-lasting, generalizable learning. As a result, learners and instructors alike can be misled into adopting training or educational experiences that are suboptimal for producing actual learning. Computer-based educational training platforms can counter this unfortunate tendency by providing only productive conditions of instruction-even if they are unintuitive (e.g., spacing instead of massing). The use of such platforms, however, introduces a different liability: being easy to interrupt. An assessment of this possible liability is needed given the enormous disruption to modern education brought about by COVID-19 and the subsequent widespread emergency adoption of computer-based remote instruction. The present study was therefore designed to (a) explore approaches for detecting interruptions that can be reasonably implemented by an instructor, (b) determine the frequency at which students are interrupted during a cognitive-science-based digital learning experience, and (c) establish the extent to which the pandemic and ensuing lockdowns affected students' metacognitive ability to maintain engagement with their digital learning experiences. Outliers in time data were analyzed with increasing complexity and decreasing subjectivity to identify when learners were interrupted. Results indicated that only between 1.565% and 3.206% of online interactions show evidence of learner interruption. And although classroom learning was inarguably disrupted by the pandemic, learning in the present, evidence-based platform appeared to be immune.
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Affiliation(s)
| | | | - Elizabeth Ligon Bjork
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095, USA;
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Critchlow E, Wodoslawsky S, Makhamreh MM, Rice SM, Turan OM, Firman B, McLaren R, Araji S, Al-Kouatly HB. Maternal outcomes of a cohort of pregnancies affected by non-immune hydrops fetalis. Int J Gynaecol Obstet 2024; 165:318-327. [PMID: 37897049 DOI: 10.1002/ijgo.15207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/09/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To describe the maternal outcomes of a prospective cohort of non-immune hydrops fetalis (NIHF) pregnancies with negative standard-of-care evaluations. METHODS This study was a secondary analysis of a prospective cohort study of NIHF pregnancies with negative work-ups (infection, alloimmune anemia, fetomaternal hemorrhage, and chromosomal disorders). Outcomes were obstetric complications, including pre-eclampsia, mirror syndrome, preterm birth, polyhydramnios, postpartum hemorrhage, and maternal mental health. RESULTS Forty pregnancies were included. Four patients developed pre-eclampsia (4/40, 10.0%); three occurred postpartum. None was diagnosed with mirror syndrome. Of the 31 continued pregnancies, 16 (51.6%) resulted in early fetal death or stillbirth and 15 (48.4%) resulted in live births. Of the 15 live births, 8 (53.3%) were delivered by primary cesarean delivery; 5 (62.5%) were for hydrops fetalis. Eleven live births (73.3%) were delivered preterm; 9 (81.8%) were indicated, most commonly for fetal indications (7/9, 77.8%). Polyhydramnios occurred in 14/40 (35.0%) cases. Where EBL was recorded (n=37), there were 5 (13.5%) cases of postpartum hemorrhage and an additional 3 (8.1%) had uterine atony without hemorrhage. Eighteen patients (18/40, 45.0%) had new-onset or exacerbated depression or anxiety symptoms. CONCLUSION Our study identified several important adverse outcomes of pregnancies complicated by NIHF with negative standard-of-care evaluations, including a high rate of postpartum pre-eclampsia and worsened mental health. We identified a higher rate of cesarean delivery and preterm birth, both primarily for fetal indications. We also observed the known relationship between polyhydramnios, hemorrhage, and atony, but noted that this risk included pregnancies concluding in dilation and evacuation. Counseling after a diagnosis of NIHF should include these adverse outcomes.
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Affiliation(s)
- Elizabeth Critchlow
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sascha Wodoslawsky
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mona M Makhamreh
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York, USA
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stephanie M Rice
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ozhan M Turan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Maryland, Baltimore, Maryland, USA
| | - Brandy Firman
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Rodney McLaren
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sara Araji
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Mississippi, Jackson, Mississippi, USA
| | - Huda B Al-Kouatly
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Johnson MS, Skjerdingstad N, Ebrahimi OV, Hoffart A, Johnson SU. Fear of giving birth alone: Experiences of psychological distress, symptoms of anxiety and depression, and coping- strategies of childbearing women during COVID-19. Midwifery 2024; 131:103951. [PMID: 38402661 DOI: 10.1016/j.midw.2024.103951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 12/23/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Psychological distress during pregnancy is a well-documented risk factor for adverse maternal outcomes. Distress related to the COVID-19 pandemic may further increase the vulnerability of pregnant women to negative mental health outcomes. AIM To explore the mental health experiences of pregnant women, focusing on mental health outcomes, challenges related to the pandemic, coping strategies, and factors buffering mental health factors during the restricted COVID-19 lockdown period. METHODS A mixed-methods survey study was conducted, examining symptoms of anxiety, depression, and burnout among 21 pregnant women. Qualitative data were gathered through open-ended questions about participants' experiences of challenges, coping strategies and buffering factors amid the pandemic. Symptoms of anxiety, depression and burnout were calculated, and qualitative data was thematically analyzed. RESULTS Approximately one-third (24 %) of the respondents reported clinically significant levels of depression, 19 % reported clinically significant levels of anxiety, and 43 % reported experiencing burnout. All participants reported distress and emotional burden, including fear, worry, stress and anxiety related to the pandemic. Specific concerns such as fear of giving birth alone, fear of the consequences due to lockdown restrictions, insufficient information, disruption of prenatal healthcare services, and fear of miscarriage were prevalent among the participants. Social support, financial stability, stable relationships, adherence to daily routines, reduced stress and social demands, a calmer daily life, physical activity, and less work-related stress including working from home, emerges as buffering factors that aided women in coping with pandemic-related distress. CONCLUSION Healthcare providers should prioritize stability, predictability, and minimizing disruptions to prenatal care. Broad-based screening is crucial to identify women at risk of depression, anxiety, and burnout. Recommendations for clinical pathways aimed at pregnant women are discussed.
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Affiliation(s)
- Miriam S Johnson
- Department of Behavioural Sciences, Oslo Metropolitan University, Oslo, Norway.
| | | | - Omid V Ebrahimi
- Department of Psychology, University of Oslo, Oslo, Norway; Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Asle Hoffart
- Department of Psychology, University of Oslo, Oslo, Norway; Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Sverre Urnes Johnson
- Department of Psychology, University of Oslo, Oslo, Norway; Modum Bad Psychiatric Hospital, Vikersund, Norway
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Ladak Z, Grewal N, Kim MO, Small S, Leber A, Hemani M, Sun Q, Hamza DM, Laur C, Ivers NM, Falenchuk O, Volpe R. Equity in prenatal healthcare services globally: an umbrella review. BMC Pregnancy Childbirth 2024; 24:191. [PMID: 38468220 PMCID: PMC10926563 DOI: 10.1186/s12884-024-06388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Timely, appropriate, and equitable access to quality healthcare during pregnancy is proven to contribute to better health outcomes of birthing individuals and infants following birth. Equity is conceptualized as the absence of differences in healthcare access and quality among population groups. Healthcare policies are guides for front-line practices, and despite merits of contemporary policies striving to foster equitable healthcare, inequities persist. The purpose of this umbrella review is to identify prenatal healthcare practices, summarize how equities/inequities are reported in relation to patient experiences or health outcomes when accessing or using services, and collate equity reporting characteristics. METHODS For this umbrella review, six electronic databases were searched (Medline, EMBASE, APA PsychInfo, CINAHL, International Bibliography of the Social Sciences, and Cochrane Library). Included studies were extracted for publication and study characteristics, equity reporting, primary outcomes (prenatal care influenced by equity/inequity) and secondary outcomes (infant health influenced by equity/inequity during pregnancy). Data was analyzed deductively using the PROGRESS-Plus equity framework and by summative content analysis for equity reporting characteristics. The included articles were assessed for quality using the Risk of Bias Assessment Tool for Systematic Reviews. RESULTS The search identified 8065 articles and 236 underwent full-text screening. Of the 236, 68 systematic reviews were included with first authors representing 20 different countries. The population focus of included studies ranged across prenatal only (n = 14), perinatal (n = 25), maternal (n = 2), maternal and child (n = 19), and a general population (n = 8). Barriers to equity in prenatal care included travel and financial burden, culturally insensitive practices that deterred care engagement and continuity, and discriminatory behaviour that reduced care access and satisfaction. Facilitators to achieve equity included innovations such as community health workers, home visitation programs, conditional cash transfer programs, virtual care, and cross-cultural training, to enhance patient experiences and increase their access to, and use of health services. There was overlap across PROGRESS-Plus factors. CONCLUSIONS This umbrella review collated inequities present in prenatal healthcare services, globally. Further, this synthesis contributes to future solution and action-oriented research and practice by assembling evidence-informed opportunities, innovations, and approaches that may foster equitable prenatal health services to all members of diverse communities.
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Affiliation(s)
- Zeenat Ladak
- University of Toronto, Toronto, Canada.
- Women's College Hospital Institute for Health System Solutions & Virtual Care, Toronto, Canada.
| | | | | | | | | | | | - Qiuyu Sun
- University of Alberta, Edmonton, Canada
| | | | - Celia Laur
- University of Toronto, Toronto, Canada
- Women's College Hospital Institute for Health System Solutions & Virtual Care, Toronto, Canada
| | - Noah M Ivers
- University of Toronto, Toronto, Canada
- Women's College Hospital Institute for Health System Solutions & Virtual Care, Toronto, Canada
- Women's College Hospital, Toronto, Canada
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13
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Fogarty A, Seymour M, Savopoulos P, Talevski T, Ruthven C, Giallo R. The COVID-19 pandemic and Australian parents with young children at risk of interparental conflict. J Reprod Infant Psychol 2024; 42:338-352. [PMID: 35650517 DOI: 10.1080/02646838.2022.2084055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The COVID-19 pandemic has created many challenges for families across the world, with those who have recently had a baby particularly vulnerable to increased stress Study Aim: The current study aimed to explore the experiences of the COVID-19 pandemic of families who have recently had a baby in Melbourne, Australia. METHODS Interviews were conducted with sixteen parents participating in a family-based intervention during early parenthood and seven clinicians who delivered the program. RESULTS Parents and clinicians described impacts of the pandemic on parent and family functioning included mental health concerns, stress and irritability, feelings of isolation, and increased relationship tension. Parents discussed coping strategies used during the crisis, including activities with their family, connecting with others, trying to stay positive, and self-care activities such as spending time outdoors. Both parents and clinicians acknowledged the importance of mental health and parenting support during and following the pandemic, and for these services to be promoted and easily accessible. DISCUSSION The study highlights the mental health and parenting support needs of families during times of crisis and emphasises the importance of early intervention for families exhibiting poor communication and relationship tension.
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Affiliation(s)
- Alison Fogarty
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Monique Seymour
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Priscilla Savopoulos
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Tom Talevski
- Family Foundations, Merri Health, Melbourne, Australia
| | | | - Rebecca Giallo
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Australia
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14
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Aydin E, Glasgow KA, Weiss SM, Austin T, Johnson MH, Barlow J, Lloyd-Fox S. Expectant parents' perceptions of healthcare and support during COVID-19 in the UK: a thematic analysis. J Reprod Infant Psychol 2024; 42:209-221. [PMID: 35579070 DOI: 10.1080/02646838.2022.2075542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/03/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND In response to the COVID-19 pandemic, expectant parents experienced changes in the availability and uptake of both National Health Service (NHS) community and hospital-based healthcare. OBJECTIVE To examine how COVID-19 and its societal related restrictions have impacted the provision of healthcare support for pregnant women during the COVID-19 pandemic. METHOD A thematic analysis using an inductive approach was undertaken using data from open-ended responses to the national COVID in Context of Pregnancy, Infancy and Parenting (CoCoPIP) Study online survey (n = 507 families). FINDINGS The overarching theme identified was the way in which the changes to healthcare provision increased parents' anxiety levels, and feelings of not being supported. Five sub-themes, associated with the first wave of the pandemic, were identified: (1) rushed and/or fewer antenatal appointments, (2) lack of sympathy from healthcare workers, (3) lack of face-to-face appointments, (4) requirement to attend appointments without a partner, and (5) requirement to use PPE. A sentiment analysis, that used quantitative techniques, revealed participant responses to be predominantly negative (50.1%), with a smaller proportion of positive (21.8%) and neutral (28.1%) responses found. CONCLUSION This study provides evidence indicating that the changes to healthcare services for pregnant women during the pandemic increased feelings of anxiety and have left women feeling inadequately supported. Our findings highlight the need for compensatory social and emotional support for new and expectant parents while COVID-19 related restrictions continue to impact on family life and society.
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Affiliation(s)
- Ezra Aydin
- Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Kevin A Glasgow
- Department of Education, University of Cambridge, Cambridge, UK
| | - Staci M Weiss
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Topun Austin
- The Rosie Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Mark H Johnson
- Department of Psychology, University of Cambridge, Cambridge, UK
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Jane Barlow
- Intervention, Department of Social Policy and Intervention, University of OxfordCentre for Evidence-Based, Oxford, UK
| | - Sarah Lloyd-Fox
- Department of Psychology, University of Cambridge, Cambridge, UK
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Mota-Pérez M, Huerta-Álvarez C, Llorente A, Cea-Soriano L. COVID-19 Distribution in Pregnancy, Drug Use Patterns and COVID-19 Medication during the Pandemic in Spain: Data from Real-World Electronic Health Records. Pharmaceuticals (Basel) 2024; 17:207. [PMID: 38399422 PMCID: PMC10892820 DOI: 10.3390/ph17020207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/04/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
Although pregnant women were considered a risk population for COVID-19, little is known of their drug use during the pandemic. We aimed to investigate COVID-19 distribution, drug use patterns and COVID-19 medication. We conducted a retrospective cohort of validated pregnancies aged 15-49 years, from January 2020 to December 2022, using the BIFAP database. An identified cohort of pregnant women with COVID-19 was matched by age, gestational age, length of pregnancy and outcome to a cohort free of COVID-19 (8413 vs. 24,975). We performed a descriptive analysis on COVID-19 cases, estimated the drug use patterns and assessed COVID-19-specific drugs within the week prior/after diagnosis, stratified by pandemic wave and gestational week. The results showed that 72% of pregnant women with COVID-19 received at least one prescription vs. 66.6% of those free of COVID-19, with analgesics, antibiotics and thyroid hormones being the most prescribed drugs in both groups. In the COVID-19 group, they were antithrombotics (40 prescriptions per 100 women), analgesic/NSAIDs (19.64/6.29) and antibiotics (6.95). COVID-19 cases gradually increased, peaking at the fifth and second waves. Prescription rates were similar when compared to pre-pandemic studies. The use of drugs compatible with COVID-19 treatments was in line with recommendations.
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Affiliation(s)
- Mercedes Mota-Pérez
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Complutense University of Madrid, Plaza Ramón y Cajal, s/n. Ciudad Universitaria, 28040 Madrid, Spain; (M.M.-P.); (L.C.-S.)
| | - Consuelo Huerta-Álvarez
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Complutense University of Madrid, Plaza Ramón y Cajal, s/n. Ciudad Universitaria, 28040 Madrid, Spain; (M.M.-P.); (L.C.-S.)
| | - Ana Llorente
- Base de datos para la Investigación Farmacoepidemiológica en el Ámbito Público (BIFAP), Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices (AEMPS), 28022 Madrid, Spain;
| | - Lucía Cea-Soriano
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Complutense University of Madrid, Plaza Ramón y Cajal, s/n. Ciudad Universitaria, 28040 Madrid, Spain; (M.M.-P.); (L.C.-S.)
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Fitzgerald L, McNab S, Njau P, Chandra P, Koyiet P, Levine R, Hardtman P, Stalls S. Beyond survival: Prioritizing the unmet mental health needs of pregnant and postpartum women and their caregivers. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002782. [PMID: 38315641 PMCID: PMC10843059 DOI: 10.1371/journal.pgph.0002782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Laura Fitzgerald
- MOMENTUM Country and Global Leadership, Jhpiego, Washington, District of Columbia, United States of America
| | - Shanon McNab
- MOMENTUM Country and Global Leadership, Jhpiego, Washington, District of Columbia, United States of America
| | | | - Prabha Chandra
- Department of Psychiatry, the National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Phiona Koyiet
- Global Technical Resource Team: Disaster Management, World Vision International, Nairobi, Kenya
| | - Rebecca Levine
- Global Health Practice, Palladium, Washington, District of Columbia, United States of America
| | - Pandora Hardtman
- Technical Leadership Office, Jhpiego, Baltimore, Maryland, United States of America
| | - Suzanne Stalls
- MOMENTUM Country and Global Leadership, Jhpiego, Washington, District of Columbia, United States of America
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Robbins N, Harvey K, Moller MD. Emotional Freedom Techniques for Postpartum Depression, Perceived Stress, and Anxiety. Nurs Womens Health 2024; 28:41-49. [PMID: 38103574 DOI: 10.1016/j.nwh.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/10/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To examine the effect of an Emotional Freedom Techniques (EFT) group intervention on perceived stress, depression, and anxiety symptoms in women in the postpartum period. DESIGN A one-group pre- and posttest quasi-experimental design. SETTING/LOCAL PROBLEM Postpartum depression (PPD) and anxiety affect nearly one in five women in the first 12 months after childbirth. The COVID-19 pandemic was associated with a significant worsening of symptoms of PPD, stress, and anxiety in this population. Mental health screening is the standard of care in perinatal settings. This practice has led to an increased rate of PPD and anxiety diagnoses and the need for evidence-based nonpharmacologic interventions to support mothers with PPD and anxiety. PARTICIPANTS Eleven mothers seeking care for lactation concerns who screened positive for PPD and anxiety symptoms. INTERVENTION/MEASUREMENTS A total of eight 1-hour group EFT sessions were offered to participants over a period of 4 weeks. During the group sessions, participants were taught how to perform the steps of EFT and apply it in a supportive group format. Measurement tools included the Subjective Unit of Distress Scale, Edinburgh Postnatal Depression Scale, and Generalized Anxiety Disorder-7. The preintervention and postintervention scores of these tools were compared using a paired-samples t test. RESULTS After implementing EFT as a group intervention, we observed a reduction in mental health burden experienced by women in the postpartum period. There was a statistically significant decrease in depression (p = .003), anxiety (p <.001), and perceived stress (p <.001) scores 1 month after the EFT intervention. CONCLUSION These findings suggest that EFT may be a viable adjunctive intervention for managing depression, anxiety, and stress in the postpartum period. Further research with larger and more diverse samples is needed to confirm these findings.
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Grech AM, Sharma S, Kizirian N, Gordon A. Impact of the COVID-19 pandemic on new parents enrolled in the 'BABY1000' birth cohort study in Sydney, Australia: A mixed-methods study. Aust N Z J Public Health 2024; 48:100127. [PMID: 38354625 DOI: 10.1016/j.anzjph.2024.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE The COVID-19 pandemic was, and continues to be, uniquely experienced by women in the perinatal period and their families. Whilst long-term impacts of the pandemic are unknown, exposures in pregnancy and early life have impacts across the life-course and future generations. The objective of this manuscript was to explore how the pregnancy, postpartum and parenting experiences of a subset of participants from the 'BABY1000' cohort in Sydney, Australia, were affected by the COVID-19 pandemic, and explore associations between these experiences and state anxiety. METHODS Mixed methods were used. Participants were requested to complete an online survey including the State-Trait Anxiety Inventory short form (STAI-6), followed by an invitation to participate in focus group discussions (FGDs). RESULTS From September to November 2021, 88 parents completed the survey (mean age 33.5 years, 60% born in Australia, 58% primiparous). Twenty-two parents participated in FGDs. Six themes were identified regarding the experience of parents: (1) Maternal support, (2) Family relationships, (3) Stress and mental health, (4) Healthcare, (5) Family lifestyle and routine, and (6) Long-term impacts. The mean STAI-6 score was 40 (SD 12.3), representing high anxiety. High anxiety was significantly associated with concern regarding COVID-19 and feeling overburdened and lonely. CONCLUSIONS The COVID-19 pandemic and associated public health orders significantly impacted participants' pregnancy, postpartum and parenting experiences. Whilst these experiences included some unexpected positives, for many, these were outweighed by negative impacts on mental health, social support, health behaviours, and family relationships. IMPLICATIONS FOR PUBLIC HEALTH Ongoing longitudinal research is imperative to identify potential long-term effects of the pandemic across the life-course, better support families in the short and long-term, and plan for public health crises in the future.
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Affiliation(s)
- Allison Marie Grech
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Sydney, Australia.
| | - Sweekriti Sharma
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, Sydney, Australia; Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Nathalie Kizirian
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Adrienne Gordon
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Sydney, Australia
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19
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Donelle L, Hiebert B, Hall J. An investigation of mHealth and digital health literacy among new parents during COVID-19. Front Digit Health 2024; 5:1212694. [PMID: 38333052 PMCID: PMC10850289 DOI: 10.3389/fdgth.2023.1212694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/29/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Especially during the COVID-19 pandemic, parents were expected to understand increasingly sophisticated information about health issues and healthcare systems and access online resources as a part of their caregiving role. Yet little is known about parents' online digital technology use and digital health literacy skill. This study aimed to investigate parents' digital technology use, their self-reported digital health literacy skill, and demographic information as potential factors influencing their use of digital technologies. Methods An online survey utilizing convenience sampling was administered to new parents during the COVID-19 pandemic that inquired about their demographic information, digital technology use, and digital health literacy skills within Ontario, Canada. Results A total of 151 individuals responded to the survey; these were primarily mothers (80%) who self-reported as white (72%), well-educated 86%), heterosexual (86%) females (85%) with incomes over $100,00 per year (48%). Participants reported consistent and persistent online activity related to their parenting role and mostly via mobile smartphone devices (92%). Participants had moderate to high digital health literacy skills, greater than the Canadian national average. Almost half of participants reported negative health and well-being consequences from their digital online behaviours. There were no significant relationships between technology use, digital health literacy skill, and demographic variables. Discussion The COVID-19 pandemic has reinforced the need for and importance of effective and equitable digital health services. Important opportunities exist within clinical practice and among parenting groups to proactively address the physical and mental health implications of digital parenting practices. Equally important are opportunities to insert into clinical workflow the inquiry into parents' online information-seeking behaviours, and to include digital health literacy as part of prenatal/postnatal health education initiatives.
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Affiliation(s)
- Lorie Donelle
- College of Nursing, University of South Carolina, Columbia, SC, United States
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Brad Hiebert
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Jodi Hall
- School of Nursing, Fanshawe College, London, ON, Canada
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20
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Matsunaga M, Okajima J, Furutani K, Kusakabe N, Nakamura-Taira N. Associations of rumination, behavioral activation, and perceived reward with mothers' postpartum depression during the COVID-19 pandemic: a cross-sectional study. Front Psychiatry 2024; 15:1295988. [PMID: 38317767 PMCID: PMC10838984 DOI: 10.3389/fpsyt.2024.1295988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction The COVID-19 pandemic has led to increased social isolation for mothers, and rumination exacerbates postpartum depression in mothers with poor social support. Although behavioral activation can help to decrease their depressive symptoms, the mechanism by which behavioral activation reduces postpartum depression remains unclear. Methods We examined the effects of rumination and behavioral activation on depression in postpartum women by examining a model mediated by subjective reward perception. A questionnaire was administered to 475 postpartum women (Age: Mean = 30.74 years, SD = 5.02) within 1 year of childbirth using an Internet survey. The measurements included perinatal depression, rumination, and behavioral activation, and we assessed environmental reward. To control for confounding variables, we assessed psychiatric history, social support, parenting perfectionism, and COVID-19 avoidance. Results Eighty-four (17.68%) mothers had possible postpartum depression. The covariance structure analysis showed that not only was there a direct positive path from rumination to postnatal depression but also a negative path via reward perception. Discussion This finding indicated that the COVID-19 pandemic could have increased depression in many of the mothers. Rumination not only directly relates to postpartum depression, but it could also indirectly relate to postpartum depression by decreasing exposure to positive reinforcers. In addition, having a history of psychiatric illness increases the effect of rumination on postpartum depression. These findings suggest that psychological interventions are needed to reduce rumination and increase contact with positive reinforcements to reduce postpartum depression, especially for high-risk groups.
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Affiliation(s)
- Miki Matsunaga
- Department of Psychology, Rikkyo University, Niiza, Japan
| | - Junko Okajima
- Department of Psychology, Rikkyo University, Niiza, Japan
| | | | - Noriko Kusakabe
- Department of Psychology, Faculty of Human Culture and Sciences, Fukuyama University, Fukuyama, Japan
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Rice K, Williams S. Partner Exclusion from Childbirth During COVID-19 in Canada: Implications for Theory and Policy. Med Anthropol 2024; 43:5-16. [PMID: 37870429 DOI: 10.1080/01459740.2023.2269467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
We explore partner exclusion from perinatal care in Canada during the COVID-19 pandemic. Participants' narratives show that pregnant couples frame partner presence as a [human] right that was denied, and articulated this as denial of the "right to experience" and the "right to care." These restrictions deprived birth partners and families of an experience that is important to them, and represent a repudiation of the resurgence of birth as a social event which entails valued forms of care. We show that the medical establishment's commitment to partner presence during perinatal care is weak, although caring masculinity is normative.
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Affiliation(s)
- Kathleen Rice
- Department of Family Medicine, McGill University, Montréal, Quebec, Canada
| | - Sarah Williams
- Anthropology and Gender Studies, Brown University, Providence, Rhode Island, USA
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Veldhuis CB, Kreski NT, Usseglio J, Keyes KM. Are Cisgender Women and Transgender and Nonbinary People Drinking More During the COVID-19 Pandemic? It Depends. Alcohol Res 2023; 43:05. [PMID: 38170029 PMCID: PMC10760999 DOI: 10.35946/arcr.v43.1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
PURPOSE This narrative review of research conducted during the first 2 years of the COVID-19 pandemic examines whether alcohol use among cisgender women and transgender and nonbinary people increased during the pandemic. The overarching goal of the review is to inform intervention and prevention efforts to halt the narrowing of gender-related differences in alcohol use. SEARCH METHODS Eight databases (PubMed, APA PsycInfo, CINAHL, Embase, Scopus, Gender Studies Database, GenderWatch, and Web of Science) were searched for peer-reviewed literature, published between March 2020 and July 2022, that reported gender differences or findings specific to women, transgender or nonbinary people, and alcohol use during the pandemic. The search focused on studies conducted in the United States and excluded qualitative research. SEARCH RESULTS A total 4,132 records were identified, including 400 duplicates. Of the remaining 3,732 unique records for consideration in the review, 51 were ultimately included. Overall, most studies found increases in alcohol use as well as gender differences in alcohol use, with cisgender women experiencing the most serious consequences. The findings for transgender and nonbinary people were equivocal due to the dearth of research and because many studies aggregated across gender. DISCUSSION AND CONCLUSIONS Alcohol use by cisgender women seems to have increased during the pandemic; however, sizable limitations need to be considered, particularly the low number of studies on alcohol use during the pandemic that analyzed gender differences. This is of concern as gender differences in alcohol use had been narrowing before the pandemic; and this review suggests the gap has narrowed even further. Cisgender women and transgender and nonbinary people have experienced sizable stressors during the pandemic; thus, understanding the health and health behavior impacts of these stressors is critical to preventing the worsening of problematic alcohol use.
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Affiliation(s)
- Cindy B Veldhuis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois
| | - Noah T Kreski
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - John Usseglio
- Augustus C. Long Health Sciences Library, Columbia Irving Medical Center, Columbia University, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Sadat BN, Zahra M, Fatemeh T. Identifying effective factors to alleviate postnatal distress and coronavirus anxiety in mothers of hospitalized preterm neonates. BMC Pregnancy Childbirth 2023; 23:838. [PMID: 38057744 DOI: 10.1186/s12884-023-06131-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 11/15/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Given the critical importance of mental health in mothers of preterm neonates during the postpartum period for Population Youth Programs, our research aims to ascertain the correlation between postnatal distress and corona-induced anxiety in women who have hospitalized preterm neonates. METHODS This descriptive-analytical study was conducted with a sample of 275 mothers of preterm neonates, were hospitalized in Gorgan city in 2020. Data collection was facilitated through the Corona Anxiety (CA) and Postnatal Distress Measured Scale (PDM). For data analysis, Spearman's correlation and univariate and multiple linear regression were employed. RESULTS The average age of the participating mothers was 28.61 ± 6.173 years, and the average gestational age of the neonates was 32.8 ± 2.89 weeks. The study found a significant, positive correlation between CA and PDM. Controlling for other variables through multiple regression analysis, the factors that significantly influenced PDM were employment status (β = 3.88, p < 0.01), education level (β = 1.96, p = 0.032), and gestational age (β=-0.60, p < 0.001). Furthermore, number of living children (β=-4.77, p = 0.01), education (β=-2.37, p = 0.01), and gestational age (β=-0.91, p < 0.001) were the factors that were significantly associated with CA scores. CONCLUSIONS The correlation between CA and PDM suggests that preterm neonate's mothers experienced increased anxiety during the pandemic. Considering the factors influencing these anxieties, targeted programs should be developed to enhance the mental health of these mothers in future pandemics. The finding that women with more children experienced less CA could serve as evidence of the positive impact of having children on the mental health of women with premature infants during a pandemic.
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Affiliation(s)
- Borghei Narjes Sadat
- Reproductive Health, Counseling and Reproductive Health Research Center, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mehrbakhsh Zahra
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
- Department of Biostatistics and Epidemiology, School of Health, Golestan University of Medical sciences, Gorgan, Iran.
| | - Torklalebaq Fatemeh
- Faculty of Nursing and Midwifery, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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24
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Harwood-Gross A, Bergman YS, Pat-Horenczyk R, Schiff M, Benbenishty R. Parenthood during the COVID-19 pandemic: Post-traumatic growth amongst university students. FAMILY PROCESS 2023; 62:1608-1623. [PMID: 36572646 PMCID: PMC9880650 DOI: 10.1111/famp.12847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 10/27/2022] [Accepted: 12/01/2022] [Indexed: 06/18/2023]
Abstract
This study sought to investigate a positive dimension of coping with the COVID-19 pandemic, that of post-traumatic growth (PTG). This study investigated coping difficulties and PTG amongst parent and nonparent students in Israeli Universities. A total of 4022 parents (3648 Jews and 374 Palestinian-Arab Citizens [PACs]) and 14,651 nonparents (12,010 Jews and 2641 PACs) completed measures of coping, social support and PTG. Parents demonstrated significantly higher levels of coping and PTG. Amongst parents, fathers coped slightly better than mothers; however, while Jewish mothers demonstrated greater PTG than Jewish fathers, PAC fathers had significantly greater PTG than both PAC mothers and Jewish parents. These findings, while specific to COVID-19, indicate that PTG should be studied in greater depth in different ethnic and minority groups in order to develop enhanced understanding and facilitate promotion of post-traumatic growth, in addition to the prevention of COVID-19-related distress.
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Affiliation(s)
- Anna Harwood-Gross
- Hebrew University of Jerusalem, Jerusalem, Israel
- Metiv, Israel Psychotrauma Center, Herzog Medical Center, Jerusalem, Israel
| | | | | | | | - Rami Benbenishty
- Hebrew University of Jerusalem, Jerusalem, Israel
- Andres Bello National University, Santiago, Chile
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Ibiwoye OH, Thomson G. COVID-19 pandemic and perinatal mental health: A commentary on the impact, risk factors, and protective factors. Birth 2023; 50:651-656. [PMID: 37455498 DOI: 10.1111/birt.12747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/31/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
In summary, birthing women are at risk of poor mental health particularly in a pandemic. Identified protective factors such as social support, good sleep, exercise, and access to prenatal care, among others are pertinent to reducing negative effects on perinatal mental health should future crises occur.
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Affiliation(s)
- Oluwaseun Helen Ibiwoye
- University of Central Lancashire, Preston, UK
- NIHR Applied Research Collaboration - Northwest Coast (ARC-NWC), Manchester, UK
| | - Gill Thomson
- Maternal and Infant Nutrition & Nurture Unit, School of Community Health & Midwifery, University of Central Lancashire, Preston, UK
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Bradley H, Fine D, Minai Y, Gilabert L, Gregory K, Smith L, Gao W, Giase G, Krogh-Jespersen S, Zhang Y, Wakschlag L, Brito NH, Feliciano I, Thomason M, Cabral L, Panigrahy A, Potter A, Cioffredi LA, Smith BA. Maternal perceived stress and infant behavior during the COVID-19 pandemic. Pediatr Res 2023; 94:2098-2104. [PMID: 37500757 PMCID: PMC10665182 DOI: 10.1038/s41390-023-02748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/07/2023] [Accepted: 07/09/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Maternal stress has negative consequences on infant behavioral development, and COVID-19 presented uniquely stressful situations to mothers of infants born during the pandemic. We hypothesized that mothers with higher levels of perceived stress during the pandemic would report higher levels of infant regulatory problems including crying and interrupted sleep patterns. METHODS As part 6 sites of a longitudinal study, mothers of infants born during the pandemic completed the Perceived Stress Scale, the Brief Infant Sleep Questionnaire, and an Infant Crying survey at 6 (n = 433) and 12 (n = 344) months of infant age. RESULTS Maternal perceived stress, which remained consistent at 6 and 12 months of infant age, was significantly positively correlated with time taken to settle infants. Although maternal perceived stress was not correlated with uninterrupted sleep length, time taken to put the infant to sleep was correlated. Perceived stress was also correlated with the amount of infant crying and fussiness reported at 6 months. CONCLUSIONS Mothers who reported higher levels of perceived stress during the pandemic reported higher levels of regulatory problems, specifically at 6 months. Examining how varying levels of maternal stress and infant behaviors relate to overall infant developmental status over time is an important next step. IMPACT Women giving birth during the COVID-19 pandemic who reported higher levels of stress on the Perceived Stress Scale also reported higher levels of infant fussiness and crying at 6 months old, and more disruptive sleep patterns in their infants at 6 months and 12 months old. Sleeping problems and excessive crying in infancy are two regulatory problems that are known risk factors for emotional and behavioral issues in later childhood. This paper is one of the first studies highlighting the associations between maternal stress and infant behaviors during the COVID-19 pandemic.
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Affiliation(s)
- Holly Bradley
- Developmental Behavioral Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Dana Fine
- Developmental Behavioral Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Yasmin Minai
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, USA
| | - Laurel Gilabert
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, USA
| | - Kimberly Gregory
- Cedars-Sinai Medical Center, Department of Obstetrics and Gynecology, Los Angeles, CA, USA
| | - Lynne Smith
- Harbor-UCLA Medical Center Department of Pediatrics, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Wei Gao
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute, Los Angeles, CA, USA
| | - Gina Giase
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | | | - Yudong Zhang
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Lauren Wakschlag
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Natalie H Brito
- Department of Applied Psychology, New York University, New York, NY, USA
| | - Integra Feliciano
- Department of Child and Adolescent Psychiatry, New York University, New York, NY, USA
| | - Moriah Thomason
- Department of Child and Adolescent Psychiatry, New York University, New York, NY, USA
| | - Laura Cabral
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ashok Panigrahy
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alexandra Potter
- University of Vermont Medical Center, Psychiatry, Burlington, VT, USA
| | - Leigh-Anne Cioffredi
- Department of Pediatrics, University of Vermont Medical Center, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Beth A Smith
- Developmental Behavioral Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA.
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA.
- Department of Pediatrics, University of Southern California, Los Angeles, CA, USA.
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Ba Z, Li Y, Ma J, Qin Y, Tian J, Meng Y, Yi J, Zhang Y, Chen F. Reflections on the dynamic zero-COVID policy in China. Prev Med Rep 2023; 36:102466. [PMID: 38116286 PMCID: PMC10728318 DOI: 10.1016/j.pmedr.2023.102466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/07/2023] [Accepted: 10/07/2023] [Indexed: 12/21/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has posed a serious threat to global healthcare and economy. In order to curb its spread, China adopted the dynamic zero-COVID policy, aiming to diagnose and isolate cases and close contacts as soon as possible. However, there is a controversy about the impact of isolation measures on social order, including the economy, personal employment and public mental health. Therefore, this review discusses and analyzes in detail the advantages and challenges of implementing dynamic zero-COVID policy. Although this public health policy might cause a shock to the economy in the short term, China still achieved a continued healthy economic performance with stable unemployment and strong export growth. Moreover, the rates of infection and mortality in China were lower than those in the United States and the European Union. However, due to the high transmissibility and low pathogenicity of the Omicron variant and prolonged lockdown-induced psychological damage, people questioned the effectiveness and necessity of this policy. Now that China has adjusted its policy in a timely manner, but many problems still remain unsolved. Some practical suggestions in terms of mental health, vaccine development, drugs supply, and economic recovery are put forward at the end of our paper to minimize negative impacts and provide a reference for future efforts.
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Affiliation(s)
- Zaihua Ba
- Jining Medical University, 133 Hehua Rd, Jining 272067, China
| | - Yuqi Li
- Jining Medical University, 133 Hehua Rd, Jining 272067, China
| | - Jiao Ma
- Jining Medical University, 133 Hehua Rd, Jining 272067, China
| | - Yining Qin
- Jining Medical University, 133 Hehua Rd, Jining 272067, China
| | - Jinzhu Tian
- Jining Medical University, 133 Hehua Rd, Jining 272067, China
| | - Yixiang Meng
- Jining Medical University, 133 Hehua Rd, Jining 272067, China
| | - Jiarong Yi
- Jining Medical University, 133 Hehua Rd, Jining 272067, China
| | - Yingze Zhang
- Jining Medical University, 133 Hehua Rd, Jining 272067, China
| | - Fei Chen
- Jining Medical University, 133 Hehua Rd, Jining 272067, China
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Futterman ID, Grace H, Weingarten S, Borjian A, Clare CA. Maternal anxiety, depression and posttraumatic stress disorder (PTSD) after natural disasters: a systematic review. J Matern Fetal Neonatal Med 2023; 36:2199345. [PMID: 37031972 DOI: 10.1080/14767058.2023.2199345] [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: 04/11/2023]
Abstract
OBJECTIVE To measure the prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) in those exposed to natural disasters. METHODS A literature search of the PubMed database and www.clinicaltrials.gov from January 1990 through June 2020 was conducted. A PRISMA review of the available literature regarding the incidence and prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) following natural disasters was performed. A natural disaster was defined as one of the following: pandemic, hurricane, earthquake and post-political conflict/displacement of people. Studies were selected that were population-based, prospective or retrospective. Case reports and case series were not used. The primary outcome was the prevalence of maternal anxiety, depression and PTSD in the post-disaster setting. Two independent extractors (I.F. & H.G.) assessed study quality using an adapted version of the Effective Public Health Practice Project Quality Assessment tool. Given the small number of studies that met inclusion criteria, all 22 studies were included, regardless of rating. Data were extracted and aggregate rates of depression, anxiety, and PTSD were calculated to provide synthesized rates of maternal mental health conditions among participants. RESULTS Twenty-two studies met the inclusion criteria. A total of 8357 pregnant or birthing persons in the antepartum and postpartum periods were studied. The prevalence of post-pandemic anxiety, depression and PTSD were calculated to be 48.2%, 27.3%, and 22.9%. Post-earthquake depression and PTSD rates were 38.8% and 22.4%. The prevalence of post-hurricane anxiety, depression and PTSD were 17.4%, 22.5%, and 8.2%. The rates of post-political conflict anxiety, depression and PTSD were 48.8%, 31.6% and 18.5%. CONCLUSION Given the high rates of anxiety, depression and PTSD among pregnant and birthing persons living through the challenges of natural disasters, obstetrician-gynecologists must be able to recognize this group of patients, and provide a greater degree of psychosocial support.
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Affiliation(s)
- Itamar D Futterman
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Holly Grace
- School of Medicine, New York Medical College, NY, USA
| | - Sarah Weingarten
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
| | - Alborz Borjian
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
| | - Camille A Clare
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
- School of Medicine, New York Medical College, NY, USA
- New York City Health + Hospitals/Metropolitan, NY, USA
- Department of Obstetrics and Gynecology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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29
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Schulz JM, Marmura H, Hewitt CM, Parkinson LJ, Thornton JS. Navigating the 'new normal': what guidelines exist for postpartum return to physical activity and sport? A scoping review. Br J Sports Med 2023; 57:1573-1578. [PMID: 37898507 DOI: 10.1136/bjsports-2023-107166] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE Women are often advised to return to activity (RTA) as early as 6 weeks postpartum, despite undergoing significant physical, physiological and psychological changes. Our objective was to examine existing evidence and clinical practice guidelines to navigate a safe and successful RTA or return to sport (RTS) postpartum. METHODS We searched CINAHL, Embase, Medline, PsycINFO and SPORTDiscus and included any secondary studies with recommendations or guidelines for RTA or RTS postpartum. Grey literature and primary sources were excluded. Four reviewers independently screened titles and abstracts, followed by full-text review for eligibility, with conflicts resolved by a third-party reviewer. One reviewer extracted data, which was cross-referenced by another reviewer. RESULTS 5851 studies were screened, and 33 were included in this scoping review. Most studies stated that RTS postpartum can begin once 'medically safe', around 6 weeks postpartum, but this term was generally left undefined. In addition, most studies recommended engaging in 150 min of moderate-vigorous physical activity per week after 6 weeks postpartum, but the type of exercise recommended was often non-specific. CONCLUSION A lack of consistent, evidence-based guidelines exist for RTA or RTS postpartum. Multiple evidence gaps require additional research to inform patient and activity specific guidelines for a safe and successful RTA or RTS postpartum.
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Affiliation(s)
- Jenna M Schulz
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Fowler-Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Bone & Joint Institute, Western University, London, Ontario, Canada
| | - Hana Marmura
- Fowler-Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Bone & Joint Institute, Western University, London, Ontario, Canada
- Department of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Chloe M Hewitt
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Laura J Parkinson
- Department of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jane S Thornton
- Fowler-Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Bone & Joint Institute, Western University, London, Ontario, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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30
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Butler MS, Smart BP, Watson EJ, Narla SS, Keenan-Devlin L. U.S. Breastfeeding Outcomes at the Intersection: Differences in Duration Among Racial and Ethnic Groups With Varying Educational Attainment in a Nationally Representative Sample. J Hum Lact 2023; 39:722-732. [PMID: 37522342 DOI: 10.1177/08903344231186786] [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] [Indexed: 08/01/2023]
Abstract
BACKGROUND As breastfeeding rates in the United States increase, barriers persist for Black, Latine, and low-socioeconomic status household dyads when compared to White and high-socioeconomic status household dyads. Previous breastfeeding disparities research has almost exclusively considered the influence of race, ethnicity, and socioeconomic status separately, although these attributes are not randomly distributed across the population. RESEARCH AIM To identify breastfeeding duration patterns by race/ethnicity and educational attainment in a nationally representative U.S. National Immunization Survey sample. METHOD We conducted a cross-sectional, secondary analysis of the U.S. Centers for Disease Control and Prevention's 2020 National Immunization Survey-Child public-use data. To examine breastfeeding and exclusive breastfeeding durations at the intersection of race/ethnicity and educational attainment, we created a 12-item, cross-classified variable using three educational attainment groups and four race/ethnicity groups. We used linear regressions to test these associations. RESULTS In all, 83% of the sample breastfed. Mean durations of breastfeeding were 7.5 (SE = 1.95) months and exclusive breastfeeding duration was 4.9 (SE = 0.87) months. In adjusted models, multi-race/other high-educational attainment participants had the longest breastfeeding duration by almost 3 weeks (β: 19.53, 95% CI [5.27, 33.79]), and Black low-educational attainment participants exclusively breastfed for 1 month less than White high-educational attainment participants (β:-30.23, 95% CI [-40.87, -19.58]). CONCLUSIONS Examining race/ethnicity and educational attainment together provides an intersectional understanding of breastfeeding outcomes and can inform targeted, culturally appropriate interventions.
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Affiliation(s)
- Margaret S Butler
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Britney P Smart
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA
| | - Elijah J Watson
- Department of Anthropology, Northwestern University, Evanston, IL, USA
| | - Shreya S Narla
- Department of Neurobiology, Northwestern University, Evanston, IL, USA
| | - Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL, USA
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Garcia-Leon MA, Martin-Tortosa PL, Cambio-Ledesma A, Caparros-Gonzalez RA. The COVID-19 Pandemic and Psychopathological symptoms in pregnant women in Spain. J Reprod Infant Psychol 2023; 41:503-515. [PMID: 35261321 DOI: 10.1080/02646838.2022.2047623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, pregnant women are exposed to potentially harmful stressors that might affect their health. The direct consequences that SARS-CoV-2 may have on perinatal mental health are still unknown. OBJECTIVE The present study aimed to explore the impact of the COVID-19 pandemic on psychopathological symptoms in a sample of Spanish pregnant women. METHODS A sample of 186 pregnant women was assessed using the revised Symptoms Check List-90 during the first lockdown in Spain. RESULTS The results showed clinical scores on the obsession and compulsion, anxiety and phobic anxiety subscales, as well as on the severity indexes. Phobic anxiety was the only variable that was inversely correlated with age and the number of previous miscarriages. A linear regression model showed that age was inversely associated with phobic anxiety scores. A younger age was associated with higher levels of phobic anxiety symptoms. CONCLUSIONS Our results indicated that younger pregnant women and women in the first trimester of pregnancy were more vulnerable to the effects of stress and concerns about COVID-19.
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Affiliation(s)
- Maria Angeles Garcia-Leon
- FIDMAG Sisters Hospitallers Research Foundation, Barcelona, Spain
- Mind, Brain and Behaviour Research Center, University of Granada, Granada, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Rafael A Caparros-Gonzalez
- Nursing Department, Faculty of Health Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
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Durmaz A, Gun Kakasci C. Investigation of the Relationship Between COVID-19 Anxiety and Perception of Risk in Pregnancy, Fears of Death and Losing Their Baby in the Pandemic. OMEGA-JOURNAL OF DEATH AND DYING 2023; 88:347-363. [PMID: 35726590 DOI: 10.1177/00302228221110328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of the study was to determine Covid-19 anxiety, obsession, perception of risk and self-care agency levels of pregnant women during the pandemic and investigate the association between Covid-19 anxiety, obsession, perception of risk and self-care agency levels and the fears of death and losing their baby in the pregnant women. The study was a cross-sectional and descriptive study. Five hundred thirty-eight pregnant women were included in the study. "COVID-19 Anxiety Scale," "COVID-19 Obsession Scale," "Risk Perception in Pregnancy Scale," and "The Exercise of Self-Care Agency Scale" were used to collect data of the study. In this study, the total Cronbach's alpha reliability coefficients of the COVID-19 Anxiety Scale, COVID-19 Obsession Scale, The Perception of Pregnancy Risk Questionnaire, The Exercise of Self-Care Agency Scale were found to be 0.73, 0.70, 0.86 and 0.95 respectively. Statistical analysis of data in the study was conducted using SPSS (22.0, IBM Corp. Armonk, NY) statistical program. Statistically significant differences were identified between the mean score from COVID-19 anxiety scale and the mean scores from COVID-19 obsession scale, the perception of pregnancy risk questionnaire and the exercise of self-care agency scale. These results suggest that education and health policies that focus on the health of pregnant women and their fetus should be developed for antenatal care services.
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Affiliation(s)
- Aysegul Durmaz
- Department of Midwifery, Faculty of Health Sciences, Kutahya Health Sciences University, Kutahya, Turkey
| | - Ciğdem Gun Kakasci
- Department of Midwifery, Faculty of Health Sciences, Suleyman Demirel University, Isparta, Turkey
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Ciolac L, Craina ML, Enatescu VR, Tudor A, Bernad ES, Nitu R, Hogea L, Boscu L, Bernad BC, Timircan MO, Ciolac V, Nediglea CO, Maghiari AL. The Impact of the COVID-19 Pandemic on Depressive Disorder with Postpartum Onset: A Cross-Sectional Study. Healthcare (Basel) 2023; 11:2857. [PMID: 37958002 PMCID: PMC10648077 DOI: 10.3390/healthcare11212857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND COVID-19 has led to a global health crisis that is defining for our times and one of the greatest challenges to emerge since World War II. The potential impact of the pandemic on mental health should not be overlooked, especially among vulnerable populations such as women who gave birth during the COVID-19 pandemic. MATERIALS AND METHODS The study is a cross-sectional survey conducted from 1 March 2020 to 1 March 2023, during the period of the SARS-CoV-2 (COVID-19) pandemic, based on a retrospective evaluation of 860 postpartum women. The screening tool used to assess symptoms of postpartum depression was the Edinburgh Postnatal Depression Rating Scale (EPDS) questionnaire. The questionnaire was completed both in the Obstetrics and Gynaecology Clinical Sections I and II of the "Pius Brînzeu" County Emergency Hospital in Timisoara, Romania, and online using Google Forms. RESULTS The highest severity of postpartum depression symptoms was observed during the COVID-19 pandemic. The results of the study conducted during the period of the SARS-CoV-2 pandemic (COVID-19) showed that the prevalence of major postpartum depressive disorder (EPDS ≥ 13) was 54.2% (466 patients), while 15.6% (134) had minor depressive disorder (10 < EPDS ≤ 12) in the first year after delivery. Comparing these results with those obtained in research conducted before the onset of the pandemic period showed an alarming increase in the prevalence of postpartum depression. The risk factors associated with postpartum depression included the type of delivery, level of education, socio-economic conditions, health status, age, background, and personal obstetric history (number of abortions on demand, parity). CONCLUSIONS The effects of the pandemic on mental health are of particular concern for women in the first year after childbirth. Observing these challenges and developing effective measures to prepare our health system early can be of great help for similar situations in the future. This will help and facilitate effective mental health screening for postpartum women, promoting maternal and child health.
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Affiliation(s)
- Livia Ciolac
- Department of Obstetrics and Gynecology, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (L.C.); (M.L.C.); (E.S.B.); (R.N.); (M.O.T.)
- Doctoral School, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Marius Lucian Craina
- Department of Obstetrics and Gynecology, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (L.C.); (M.L.C.); (E.S.B.); (R.N.); (M.O.T.)
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Virgil Radu Enatescu
- Psychiatric Clinic, “Pius Brinzeu” Emergency County Hospital, 156 Liviu Rebreanu Blvd., 300723 Timisoara, Romania;
- Department of Neuroscience, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
| | - Anca Tudor
- Discipline of Computer Science and Medical Biostatistics, University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Research Center in Dental Medicine Using Conventional and Alternative Technologies, School of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy of Timisoara, 9 Revolutiei 1989 Ave., 300070 Timisoara, Romania
| | - Elena Silvia Bernad
- Department of Obstetrics and Gynecology, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (L.C.); (M.L.C.); (E.S.B.); (R.N.); (M.O.T.)
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Razvan Nitu
- Department of Obstetrics and Gynecology, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (L.C.); (M.L.C.); (E.S.B.); (R.N.); (M.O.T.)
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Lavinia Hogea
- Department of Neuroscience, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Center for Neuropsychology and Behavioral Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Lioara Boscu
- Doctoral School, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Senate Office, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Brenda-Cristiana Bernad
- Doctoral School, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Department of Neuroscience, “Victor Babes” University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania;
- Center for Neuropsychology and Behavioral Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Madalina Otilia Timircan
- Department of Obstetrics and Gynecology, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (L.C.); (M.L.C.); (E.S.B.); (R.N.); (M.O.T.)
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Valeria Ciolac
- Department of Sustainable Development and Environmental Engineering, University of Life Sciences “King Michael I”, 300645 Timisoara, Romania;
| | - Cristian-Octavian Nediglea
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu”, 325100 Timisoara, Romania;
| | - Anca Laura Maghiari
- Department of Anatomy and Embryology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
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White LK, Himes MM, Waller R, Njoroge WFM, Chaiyachati BH, Barzilay R, Kornfield SL, Burris HH, Seidlitz J, Parish-Morris J, Brady RG, Gerstein ED, Laney N, Gur RE, Duncan AF. The Influence of Pandemic-Related Worries During Pregnancy on Child Development at 12 Months. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01605-x. [PMID: 37805964 PMCID: PMC10999505 DOI: 10.1007/s10578-023-01605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023]
Abstract
The COVID-19 pandemic has been linked to increased risk for perinatal anxiety and depression among parents, as well as negative consequences for child development. Less is known about how worries arising from the pandemic during pregnancy are related to later child development, nor if resilience factors buffer negative consequences. The current study addresses this question in a prospective longitudinal design. Data was collected from a sub-study (n = 184) of a longitudinal study of pregnant individuals (total n = 1173). During pregnancy (April 17-July 8, 2020) and the early postpartum period (August 11, 2020-March 2, 2021), participants completed online surveys. At 12 months postpartum (June 17, 2021-March 23, 2022), participants completed online surveys and a virtual laboratory visit, which included parent-child interaction tasks. We found more pregnancy-specific pandemic worries were prospectively related to lower levels of child socioemotional development based on parent report (B = - 1.13, SE = .43, p = .007) and observer ratings (B = - 0.13, SE = .07, p = .045), but not to parent-reported general developmental milestones. Parental emotion regulation in the early postpartum period moderated the association between pregnancy-specific pandemic worries and child socioemotional development such that pregnancy-specific pandemic worries did not relate to worse child socioemotional development among parents with high (B = - .02, SE = .10, t = - .14, p = .89) levels of emotion regulation. Findings suggest the negative consequences of parental worry and distress during pregnancy on the early socioemotional development of children in the context of the COVID-19 pandemic. Results highlight that parental emotion regulation may represent a target for intervention to promote parental resilience and support optimized child development.
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Affiliation(s)
- Lauren K White
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA.
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Megan M Himes
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA
| | - Rebecca Waller
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Wanjikũ F M Njoroge
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA
- Policy Lab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara H Chaiyachati
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA
- Policy Lab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Ran Barzilay
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sara L Kornfield
- Department of Psychiatry, Perelman School of Medicine, Penn Center for Women's Behavioral Wellness, University of Pennsylvania, Philadelphia, PA, USA
| | - Heather H Burris
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Jakob Seidlitz
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA
| | - Julia Parish-Morris
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca G Brady
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Emily D Gerstein
- Department of Psychological Sciences, University of Missouri-St. Louis, 325 Stadler Hall, 1 University Blvd., St. Louis, MO, USA
| | - Nina Laney
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA
| | - Raquel E Gur
- Lifespan Brain Institute, 3400 Spruce St. 10th floor, Gates Pavilion, Philadelphia, PA, 19104, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea F Duncan
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
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MacNeil M, Campbell-Yeo M, McCulloch H, Hughes B, Dol J, Marriott N, Smith V, Alcock L. Parental Perspectives on Impact of Parental Presence Restrictions in the Neonatal Intensive Care Unit During the COVID-19 pandemic: A Cross-Sectional Study. J Perinat Neonatal Nurs 2023; 37:E17-E23. [PMID: 37773590 DOI: 10.1097/jpn.0000000000000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
PURPOSE To describe parental experiences in the neonatal intensive care unit (NICU) during the COVID-19 restrictions. We explore what parents found most challenging, the impact these restrictions had on them and their infant, and how they coped. METHODS A cross-sectional online survey was completed by parents of infants who required care in a Canadian NICU during the early period of the COVID-19 pandemic. Data from 3 questions were coded using thematic analysis. RESULTS Participants ( n = 161) were primarily mothers (93%), with an average length of stay of 32.1 days. Three themes were identified from responses: (1) emotional and physical closeness of the parents to their infant; (2) physical and psychosocial well-being of the infant and parent; and (3) how parents coped, and strategies for moving forward. Parents reported that parental restriction policies adversely impacted their perceived physical and emotional closeness with their infant and their infant's physical and psychosocial well-being. Parents reported that being able to be present with their infant, having their partner able to be present with them, and effective communication helped them cope. CONCLUSION Despite the need for some restrictive policies to control the spread of the virus, the benefits and risks to the overall well-being of the parents and infants must be weighed.
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Affiliation(s)
- Morgan MacNeil
- School of Nursing, Faculty of Health (Mss MacNeil and Hughes and Dr Campbell-Yeo), and Departments of Pediatrics, Psychology and Neuroscience (Dr Campbell-Yeo), Dalhousie University, Halifax, Nova Scotia, Canada; IWK Health, Halifax, Nova Scotia, Canada (Mss MacNeil, McCulloch, Hughes, Marriott, Smith, and Alcock and Drs Campbell-Yeo and Dol); Department of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada (Ms Hughes); and Mothering Transitions Research Lab, St Michael's Hospital, Toronto, Ontario, Canada (Dr Dol)
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Tsoneva K, Chechko N, Losse E, Nehls S, Habel U, Shymanskaya A. Pandemic-induced increase in adjustment disorders among postpartum women in Germany. BMC Womens Health 2023; 23:486. [PMID: 37700310 PMCID: PMC10498631 DOI: 10.1186/s12905-023-02638-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND The current paper analyzed the effect of the pandemic-induced lockdown on maternal mental health during the first 12 postpartum weeks in Germany. METHODS In this cohort study, we compared the participants' anamnestic backgrounds and the results of psychological tests, measuring stress levels, depressive symptoms and attachment. The 327 participants were divided into two groups with one representing the "pre-COVID" sample and the other the "lockdown" sample. We performed multiple comparisons, investigating the distribution of diagnoses and the correlating risk profiles between the two cohorts. RESULTS Our analysis showed a significant difference between the two cohorts, with a 13.2% increase in the prevalence of adjustment disorders (AD), but not postpartum depression (PPD), in the first 12 weeks postpartum. However, during the pandemic, women with AD had fewer risk factors compared to their pre-pandemic counterparts. In the "lockdown" cohort, a tendency toward higher stress and lower mother-child attachment was observed in AD. CONCLUSIONS In sum, we observed some negative impact of the pandemic on maternal mental health. The lockdown might have contributed to an increase in the number of cases involving AD in the postpartum period. The prevalence of PPD (ca. 6-10%), on the other hand, was not affected by the lockdown. Thus, the effect of COVID-19 on maternal mental health might not, after all, have been as severe as assumed at the beginning of the pandemic.
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Affiliation(s)
- K Tsoneva
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - N Chechko
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
- Institute of Neuroscience and Medicine, JARA-BRAIN Institute Brain Structure and Function, Jülich Research Centre, INM-10, Jülich, Germany.
- Institute of Neuroscience and Medicine, Brain & Behavior (INM-7), Research Center Jülich, Jülich, Germany.
| | - E Losse
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - S Nehls
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Neuroscience and Medicine, JARA-BRAIN Institute Brain Structure and Function, Jülich Research Centre, INM-10, Jülich, Germany
| | - U Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- Institute of Neuroscience and Medicine, JARA-BRAIN Institute Brain Structure and Function, Jülich Research Centre, INM-10, Jülich, Germany
| | - A Shymanskaya
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
- Institute of Neuroscience and Medicine, JARA-BRAIN Institute Brain Structure and Function, Jülich Research Centre, INM-10, Jülich, Germany.
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Deindl P, Witting A, Dür M, Berger A, Klebermass-Schrehof K, Singer D, Giordano V, Fuiko R. Perceived stress of mothers and fathers on two NICUs before and during the SARS-CoV-2 pandemic. Sci Rep 2023; 13:14540. [PMID: 37666877 PMCID: PMC10477236 DOI: 10.1038/s41598-023-40836-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023] Open
Abstract
Parents of very low birth weight (VLBW) infants in a neonatal intensive care unit experienced additional stress during the SARS-CoV-2 pandemic due to the related restrictions in hospital visiting policies. Our study aimed to compare parents' burdens before and during the pandemic. This survey included 121 parents of 76 VLBW infants in two European Level IV perinatal centers before and during the pandemic. We performed standardized parent questionnaires with mothers and fathers separately to evaluate their emotional stress and well-being. The pandemic worsened the emotional well-being of parents of VLBW infants, particularly of mothers. During the pandemic, mothers reported significantly higher state anxiety levels (48.9 vs. 42.9, p = 0.026) and hampered bonding with the child (6.3 vs. 5.2, 0 = 0.003) than before. In addition, mothers felt more personally restricted than fathers (6.1 vs. 5.2, p = 0.003). Fathers experienced lower levels of stress than mothers; they were equally burdened before and during the pandemic. Restrictions in visiting policies for families of VLBW infants during the SARS-CoV-2 pandemic have a significant negative impact on parental stress and should therefore be applied cautiously.
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Affiliation(s)
- Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Witting
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Mona Dür
- Duervation, Krems, Austria
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Katrin Klebermass-Schrehof
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Dominique Singer
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
| | - Renate Fuiko
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Merriman B, Jarmoc G, van der Rijn M, Pierre-Joseph N. Impact of COVID-19 on Mental Health and Resiliency of Pregnant and Parenting Adolescents and Young Adults: A Qualitative Study. J Pediatr Health Care 2023; 37:484-491. [PMID: 36973102 PMCID: PMC10008786 DOI: 10.1016/j.pedhc.2023.03.002] [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: 01/16/2023] [Revised: 02/25/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
INTRODUCTION This study aimed to understand the impacts the COVID-19 pandemic has on the mental health and well-being of pregnant and parenting adolescents and young adults (AYA) to identify unique challenges they faced. METHOD Pregnant and parenting AYA from a teen and tot program at a safety-net hospital in the northeast participated in semistructured qualitative interviews. Interviews were audio-recorded, transcribed, and coded. Analysis was conducted using modified grounded theory and content analysis. RESULTS Fifteen pregnant and parenting AYA participated in interviews. Participants were aged 19-28 years (mean age, 22.6). Participants reported adverse mental health experiences, namely increased loneliness, depression, and anxiety, engagement in preventive measures to protect their children's health, positive attitudes toward telemedicine because of efficiency and safety, delayed attainment of personal and professional goals, and increased attitudes of resilience. DISCUSSION Health care professionals should offer expanded screening and support resources to pregnant and parenting AYA during this time.
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Affiliation(s)
- Bridgette Merriman
- Bridgette Merriman, Medical Student, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Grace Jarmoc
- Grace Jarmoc, Medical Student, Boston University Chobanian & Avedisian School of Medicine, Boston, MA.
| | - Madeleine van der Rijn
- Madeleine van der Rijn, Medical Student, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Natalie Pierre-Joseph
- Natalie Pierre-Joseph, Clinical Associate Professor of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
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Thibaut F, ELNahas G. Women's Mental Health and Lessons Learnt from the COVID-19 Pandemic. Psychiatr Clin North Am 2023; 46:415-426. [PMID: 37500241 PMCID: PMC10110924 DOI: 10.1016/j.psc.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Women are at the highest risk of pandemic adversities as they represent the majority of health and frontline workers in addition to their essential roles at home. We review gender differences during the COVID-19 pandemic by demonstrating risk-exposure during specific situations such as pregnancy, women's mental health fallouts, COVID-19 disease itself and exposure to different forms of violence. We discuss the particularities that women face in developing countries with depicted examples from some countries in Africa and the Middle East. Women mental health care service stands out as an essential component of the national response to pandemics. Women's integration and leadership in the national pandemic response planning is crucial.
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Affiliation(s)
- Florence Thibaut
- University Paris Cité, Paris, France; INSERM U1266 Institute of Psychiatry and Neurosciences, Department of Psychiatry and Addiction, University Hospital Cochin (Site Tarnier), AP-HP.
| | - Gihan ELNahas
- NeuroPsychiatry Department Faculty of Medicine, Ain Shams University, Egypt
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Currie S, Eadie A, O'Carroll RE. Qualitatively exploring the application of the necessity concerns framework to antenatal physical activity. BMC Pregnancy Childbirth 2023; 23:609. [PMID: 37620798 PMCID: PMC10463828 DOI: 10.1186/s12884-023-05918-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Adherence to physical activity (PA) recommendations during pregnancy is low. A common reason for low adherence is concern of harm to mother and/or baby. The Necessity-Concerns Framework (NCF), is a well-established framework in medicine adherence, however it has not been used to explore adherence to antenatal PA. This study aims to explore (1) what influences pregnant women's PA in the context of the NCF; and (2) if the NCF is an appropriate framework to understand antenatal PA engagement. METHODS Semi-structured interviews were conducted with 18 pregnant women in the UK and Ireland (mean gestation 27 weeks). Interviews explored beliefs, experiences, perceived necessities and concerns about PA. Interviews were transcribed verbatim and analysed using thematic framework analysis. RESULTS Five themes were identified as influential to antenatal PA: (1) Perceived benefits and necessity of PA, (2) Concerns regarding antenatal PA, (3) Balancing the necessity and concern, (4) Barriers to antenatal PA, (5) Facilitators of antenatal PA. Women described a number of perceived necessities and concerns regarding antenatal PA. These necessities and concerns were described as being consciously balanced, supporting the NCF. However, a number of additional influences (for example, feelings of nausea and lack of advice and knowledge) seemed to impact antenatal PA engagement before women could consider their perceived necessities and concerns around antenatal PA. CONCLUSIONS The Necessity Concerns Framework is a useful framework to help explain how and why women engage with antenatal PA, more specifically why women do and do not engage in antenatal PA at different times during their pregnancy. However, there are a number of other interpersonal and intrapersonal influences on antenatal PA (e.g. physical symptoms, motivation and time), suggesting the NCF alone may be too simplistic to understand and influence complex behaviour such as antenatal PA.
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Affiliation(s)
- Sinéad Currie
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, Scotland.
| | - Alison Eadie
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, Scotland
| | - Ronan E O'Carroll
- Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, Scotland
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Saleh L, Canclini S, Mathison C, Combs S, Dickerson B. "This is not what I imagined motherhood would look like": pregnancy, postpartum, and parenting during COVID-19 - a qualitative analysis of the first year since birth. BMC Pregnancy Childbirth 2023; 23:578. [PMID: 37568087 PMCID: PMC10422746 DOI: 10.1186/s12884-023-05872-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Childbearing is one of the most emotional and transformative events in a woman's life. This study aims to explore the impact COVID-19 had on childbirth, postpartum, and the first year since giving birth. METHODS This was a qualitative study using data previously collected for a larger study of women who had given birth during the COVID-19 pandemic in the United States. The findings presented here are from an analysis of a subset of open-ended questions. Sixty-six participants completed questions about how COVID-19 affected childbearing and postpartum experiences. Data was analyzed using inductive thematic analysis. RESULTS Thematic analysis of the data identified five major themes and several subthemes, including: (1) amplification of new mother typical emotions (positive emotions and negative emotions), (2) financial impact on mothers and their families, (3) persistent impact of COVID-19, (4) new mom paradigm crash (first time mothers and experienced mothers faced different issues such as lack of education and support, adding a layer to the day-to-day, and negotiating time with others) and (5) validating the importance of maternal health. On the whole, participants were overwhelmed, isolated, and did not have enough physical and emotional support. There was a lack of supportive maternal healthcare both in the short-term and long-term, with an emphasis on poor postpartum support. CONCLUSIONS This study supports previous findings that women who gave birth and entered motherhood during the COVID-19 pandemic were impacted in many ways. These findings contribute to the understanding of women's experiences not just in the immediate postpartum period, but in their daily lives one year after childbirth. The results highlight that our nation's traditional maternal healthcare model may be insufficient, especially when facing a national crisis. Strain placed on the healthcare system by COVID-19 impacted both the physical and mental health of mothers who were often left with inadequate care, education, and support. Our findings point to the need for more supportive maternal health both during childbirth and postpartum.
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Affiliation(s)
| | | | | | - Shanna Combs
- Anne Marion Burnett School of Medicine at Texas Christian University, Fort Worth, USA
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Lantigua-Martinez M, Trostle ME, Torres AM, Rajeev P, Dennis A, Silverstein JS, Talib M. Perinatal depression before and during the COVID-19 pandemic in New York City. AJOG GLOBAL REPORTS 2023; 3:100253. [PMID: 37560009 PMCID: PMC10407240 DOI: 10.1016/j.xagr.2023.100253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Quarantining and isolation during previous pandemics have been associated with higher levels of depression symptomatology. Studies in other countries found elevated rates of anxiety and/or depression among pregnant people during the COVID-19 pandemic compared with prepandemic rates. New York City was the initial epicenter of the pandemic in the United States, and the effects of the pandemic on perinatal depression in this population are not well known. OBJECTIVE This study aimed to evaluate the rates of perinatal depression before and during the COVID-19 pandemic. STUDY DESIGN This is a single-center retrospective cohort study of patients screened for perinatal depression with the Edinburgh Postnatal Depression Scale at 2 private academic practices in New York City. This screen is done in these practices at the time of the glucose challenge test and at the postpartum visit. Patients aged ≥18 years who completed a screen at a postpartum visit and/or glucose challenge test from February 1, 2019 to July 31, 2019 and from February 1, 2020 to July 31, 2020 were identified, and the 2019 and 2020 groups were compared. The primary outcome was a positive screen, defined as ≥13 and ≥15 for postnatal and prenatal screens, respectively. Secondary outcomes included monthly changes in rates of positive screens and factors associated with perinatal depression. Data were analyzed using Mann-Whitney U test, chi-square, or Fisher exact test, and univariate and multivariate analyses with P<.05 defined as significant. RESULTS A total of 1366 records met the inclusion criteria; 75% of the prepandemic (2019) records were included, as opposed to 65% of pandemic (2020) records due to a lower screen completion rate in the pandemic cohort. The 2020 cohort had a higher proportion of Hispanic patients (P=.003) and higher rates of diabetes mellitus (P=.007), preterm labor (P=.03), and current or former drug use (P<.001). The 2019 cohort had higher rates of hypertension (P=.002) and breastfeeding (P=.03); 4.6% of the 2020 cohort had a suspected or confirmed COVID-19 infection. There was no difference in perinatal depression between the 2019 and 2020 cohorts (2.8% vs 2.6%; P>.99). This finding persisted after adjusting for baseline differences (adjusted odds ratio, 0.89; 95% confidence interval, 0.38-1.86; P=.76). There were no differences in rates of positive Edinburgh Postnatal Depression Scale by month. Several risk factors were associated with a positive screen, including being unmarried (P<.001), pulmonary disease (P=.02), depression (P<.001), anxiety (P=.01), bipolar disorder (P=.009), and use of anxiolytics (P=.04). CONCLUSION There were no differences in the rates of perinatal depression between the periods before and during the COVID-19 pandemic. The rate of perinatal depression in this cohort was below the reported averages in the literature. Fewer women were screened for perinatal depression in 2020, which likely underestimated the prevalence of depression in our cohort. These findings highlight potential gaps in care in a pandemic setting.
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Affiliation(s)
- Meralis Lantigua-Martinez
- Department of Obstetrics and Gynecology, NYU Langone Health (Drs Lantigua-Martinez, Melendez Torres, and Talib), New York, NY
| | - Megan E. Trostle
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health (Drs Trostle and Silverstein), New York, NY
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke's University Hospital (Dr Trostle), Bethlehem, PA
| | - Anthony Melendez Torres
- Department of Obstetrics and Gynecology, NYU Langone Health (Drs Lantigua-Martinez, Melendez Torres, and Talib), New York, NY
| | - Pournami Rajeev
- NYU Grossman School of Medicine (Mses Rajeev and Dennis), New York, NY
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine (Ms Rajeev), New York, NY
| | - Alyson Dennis
- NYU Grossman School of Medicine (Mses Rajeev and Dennis), New York, NY
| | - Jenna S. Silverstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, NYU Langone Health (Drs Trostle and Silverstein), New York, NY
| | - Mahino Talib
- Department of Obstetrics and Gynecology, NYU Langone Health (Drs Lantigua-Martinez, Melendez Torres, and Talib), New York, NY
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Chávez-Tostado M, Chávez-Tostado KV, Cervantes-Guevara G, Cervantes-Cardona G, Hernandez-Corona DM, González-Heredia T, Méndez-Del Villar M, Corona-Meraz FI, Guzmán-Ornelas MO, Barbosa-Camacho FJ, Álvarez-Villaseñor AS, Cervantes-Pérez E, Fuentes-Orozco C, Barrera-López NG, López-Bernal NE, González-Ojeda A. Breastfeeding Practices and Postpartum Depression in Mexican Women during the COVID-19 Pandemic: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1330. [PMID: 37512141 PMCID: PMC10385480 DOI: 10.3390/medicina59071330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
Background: Breastfeeding is a characteristic process of mammals that ensures delivery of an adequate nutritional supply to infants. It is the gold standard food source during an infant's first months of life. Since the onset of the COVID-19 pandemic in 2020, people in quarantine have experienced a wide range of feelings, which may make isolation challenging in terms of maternal health. This study focused on the prevalence of breastfeeding practices and postpartum depression (PPD) among Mexican women during the COVID-19 pandemic. Materials and Methods: This cross-sectional study included 586 postpartum women who completed an online survey 4-8 weeks after delivery from April to December 2020 in Guadalajara, Mexico. The aim was to identify potentially depressed mothers according to the Edinburgh Postnatal Depression Scale (EPDS) and describe their breastfeeding practices. Results: The mean maternal age was 30.4 ± 4.6 years, the mean EPDS score was 9.6 ± 5.0, and the PPD prevalence according EPDS scores was 27.1%. Exclusive breastfeeding (EBF) was reported by 32.3% of mothers in the first 48 h and by 70.3% of mothers 48 h after delivery. EBF was associated with a lower prevalence of PPD during the first 48 h (p = 0.015) and after the first 48 h (p = 0.001) after delivery. Skin-to-skin contact (SSC) was reported by 385 (65.7%) mothers. PPD was less frequent in mothers practicing SSC (20.3%) than it was in those not practicing SSC (40.3%) (p = 0.001). A higher percentage of mothers practiced SSC breastfed (66.9%) and used EBF (150, 79.4%) (p = 0.012 and 0.001, respectively). Conclusions: Results suggest that the pandemic emergency and restrictions imposed on the population significantly affected the well-being of mothers after birth, and that these effects may have posed risks to the mental health and emotional stability of postpartum mothers. Therefore, encouraging BF or EBF and SSC may improve or limit depressive symptoms in postpartum mothers.
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Affiliation(s)
- Mariana Chávez-Tostado
- Departamento de Reproducción, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44410, Mexico
| | | | - Gabino Cervantes-Guevara
- Departamento de Bienestar y Desarrollo Sustentable, Centro Universitario del Norte, Universidad de Guadalajara, Colotlán 46200, Mexico
| | - Guillermo Cervantes-Cardona
- Departamento de Disciplinas Filosóficas, Metodológicas e Instrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44410, Mexico
| | - Diana Mercedes Hernandez-Corona
- Departamento de Ciencias Biomédicas, División de Ciencias de la Salud, Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá 45425, Mexico
| | - Tonatiuh González-Heredia
- Departamento de Ciencias Biomédicas, División de Ciencias de la Salud, Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá 45425, Mexico
| | - Miriam Méndez-Del Villar
- Departamento de Ciencias Biomédicas, División de Ciencias de la Salud, Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá 45425, Mexico
| | - Fernanda Isadora Corona-Meraz
- Departamento de Ciencias Biomédicas, División de Ciencias de la Salud, Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá 45425, Mexico
| | - Milton Omar Guzmán-Ornelas
- Departamento de Ciencias Biomédicas, División de Ciencias de la Salud, Centro Universitario de Tonalá, Universidad de Guadalajara, Tonalá 45425, Mexico
| | | | | | - Enrique Cervantes-Pérez
- Departamento de Medicina Interna, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Universidad de Guadalajara, Guadalajara 44340, Mexico
| | - Clotilde Fuentes-Orozco
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico
| | - Natalia Guadalupe Barrera-López
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico
| | - Noelia Esthela López-Bernal
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico
| | - Alejandro González-Ojeda
- Unidad de Investigación Biomédica 02, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara 44340, Mexico
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Rodríguez-Reynaldo M, Rivera-Orraca Z, Ramos Monserrate G, Martínez-González K. Mental health impact of the COVID-19 pandemic in perinatal women living in Puerto Rico. J Reprod Infant Psychol 2023:1-14. [PMID: 37427837 PMCID: PMC10776800 DOI: 10.1080/02646838.2023.2232388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Studies have reported an increase in mental health disorders during the perinatal period as a result of the COVID-19 pandemic and the quarantine restrictions imposed. The effects of untreated maternal mental health have an adverse impact on the mother, the development of the baby, and the family system. Determinants of health, recent natural disasters, and disparities in perinatal care that impact perinatal women in Puerto Rico place them at a higher risk of mental health difficulties. AIM It is therefore, of extreme importance, to evaluate the effect that the COVID-19 pandemic has had on this vulnerable population. DESIGN This is a cross-sectional observational study that interviewed 100 women in the perinatal period during the COVID-19 lockdown measures in Puerto Rico. Participants completed the Spanish version of the COVID-19 Perinatal Experiences (COPE-IS) questionnaire and assessments of clinical depression (PHQ-9) and anxiety (GAD-7). RESULTS The prevalence of moderate to severe risk of depression in this sample is 14%, while 17% showed clinical signs of anxiety. Concerns about social impact and the quarantine mandate were the most common stressors reported. Additionally, our sample reported concerns about the impact the pandemic would have on future employment and finances. CONCLUSION Perinatal women showed significantly higher prevalence of depression and anxiety during the COVID -19 pandemic when compared to the mental health prevalence of the general population pre-pandemic in Puerto Rico. The concerns identified during the pandemic provide information on the importance of a biopsychosocial approach to perinatal mental health care.
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Affiliation(s)
- Marianela Rodríguez-Reynaldo
- Department of Obstetrics and Gynecology, University of Puerto Rico- Conceptualization, Investigation, Methodology, Resources, Writing - Original Draft, Writing - Review & Editing, San Juan, Puerto Rico
| | - Zilkia Rivera-Orraca
- Department of Psychiatry, University of Puerto Rico- Investigation, Methodology, Analysis, Resources, Review & Editing, San Juan, Puerto Rico
| | - Gian Ramos Monserrate
- Department of Psychiatry, University of Puerto Rico- Investigation, Methodology, Analysis, Resources, Review & Editing, San Juan, Puerto Rico
| | - Karen Martínez-González
- Department of Psychiatry, University of Puerto Rico- Investigation, Methodology, Analysis, Resources, Review & Editing, San Juan, Puerto Rico
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Na X, Glasier CM, Andres A, Bellando J, Chen H, Gao W, Livingston LW, Badger TM, Ou X. Associations between mother's depressive symptoms during pregnancy and newborn's brain functional connectivity. Cereb Cortex 2023; 33:8980-8989. [PMID: 37218652 PMCID: PMC10350841 DOI: 10.1093/cercor/bhad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
Depression during pregnancy is common and the prevalence further increased during the COVID pandemic. Recent findings have shown potential impact of antenatal depression on children's neurodevelopment and behavior, but the underlying mechanisms are unclear. Nor is it clear whether mild depressive symptoms among pregnant women would impact the developing brain. In this study, 40 healthy pregnant women had their depressive symptoms evaluated by the Beck Depression Inventory-II at ~12, ~24, and ~36 weeks of pregnancy, and their healthy full-term newborns underwent a brain MRI without sedation including resting-state fMRI for evaluation of functional connectivity development. The relationships between functional connectivities and maternal Beck Depression Inventory-II scores were evaluated by Spearman's rank partial correlation tests using appropriate multiple comparison correction with newborn's gender and gestational age at birth controlled. Significant negative correlations were identified between neonatal brain functional connectivity and mother's Beck Depression Inventory-II scores in the third trimester, but not in the first or second trimester. Higher depressive symptoms during the third trimester of pregnancy were associated with lower neonatal brain functional connectivity in the frontal lobe and between frontal/temporal lobe and occipital lobe, indicating a potential impact of maternal depressive symptoms on offspring brain development, even in the absence of clinical depression.
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Affiliation(s)
- Xiaoxu Na
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Charles M Glasier
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Aline Andres
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
- Arkansas Children’s Nutrition Center, Little Rock 72202, AR, United States
- Arkansas Children’s Research Institute, Little Rock 72202, AR, United States
| | - Jayne Bellando
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Haitao Chen
- Department of Biomedical Sciences and Imaging, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
- Department of Bioengineering, University of California at Los Angeles, Los Angeles, CA 90095, United States
| | - Wei Gao
- Department of Biomedical Sciences and Imaging, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Luke W Livingston
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Thomas M Badger
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
- Arkansas Children’s Nutrition Center, Little Rock 72202, AR, United States
- Arkansas Children’s Research Institute, Little Rock 72202, AR, United States
| | - Xiawei Ou
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
- Arkansas Children’s Nutrition Center, Little Rock 72202, AR, United States
- Arkansas Children’s Research Institute, Little Rock 72202, AR, United States
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46
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Bucciarelli V, Mattioli AV, Sciomer S, Moscucci F, Renda G, Gallina S. The Impact of Physical Activity and Inactivity on Cardiovascular Risk across Women's Lifespan: An Updated Review. J Clin Med 2023; 12:4347. [PMID: 37445383 DOI: 10.3390/jcm12134347] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/08/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Physical inactivity (PI) represents a significant, modifiable risk factor that is more frequent and severe in the female population worldwide for all age groups. The physical activity (PA) gender gap begins early in life and leads to considerable short-term and long-term adverse effects on health outcomes, especially cardiovascular (CV) health. Our review aims to highlight the prevalence and mechanisms of PI across women's lifespan, describing the beneficial effects of PA in many physiological and pathological clinical scenarios and underlining the need for more awareness and global commitment to promote strategies to bridge the PA gender gap and limit PI in current and future female generations.
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Affiliation(s)
- Valentina Bucciarelli
- Cardiovascular Sciences Department, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
| | - Anna Vittoria Mattioli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
- National Institute for Cardiovascular Research-INRC, 40126 Bologna, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Policlinico Umberto I, 49971 Rome, Italy
| | - Federica Moscucci
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Policlinico Umberto I, 49971 Rome, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
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Miura Y, Ogawa Y, Shibata A, Kamijo K, Joko K, Aoki T. App-based interventions for the prevention of postpartum depression: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:441. [PMID: 37316768 DOI: 10.1186/s12884-023-05749-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND This study explored whether psychosocial intervention applications (apps) are effective in preventing postpartum depression. METHODS We conducted an initial article search on 26 March 2020, and the updated search on 17 March 2023 on the electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, Scopus, PsycINFO, CINAHL, and ProQuest Dissertations & Theses A&I. Furthermore, we searched the International Clinical Trials Platform Search Portal (ICTRP), and Clinical Trials. RESULTS We identified 2515 references, and sixteen studies were ultimately included in this review. We conducted a meta-analysis of two studies on the onset of postpartum depression. There were no significant differences between the intervention and control groups (RR 0.80; 95% CI 0.62 to 1.04; P = 0.570). We performed a meta-analysis of the Edinburgh Postnatal Depression Scale (EPDS). The intervention group had significantly lower EPDS scores than the control group (mean difference -0.96; 95% CI -1.44 to -0.48; P < 0.001, I2 = 82%, Chi2 = 62.75, P < 0.001; high heterogeneity). CONCLUSION This study presents the results of current RCTs on interventions with apps, including an app with an automated psychosocial component for preventing postpartum depression that has been conducted. These apps improved the EPDS score; furthermore, they may prevent postpartum depression.
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Affiliation(s)
- Yumika Miura
- Hamamatsu Satocho Clinic, 1-22-22 Sato, Naka-Ku, Hamamatsu-Shi, Shizuoka, 430-0807, Japan
| | - Yusuke Ogawa
- Department of Healthcare Epidemiology, School of Public Health, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto, 606-8501, Japan
| | - Ayako Shibata
- Department of Obstetrics and Gynecology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashiyodogawa-Ku, Osaka, 533-0024, Japan
| | - Kyosuke Kamijo
- Department of Gynecology, Nagano Municipal Hospital, 1333-1 Tomitake, Nagano, 381-8551, Japan
| | - Ken Joko
- Department of Obstetrics and Gynecology, Kikugawa General Hospital, 1632 Higashiyokochi, Kikugawa, Shizuoka, 439-0022, Japan
| | - Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-Cho, Syogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.
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48
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Dungan M, Lincoln M, Aichele S, Clark ELM, Harvey A, Hoyer L, Jiao Y, Joslin S, Russell F, Biringen Z. Mother-Child and Father-Child Emotional Availability during the COVID-19 Pandemic. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1044. [PMID: 37371275 DOI: 10.3390/children10061044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023]
Abstract
While the body of literature on COVID-19's impacts on family life is rapidly expanding, most studies are based entirely on self-report data, leaving a critical gap in observational studies of parent-child interactions. The goal of this study was to evaluate parent-child relationships during the COVID-19 pandemic using the observational emotional availability (EA) construct. Parents (n = 43) were assessed using the Epidemic-Pandemic Impacts Inventory (EPII), the Flourishing Scale (FLS), and the adverse childhood experiences (ACEs) questionnaires. The subcategories of the EPII were used to develop an EPII negative and an EPII positive for each parent. EA (sensitivity, structuring, nonhostility, nonintrusiveness, child responsiveness, and child involvement) was coded from filmed parent-child interactions. Separate hierarchical multiple regressions (HMRs) were run to evaluate each of the variables of interest (EPII and FLS) as predictive of EA. Child age (M = 6, SD = 4.68) and ACEs were added in subsequent steps for EPII negative and positive if the initial step was significant. For mothers (n = 25), results demonstrated EPII negative as a significant predictor of EA with child age and ACEs adding only small amount of variance to the prediction. The same HMR process was repeated for flourishing, with the covariate child age alone. For fathers (n = 18), flourishing was a significant predictor of EA and child age added only a small amount of variance to the prediction. Results indicate that experiencing high COVID-19-related stressors is associated with lower EA for mothers, but not fathers. Having high levels of flourishing during the pandemic was predictive of higher EA for fathers, but not mothers.
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Affiliation(s)
- Maggie Dungan
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO 80528, USA
| | - Michael Lincoln
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO 80528, USA
| | - Stephen Aichele
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO 80528, USA
| | - Emma L M Clark
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO 80528, USA
| | - Ashley Harvey
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO 80528, USA
| | - Lillian Hoyer
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO 80528, USA
| | - Yuqin Jiao
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO 80528, USA
| | - Steffany Joslin
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO 80528, USA
| | - Frances Russell
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO 80528, USA
| | - Zeynep Biringen
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO 80528, USA
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Inkster B, Kadaba M, Subramanian V. Understanding the impact of an AI-enabled conversational agent mobile app on users' mental health and wellbeing with a self-reported maternal event: a mixed method real-world data mHealth study. Front Glob Womens Health 2023; 4:1084302. [PMID: 37332481 PMCID: PMC10272556 DOI: 10.3389/fgwh.2023.1084302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Background Maternal mental health care is variable and with limited accessibility. Artificial intelligence (AI) conversational agents (CAs) could potentially play an important role in supporting maternal mental health and wellbeing. Our study examined data from real-world users who self-reported a maternal event while engaging with a digital mental health and wellbeing AI-enabled CA app (Wysa) for emotional support. The study evaluated app effectiveness by comparing changes in self-reported depressive symptoms between a higher engaged group of users and a lower engaged group of users and derived qualitative insights into the behaviors exhibited among higher engaged maternal event users based on their conversations with the AI CA. Methods Real-world anonymised data from users who reported going through a maternal event during their conversation with the app was analyzed. For the first objective, users who completed two PHQ-9 self-reported assessments (n = 51) were grouped as either higher engaged users (n = 28) or lower engaged users (n = 23) based on their number of active session-days with the CA between two screenings. A non-parametric Mann-Whitney test (M-W) and non-parametric Common Language effect size was used to evaluate group differences in self-reported depressive symptoms. For the second objective, a Braun and Clarke thematic analysis was used to identify engagement behavior with the CA for the top quartile of higher engaged users (n = 10 of 51). Feedback on the app and demographic information was also explored. Results Results revealed a significant reduction in self-reported depressive symptoms among the higher engaged user group compared to lower engaged user group (M-W p = .004) with a high effect size (CL = 0.736). Furthermore, the top themes that emerged from the qualitative analysis revealed users expressed concerns, hopes, need for support, reframing their thoughts and expressing their victories and gratitude. Conclusion These findings provide preliminary evidence of the effectiveness and engagement and comfort of using this AI-based emotionally intelligent mobile app to support mental health and wellbeing across a range of maternal events and experiences.
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Affiliation(s)
- Becky Inkster
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Wysa Inc., Boston, MA, United States
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50
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Remartínez-Hamed A, Pérez-Morente MÁ, Álvarez-Serrano MA, Martínez-García E, González-García A, García-García I, Martín-Salvador A. Levels and predictors of postpartum depression and anxiety during the first year of the COVID-19 pandemic in a confined cross-border city. CURRENT PSYCHOLOGY 2023:1-10. [PMID: 37359590 PMCID: PMC10170432 DOI: 10.1007/s12144-023-04719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/28/2023]
Abstract
Pregnancy and/or the puerperium involve social, physiological and psychological changes that make women more vulnerable to mental disorders such as anxiety and depression, even more so if these develop in stressful contexts such as the pandemic. The aim of this study is to identify factors associated with the risk of postpartum anxiety and depression during the COVID-19 pandemic. A cross-sectional study was conducted among postpartum women (n = 69) who gave birth between March 2020 and March 2021 in Melilla, a Spanish cross-border city with Morocco whose borders were closed, making it a confined city. The scales used were the State-Trait Anxiety Inventory and the Edinburgh Postnatal Depression Scale. Results reported an elevated risk of depression (85.5%) and anxiety (63.8%), with severe anxiety reaching 40.6% of cases. Predictors of postpartum depression comprised a personal history of mood disorders (β = 8.421; CI95% = 4.863/11.978) and having been diagnosed with COVID-19 during pregnancy or postpartum (β = 4.488; CI95% = 1.331/7.646). As regards anxiety, it is predicted on the basis of mood antecedents (β = 14.175; CI95% = 7.870/20.479), the fact of having been diagnosed with COVID-19 during pregnancy or postpartum (β = 8.781; CI95% = 2.970/14.592) and the fact of being a multipara (β = 5.513; CI95% = 0.706/10.321). In conclusion, special attention should be paid to women with a history of mood disorders and a positive diagnosis of COVID-19 during pregnancy or postpartum, even more so in the case of multiparous women, because of its impact on mental health during the postpartum period. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-023-04719-6.
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Affiliation(s)
- Alicia Remartínez-Hamed
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | | | - María Adelaida Álvarez-Serrano
- Department of Nursing, Faculty of Health Sciences, University of Granada, St. Cortadura del Valle S/N, 51001 Ceuta, Spain
| | - Encarnación Martínez-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
- Guadix High Resolution Hospital, 18500 Granada, Spain
| | - Alberto González-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | | | - Adelina Martín-Salvador
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
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