Do Psychological and Behavioural Factors Change Over Pregnancy?

OBJECTIVES

To investigate how psychological and behavioural factors change from the first to the last half of pregnancy.

METHODS

In this prospective cohort study, we assessed the changes in psychological and behavioural factors across 10 domains among 445 women (mean age = 30.9 years) in Ontario, Canada. We collected data using 2 standardized questionnaires administered at <21 and 32-36 weeks of gestation. We computed intraclass correlation coefficients, percentages of no change, decrease, and increase, and mean differences between the 2 surveys.

RESULTS

Most psychological and behavioural factors had intraclass correlation coefficients < 0.50 between the first and the second half of pregnancy, suggesting remarkable changes over the course of pregnancy. We observed significant decreases in self-efficacy, compensatory health beliefs, guilt regarding binge eating, emotional eating, dietary restriction, pregnancy-related nausea and food cravings, sleep duration, and physical activity. We also found increases in anxious and depressive symptoms and the tendency to accept friends' and family's beliefs regarding pregnancy.

CONCLUSIONS

In the first prospective analysis, we found that many psychological and behavioural factors changed significantly over pregnancy.

The mental health experience of treatment-seeking military members and public safety personnel: a qualitative investigation of trauma and non-trauma-related concerns

INTRODUCTION

Paramedics, firefighters, police officers and other public safety personnel (PSP) as well as Canadian Armed Forces (CAF) members are frequently exposed to stressors and demanding work environments. Although their specific work-related tasks may vary, a commonality between these occupations is the significant likelihood of repeated exposure to potentially psychologically traumatic events (PPTE) over the course of their careers. Due in part to these repeated exposures, CAF members and PSP are at an elevated risk of mental health concerns including posttraumatic stress disorder. The purpose of this study was to obtain a more in-depth understanding of the trauma- and non-trauma-related experiences of active or retired PSP and CAF members that may be implicated in mental health issues and resultant treatment and recovery.

METHODS

Study participants were recruited during inpatient treatment at a private mental health and addictions inpatient hospital in Canada. We conducted and audiotaped semistructured focus groups and transcribed the discussions. Interpretive phenomenological analysis and thematic coding generated a coding scheme from which to identify concepts and linkages in the data.

RESULTS

Analysis generated four primary themes: interpersonal relationships, personal identity, mental health toll and potential moral injury. A variety of subthemes were identified, including family dynamics, inability to trust, feelings of professional/personal betrayal, stigma within the CAF/PSP culture, increased negative emotions about self/others, and a reliance on comradery within the service.

CONCLUSION

The information gathered is critical to understanding the perspectives of PSP and military members as the career stressors and related exposure to PPTE of these occupations are unique.

A goal set too high: factors associated with planning excess gestational weight gain in a prospective cohort study

OBJECTIVE

This study aimed to understand physical, knowledge, psychological, and lifestyle factors associated with planned excess gestational weight gain (GWG), a strong and potentially modifiable predictor of actual excess GWG, which contributes to maternal and child obesity along with other adverse maternal and fetal outcomes.

METHODS

This is a secondary analysis of data from a prospective cohort study where women completed a questionnaire in early pregnancy. Women were asked to report their planned GWG, which was then categorized as above, within, or below the Institute of Medicine (IOM) guidelines. Univariable and multivariable analyses were performed to identify variables associated with planned excess GWG.

RESULTS

Of 970 women included in the analysis, 300 reported a planned GWG above the IOM guidelines. Predictors of excess planned GWG included reporting healthcare provider recommendations to gain weight above the guidelines (adjusted odds ratio [aOR], 62.17; 95% confidence interval [CI], 13.75-281.03), overestimating first trimester weight gain recommendations (aOR, 1.83; 95% CI, 1.21-2.77), believing in risks to the baby with inadequate GWG (aOR 2.16; 95% CI,1.29-3.60), inaccurate self-perceived prepregnancy body size (aOR, 1.88; 95% CI, 1.22-2.89), low or high emotional suppression (aOR, 1.78; 95% CI, 1.06-2.99; and aOR, 2.57; 95% CI, 1.21-5.45, respectively), physical inactivity (aOR, 1.10; 95% CI, 1.03-1.17), and overweight or obesity (aOR, 5.76; 95% CI, 3.70-8.98; and aOR, 11.46; 95% CI, 6.54-20.06, respectively). Protective factors against planned excess GWG included increased maternal age (aOR, 0.95; 95% CI, 0.92-0.99), and believing in risks to themselves with inadequate GWG (aOR 0.64; 95% CI, 0.42-0.97) or believing in risks to the baby with excess GWG (aOR, 0.49; 95% CI, 0.27-0.88).

CONCLUSIONS

Women with overweight or obesity are at greater risk of prospectively planning excess GWG, and may especially benefit from healthcare provider counseling on appropriate GWG. Other modifiable factors for planned excess GWG included knowledge about risks of inappropriate weight gain and physical inactivity.

Predictors of Gestational Weight Gain Examined As a Continuous Outcome: A Prospective Analysis

Background: Excess gestational weight gain (GWG) is common and adversely affects both mothers and offspring, including increasing the risk of maternal and childhood obesity. GWG is typically examined categorically, with women grouped into categories of those who gain above, within, and below guideline recommendations. Examining GWG as a continuous variable, rather than categorically, allows for a consideration of GWG at a finer level of detail, increasing precision. Methods: We collected exposure data among 970 pregnant women in early gestation using a standardized questionnaire in Ontario, Canada, from 2015 to 2017. Maternal weight and height were extracted from antenatal records. Continuous GWG was calculated using four methods: percentage of ideal weight gain, excess GWG, GWG adequacy ratio, and GWG z-score. We used the stepwise linear regression analyses to select variables associated with GWG. Results: We found that a common set of variables (parity, prepregnancy body mass index, planned pregnancy weight gain, smoking, pregnancy-related food cravings, and fast food intake) significantly predicted GWG in a manner consistent across the four GWG outcomes. Certain psychological factors, including the perception of families' and friends' attitudes toward the food cravings of pregnant women, emotion suppression, compensatory health beliefs coupled with eating unhealthy foods, frequent prepregnancy dietary restraint in carbohydrates, sugar, and meals, preferred prepregnancy body size image, agreeable and conscientious personalities, and depression, also were related with GWG. Conclusions: Our findings demonstrate that psychological factors play an important role in the magnitude of GWG, providing key avenues to inform interventions to support healthy weight gain in pregnancy.

Personality differences in the susceptibility to stress-eating: The influence of emotional control and impulsivity

PURPOSE

Stress has been associated with deviations from typical eating patterns, with respect to both food choice and overall caloric intake. Both increases and decreases in dietary intake have been previously noted in response to stress. The purpose of the present study was to determine whether the affect regulation strategies of emotional control and impulsivity predict susceptibility to eating in response to stress. Specifically, it was anticipated that emotional suppression would predict decreases in caloric intake, whereas impulsivity would predict increases in caloric intake, in response to a stressor.

METHOD

Participants were randomly assigned to view either a video designed to elicit stress or a control video. Food was provided during the video and the amount and type of food consumed was measured.

RESULTS

Participants' nutritional intake was greater in the stress condition than in the control condition. One aspect of affect regulation, impulsivity, moderated this relationship, with a tendency for greater impulsivity to be associated with greater caloric intake in the stress condition. The degree of negative affect that participants experienced in the stress condition predicted food choice and overall caloric intake. Both emotional control and impulsivity moderated the relationship between negative affect and both food choice and caloric intake in the stress condition.

DISCUSSION

The present study highlights the importance of considering the personality attributes of both impulsivity and emotional suppression in understanding stress eating.

The effect of academic stress and attachment stress on stress-eaters and stress-undereaters

It is well established that stress is related to changes in eating patterns. Some individuals are more likely to increase their overall food intake under conditions of stress, whereas others are more likely to consume less food when stressed. Attachment style has been linked to disordered eating and eating disorders; however, comparisons of eating behaviors under attachment versus other types of stress have yet to be explored. The present laboratory study examined the eating patterns in self-identified stress-undereaters and stress-eaters under various types of stress. More specifically, the study examined the effects of academic and attachment stress on calorie, carbohydrate and sugar consumption within these two groups. Under the guise of critiquing student films, university students viewed either one of two stress-inducing videos (academic stress or attachment stress, both designed to be emotionally arousing) or a control video (designed to be emotionally neutral), and their food intake was recorded. Results demonstrated that the video manipulations were effective in inducing stress. Differential patterns of eating were noted based on group and stress condition. Specifically, stress-undereaters ate fewer calories, carbohydrates and sugars than stress-eaters in the academic stress condition, but not in the attachment stress or control condition. Findings suggest that specific types of stressors may influence eating behaviors differently.

Psychological factors and trimester-specific gestational weight gain: a systematic review

Excess gestational weight gain (GWG), which has reached epidemic proportions, is associated with numerous adverse pregnancy outcomes. Early pregnancy provides a unique opportunity for counseling pregnant women since many women are motivated to engage in healthy behaviors. A systematic review was conducted to summarize the relation between psychological factors and trimester-specific GWG, i.e. GWG measured at the end of each trimester. Eight databases were searched for affect, cognition and personality factors. The guidelines on meta-analysis of Observational Studies in Epidemiology were followed. The methodological quality of each study was assessed using a modified Newcastle-Ottawa Scale. Of 3620 non-duplicate titles and abstracts, 74 articles underwent full-text review. Two cohort studies met the inclusion criteria. Distress was negatively associated with first trimester GWG among both adolescents and non-adolescents. Body image dissatisfaction was associated with second trimester GWG only among non-adolescents. No association emerged between perceived stress, state and trait anxiety and body image dissatisfaction among adolescents and trimester-specific GWG. The relation between trimester-specific GWG and a number of weight-related and dietary-related cognitions, affective states and personality traits remain unexplored. Given the limited number of studies, further high-quality evidence is required to examine the association between psychological factors and trimester-specific GWG, especially for cognitive and personality factors.

Psychological antecedents of excess gestational weight gain: a systematic review

BACKGROUND

Excess gestational weight gain (GWG), which has reached epidemic proportions, is associated with adverse outcomes during pregnancy and postpartum obesity in women and children. Psychological variables represent potentially modifiable factors. Moreover, previous systematic reviews on GWG interventions have called for the need for a clearer understanding of psychological factors affecting GWG. Hence, a systematic review was conducted to summarize the relation between psychological factors and GWG.

METHODS

Eight databases were searched, and the guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Methodological quality of the included studies was assessed using a modified Newcastle-Ottawa scale. Two assessors independently reviewed titles, abstracts and full articles, extracted data and assessed quality.

RESULTS

A total of 6198 titles and abstracts were reviewed of which 90 full text articles were retrieved. Thirty-five studies (25 cohort, eight cross-sectional and two case-control) met the inclusion criteria, assessing 26 different psychological constructs in affect, cognitions and personality. Negative affective states such as depression, anxiety and stress were not related to excess GWG. Among weight-related and dietary-related cognitions, risk factors for excess GWG included concern about weight gain, negative body image and attitude towards weight gain, inaccurate perceptions regarding weight, higher than recommended target weight gain, less knowledge about weight gain, higher levels of cognitive dietary restraint, and perceived barriers to healthy eating. Protective factors included an internal locus of control for weight gain, lower than recommended target weight gain and higher self-efficacy for healthy eating. Only one study examined the relation between personality and excess GWG.

CONCLUSION

In this systematic review, a number of cognitive factors were identified that were associated with excess GWG. To address excess GWG, more high quality, adequately powered studies are required examining cognitions, motivation and personality factors.

Using a knowledge transfer framework to identify factors facilitating implementation of family-based treatment

OBJECTIVE

To conduct a qualitative study to identify factors that would facilitate the transfer of the research evidence on Family-Based Treatment (FBT) into clinical practice.

METHOD

Fundamental qualitative description guided sampling, data collection, and analytic decisions for this study. Forty therapists who treat children and adolescents under the age of 18 with Anorexia Nervosa (AN) and belong to Ontario's provincial network of specialized eating disorder services completed an in-depth interview focusing on elements proposed by the Lavis knowledge transfer framework. An experienced coder conducted content analysis, with 20% of the interviews double-coded for reliability purposes.

RESULTS

Participants requested training in the FBT model, including the provision of research evidence (i.e., journal articles), as well as the specific tenets of the model according to the FBT manual. The suggested audience for implementation included not only therapists themselves, but administrators, physicians, and community members. The development of best practice guidelines was also supported. Local FBT experts were suggested as credible messengers. Infrastructure relating to financial support and time away from clinical duties were reported to be essential for training. Ongoing supervision and mentorship were reported to be important elements of implementation and evaluation processes.

DISCUSSION

Suggestions for moving FBT into practice were consistent with previous research, however, the importance of obtaining the evidence in the form of primary research articles and obtaining team buy-in were remarkable. Developing context-specific training programs and administrative processes for the implementation of FBT are warranted.

Decision-making processes for the uptake and implementation of family-based therapy by eating disorder treatment teams: a qualitative study

OBJECTIVE

To explore the decision-making processes involved in the uptake and implementation of evidence-based treatments (EBTs), namely, family-based treatment (FBT), among therapists and their administrators within publically funded eating disorder treatment programs in Ontario, Canada.

METHOD

Fundamental qualitative description guided sampling, data collection, and analytic decisions. Forty therapists and 11 administrators belonging to a network of clinicians treating eating disorders completed an in-depth interview regarding the decision-making processes involved in EBT uptake and implementation within their organizations. Content analysis and the constant comparative technique were used to analyze interview transcripts, with 20% of the data independently double-coded by a second coder.

RESULTS

Therapists and their administrators identified the importance of an inclusive change culture in evidence-based practice (EBP) decision-making. Each group indicated reluctance to make EBP decisions in isolation from the other. Additionally, participants identified seven stages of decision-making involved in EBT adoption, beginning with exposure to the EBT model and ending with evaluating the impact of the EBT on patient outcomes. Support for a stage-based decision-making process was in participants' indication that the stages were needed to demonstrate that they considered the costs and benefits of making a practice change. Participants indicated that EBTs endorsed by the Provincial Network for Eating Disorders or the Academy for Eating Disorders would more likely be adopted.

DISCUSSION

Future work should focus on integrating the important decision-making processes identified in this study with known implementation models to increase the use of low-cost and effective treatments, such as FBT, within eating disorder treatment programs.

Understanding the uptake of family-based treatment for adolescents with anorexia nervosa: therapist perspectives

OBJECTIVE

To explore and describe therapists' perceptions of the factors affecting their uptake of family-based treatment (FBT) for adolescents with anorexia nervosa (AN).

METHOD

Fundamental qualitative description guided the sampling and data collection in this study. A purposeful sample of 40 therapists providing treatment to youth with AN, completed an in-depth interview. Conventional content analysis guided the development of initial codes and categories, whereas constant comparison analytic techniques were used to compare and contrast therapist perceptions across contexts. Summative content analysis was used to provide counts of keywords, phrases, and themes.

RESULTS

Therapists face several barriers to the implementation of FBT, divided broadly into interventional, organizational, interpersonal, patient/family, systemic, and illness factors. Therapists support the implementation of evidence-based practices, including FBT for AN, but fidelity to this model is not practiced. Specific concerns about the intervention included weighing the patient, providing nutritional advice, and the family meal. Ninety-five percent of therapists requested further training in the FBT model.

DISCUSSION

Further investigation into the barriers and facilitating factors to the use of FBT is warranted. Understanding effective dissemination and training strategies is critical to ensuring patients receive the best possible care.

The integration of a specialized eating disorders nurse on a general inpatient pediatric unit

Eating disorders (EDs) affect approximately 5% of Canadian adolescents. Patients experiencing acute medical complications of their illness are often treated on a general pediatric ward with mixed populations. Twenty-one health care providers shared their experiences caring for youth with EDs and provided feedback regarding the integration of a specialized ED nurse (ED-RN). Findings suggest that an RN and ED-RN model produces consistent care for ED patients and satisfying therapeutic relationships for nurses. ED-RNs caring for youth with EDs need support from their peers, whereas other nurses need training regarding this population. Suggestions for the integration of specialized RN roles are discussed.