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Katrinli S, Michopoulos V. Decoding Sex Differences in PTSD Heritability: A Comprehensive Twin Study. Am J Psychiatry 2024; 181:690-692. [PMID: 39086294 DOI: 10.1176/appi.ajp.20240496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- Seyma Katrinli
- Department of Gynecology and Obstetrics (Katrinli) and Department of Psychiatry and Behavioral Sciences (Michopoulos), Emory University School of Medicine, Atlanta
| | - Vasiliki Michopoulos
- Department of Gynecology and Obstetrics (Katrinli) and Department of Psychiatry and Behavioral Sciences (Michopoulos), Emory University School of Medicine, Atlanta
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2
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Miller ML, Laifer LM, Thomas EBK, Grekin R, O'Hara MW, Brock RL. From pregnancy to the postpartum: Unraveling the complexities of symptom profiles among trauma-exposed women. J Affect Disord 2024; 357:11-22. [PMID: 38663559 PMCID: PMC11149003 DOI: 10.1016/j.jad.2024.04.079] [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] [Received: 08/23/2023] [Revised: 03/18/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Many women experience new onset or worsening of existing posttraumatic stress disorder (PTSD) symptoms during pregnancy and the early postpartum period. However, perinatal PTSD symptom profiles and their predictors are not well understood. METHODS Participants (N = 614 community adults) completed self-report measures across three methodologically similar longitudinal studies. Mixture modeling was used to identify latent subgroups of trauma-exposed women with distinct patterns of symptoms at pregnancy, 1-month, and 3-month postpartum. RESULTS Mixture modeling demonstrated two classes of women with relatively homogenous profiles (i.e., low vs. high symptoms) during pregnancy (n = 237). At 1-month postpartum (n = 391), results suggested a five-class solution: low symptoms, PTSD only, depression with primary appetite loss, depression, and comorbid PTSD and depression. At 3-months postpartum (n = 488), three classes were identified: low symptoms, elevated symptoms, and primary PTSD. Greater degree of exposure to interpersonal trauma and reproductive trauma, younger age, and minoritized racial/ethnic identity were associated with increased risk for elevated symptoms across the perinatal period. LIMITATIONS Only a subset of potential predictors of PTSD symptoms were examined. Replication with a larger and more racially and ethnically diverse sample of pregnant women is needed. CONCLUSIONS Results highlight limitations of current perinatal mental health screening practices, which could overlook women with elevations in symptoms (e.g., intrusions) that are not routinely assessed relative to others (e.g., depressed mood), and identify important risk factors for perinatal PTSD symptoms to inform screening and referral.
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Affiliation(s)
- Michelle L Miller
- Indiana University School of Medicine, Department of Psychiatry, Goodman Hall/IU Health Neuroscience Center, Suite 2800, 355 W. 16th St., Indianapolis, IN 46202, United States of America; University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America.
| | - Lauren M Laifer
- University of Nebraska-Lincoln, Department of Psychology, 238 Burnett Hall, Lincoln, NE 68588, United States of America
| | - Emily B K Thomas
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Rebecca Grekin
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Michael W O'Hara
- University of Iowa, Department of Psychological & Brain Sciences, G60 Psychological and Brain Sciences Building, Iowa City, IA 52242, United States of America
| | - Rebecca L Brock
- University of Nebraska-Lincoln, Department of Psychology, 238 Burnett Hall, Lincoln, NE 68588, United States of America
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3
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Dindinger RA, Manzo LL, Manupule SE, Harp SL. Perinatal Care for Persons with Dissociative Disorders. MCN Am J Matern Child Nurs 2024:00005721-990000000-00055. [PMID: 38864882 DOI: 10.1097/nmc.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
ABSTRACT Caring for persons with mental health diagnoses can be daunting, especially when the conditions are rare, and there is little evidence to guide nursing practice. There is minimal information about caring for persons with dissociative disorders beyond the behavioral health literature, much less as in obstetric context. Women are more likely to experience dissociative disorders and post-traumatic stress disorders than men. Severe maternal morbidity is significantly more common in women with a history of stress and trauma-related conditions, highlighting the importance of providing guidance for clinicians caring for them. It is imperative that nurses caring for women who may dissociate understand the complexities of the disorders and advocate for early, interdisciplinary care. Dissociative disorders, including dissociative identity disorder, post-traumatic stress disorder with dissociation, dissociative amnesia, depersonalization-derealization disorder, other specified dissociative disorders, and the care of pregnant persons with these conditions are presented.
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Muthelo L, Mbombi MO, Mphekgwana P, Mabila LN, Dhau I, Tlouyamma J, Mashaba RG, Mothapo K, Ntimane CB, Seakamela KP, Nemuramba R, Maimela E, Sodi T. Exploring mental health problems and support needs among pregnant and parenting teenagers in rural areas Of Limpopo, South Africa. BMC Womens Health 2024; 24:236. [PMID: 38614989 PMCID: PMC11015670 DOI: 10.1186/s12905-024-03040-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: 03/04/2023] [Accepted: 03/21/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Globally, teenage pregnancy is among the most social problems, affecting 21 million adolescents aged 15-19. Due to the increased responsibility of prenatal and postnatal care for their infants without support, pregnant and parenting teenagers, tend to experience mental health problems. Factors contributing to these problems among pregnant and parenting teenagers in rural African settings have hardly received scholarly attention and, therefore, are less understood. The purpose of the study was to explore mental health and challenges among pregnant and parenting teenagers,. METHOD(S) The study adopted a qualitative descriptive, exploratory, and phenomenological design. Purposive sampling was used to select 22 pregnant and parenting teenagers 18 years or older. Data were collected in ten selected clinics within the Demographic Surveillance Systems (HDSS) of DIMAMO and analysed using qualitative content analysis. RESULTS The findings reveal that pregnant and parenting teenagers in rural areas experience various mental challenges such as depression. These challenges are caused by social problems such as stigmatisation, lack of support from families and friends, as well as parenting demands that contribute to poor progress at school or dropouts. Pregnant teens expressed concerns about the lack of spousal support resulting from abandoning their partners. CONCLUSIONS Stress and depression were self-reported as mental problems among participants with various psychosocial implications, such as school dropout and miscarriage. There are various contributing factors to the mental health problems identified among pregnant and parenting teenagers, including inadequate family and spousal support. Access to integrated reproductive, psychosocial, and mental health services could be essential for these pregnant and parenting teenagers, to improve their mental well-being and improve the support system.
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Affiliation(s)
- Livhuwani Muthelo
- Department of Nursing Science, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa.
| | - Masenyani Oupa Mbombi
- Department of Nursing Science, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Peter Mphekgwana
- Research Administration and Development, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Linneth Nkateko Mabila
- Department of Pharmacy, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Inos Dhau
- Department of Geography and Environmental Studies, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Joseph Tlouyamma
- Department of Computer Science, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Reneilwe Given Mashaba
- DIMAMO Population Health Research Centre, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Katlego Mothapo
- DIMAMO Population Health Research Centre, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Cairo Bruce Ntimane
- DIMAMO Population Health Research Centre, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Kagiso Peace Seakamela
- DIMAMO Population Health Research Centre, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Rathani Nemuramba
- DIMAMO Population Health Research Centre, University of Limpopo, SOVENGA, Private Bag X1106, Polokwane, 0727, South Africa
| | - Eric Maimela
- Department of Public Health, University of Limpopo, Private Bag X1106, SOVENGA 0727, Polokwane, South Africa
| | - Tholene Sodi
- Research Chair Mental Health, University of Limpopo, Private Bag X1106, Polokwane, 0727, SOVENGA, South Africa
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Drake MH, Friesen-Haarer AJ, Ward MJ, Miller ML. Obsessive-compulsive disorder symptoms and intrusive thoughts in the postpartum period: Associations with trauma exposure and PTSD symptoms. Stress Health 2024; 40:e3316. [PMID: 37676396 DOI: 10.1002/smi.3316] [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: 12/16/2022] [Revised: 06/05/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
In a community sample of trauma-exposed postpartum individuals (N = 167; mean age = 30, 90% White; 61.7% completed bachelor's degree or higher) longitudinally completed self-report measures on PTSD, depressive, and Obsessive-compulsive disorder (OCD) symptoms (specifically checking, ordering, washing, and obsessing symptoms), preoccupation with intrusive postpartum thoughts/neutralising strategies, and trauma exposure at 4 and 12 weeks postpartum. PTSD symptoms were strongly associated with all OCD symptoms (r = 0.32- 0.49, p < 0.001), preoccupation with postpartum-specific intrusive thoughts (r = 0.32-0.45, p < 0.001), and preoccupation with neutralising strategies (r = 0.21-0.29, p < 0.05) at both time points. PTSD symptoms were also predictive of checking and obsessing symptoms. This study identified PTSD symptoms as a new correlate for preoccupation with postpartum-specific intrusive thoughts and neutralising strategies in the postpartum period in a community sample. These findings add to the evidence suggesting a strong association between PTSD and OCD symptoms across the lifespan, including in non-clinical samples. Future research should examine best practices to assess and treat a variety of postpartum psychopathology symptoms, not just depression.
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Affiliation(s)
- Margaret H Drake
- Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA
| | | | | | - Michelle L Miller
- University of Iowa, Iowa City, Iowa, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
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Hall SV, Bell S, Courant A, Admon LK, Zivin K. Perinatal Posttraumatic Stress Disorder Diagnoses Among Commercially Insured People Increased, 2008-20. Health Aff (Millwood) 2024; 43:504-513. [PMID: 38560801 PMCID: PMC11225106 DOI: 10.1377/hlthaff.2023.01447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Posttraumatic stress disorder (PTSD) is a burdensome disorder, affecting 3-4 percent of delivering people in the US, with higher rates seen among Black and Hispanic people. The extent of clinical diagnosis remains unknown. We describe the temporal and racial and ethnic trends in perinatal PTSD diagnoses among commercially insured people with live-birth deliveries during the period 2008-20, using administrative claims from Optum's Clinformatics Data Mart Database. Predicted probabilities from our logistic regression analysis showed a 394 percent increase in perinatal PTSD diagnoses, from 37.7 per 10,000 deliveries in 2008 to 186.3 per 10,000 deliveries in 2020. White people had the highest diagnosis rate at all time points (208.0 per 10,000 deliveries in 2020), followed by Black people, people with unknown race, Hispanic people, and Asian people (188.7, 171.9, 146.9, and 79.8 per 10,000 deliveries in 2020, respectively). The significant growth in perinatal PTSD diagnosis rates may reflect increased awareness, diagnosis, or prevalence of the disorder. However, these rates fall well below the estimated prevalence of PTSD in the perinatal population.
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Affiliation(s)
| | | | | | | | - Kara Zivin
- Kara Zivin, University of Michigan, Veterans Affairs Ann Arbor Healthcare System, and Mathematica, Ann Arbor, Michigan
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7
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Khalil D, George Z, Dannawey E, Hijawi J, ElFishawy S, Jenuwine E. Maternal stressors and maternal bonding among immigrant and Refugee Arab Americans resettled in the United States. Res Nurs Health 2024; 47:141-150. [PMID: 38149856 DOI: 10.1002/nur.22365] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 12/02/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
Maternal bonding with the infant and child is essential for the growth and development of the child, and for establishing the relationship between them. The effect of maternal acculturative stress, trauma, and depressive symptoms on maternal bonding has been established in nonimmigrant populations, but not in immigrant and refugee populations. In this study, we aimed to (1) examine the relationships among maternal psychosocial stress (acculturative stress, posttraumatic stress), depressive symptoms, and maternal bonding, and (2) examine whether maternal depression is a mediator of the relationship between maternal psychosocial stress and maternal bonding among a sample of Arab American immigrant and refugee mothers. Using a cross-sectional design, we recruited 78 immigrant and refugee Arab American mothers. Acculturative stress was correlated with posttraumatic stress (ρ = 0.56, p < 0.001), depressive symptoms (ρ = 0.48, p < 0.001), and bonding impairment (ρ = 0.39, p < 0.001). Posttraumatic stress and depressive symptoms were also correlated with maternal bonding impairment (ρ = 0.39, and 0.52, respectively, p < 0.001 for both). The effect of maternal psychosocial stress on maternal bonding was mediated by depressive symptoms. We concluded that higher levels of acculturative stress and posttraumatic stress were associated with higher levels of depressive symptoms and impairment of maternal bonding. Additionally, maternal depressive symptoms mediated the relationship between maternal stress and bonding. Assessing the stressors and depressive symptoms of immigrant and refugee mothers is key to avoiding negative effects on child outcomes.
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Affiliation(s)
- Dalia Khalil
- College of Nursing, Wayne State University, Detroit, Michigan, USA
| | - Zinah George
- College of Nursing, Wayne State University, Detroit, Michigan, USA
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Valentine SE, Godfrey LB, Gellatly R, Paul E, Clark C, Giovannini K, Saia KA, Nillni YI. Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United States. SSM - MENTAL HEALTH 2023; 4:100256. [PMID: 38645900 PMCID: PMC11027481 DOI: 10.1016/j.ssmmh.2023.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Pregnant people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) constitute a highly vulnerable population. PTSD and SUD confer risks to both the pregnant person and the fetus, including a host of physical and mental health consequences. When PTSD and SUD co-occur, potential negative impacts are amplified, and the symptoms of each may exacerbate and maintain the other. Pregnancy often increases engagement in the healthcare system, presenting a unique and critical opportunity to provide PTSD and SUD treatment to birthing people motivated to mitigate risks of losing custody of their children. This paper presents implementation process outcomes of Written Exposure Therapy (WET), a brief, scalable, and sustainable evidence-based PTSD treatment delivered to pregnant persons receiving care in an integrated obstetrical-addiction recovery program at Boston Medical Center. Trial participants (N = 18) were mostly White, non-Hispanic (61.1%), not currently working (77.8%), had a high school or lower level of education (55.5%), had an annual household income less than $35,000 (94.4%), and were living in a substance use residential program (55.6%). We examined intervention feasibility, acceptability, appropriateness, adoption; barriers and facilitators to implementation; and feedback on supporting uptake and sustainability of the intervention using coded qualitative sources (consultation field notes [N = 47] and semi-structured interviews [N = 5]) from providers involved in trial planning and treatment delivery. Results reflected high acceptability, appropriateness, and adoption of WET. Participants described system-, provider-, and patient-level barriers to implementation, offered suggestions to enhance uptake, but did not raise concerns about core components of the intervention. Findings suggest that WET is an appropriate and acceptable PTSD treatment for this difficult-to-reach, complex population, and has the potential to positively impact pregnant persons and their children.
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Affiliation(s)
- Sarah E. Valentine
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Laura B. Godfrey
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Resham Gellatly
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Immigrant and Refugee Health Center, Boston Medical Center, Boston, MA, USA
| | - Emilie Paul
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Caitlin Clark
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA
| | - Karissa Giovannini
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA
| | - Kelley A. Saia
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA
- Department of Obstetrics & Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Yael I. Nillni
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA
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Wiseman M, Hinks M, Hallett D, Blundell J, Sweeney E, Thorpe CM, Walling SG, Swift-Gallant A. Evidence that ovarian hormones, but not diet and exercise, contribute to the sex disparity in post-traumatic stress disorder. J Psychiatr Res 2023; 168:213-220. [PMID: 37918034 DOI: 10.1016/j.jpsychires.2023.10.048] [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: 04/03/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023]
Abstract
Females are twice as likely as males to receive a diagnosis of post-traumatic stress disorder (PTSD). One hypothesis for this sex disparity is that ovarian hormones, including estrogen and progesterone, contribute to PTSD risk. Alternatively, sex differences in lifestyle factors, such as diet and exercise, may play a role in PTSD risk. Using data from the Atlantic Partnership for Tomorrow's Health (PATH) cohort (n = 16,899), the relationship between endogenous hormone fluctuations (e.g., menarche, pregnancy, and menopause), exogenous hormone use (e.g., hormonal contraception and hormone replacement therapy (HRT)) and lifestyle variables (diet and exercise habits, as measured by the Mediterranean Diet Adherence Screener, Healthy Eating Index, and International Physical Activity Questionnaire) with PTSD diagnosis and treatment were analyzed. While several hormonal variables, including contraceptive use, higher total number of pregnancies, younger menarche age, and having undergone menopause increased the risk of PTSD, no lifestyle variables contributed to an increased risk of PTSD diagnosis. These findings support the theory that ovarian hormones contribute to the sex-linked disparity in PTSD diagnosis.
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Affiliation(s)
- Megan Wiseman
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Meagan Hinks
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Darcy Hallett
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Jacqueline Blundell
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Ellen Sweeney
- Atlantic PATH, Faculty of Medicine, Dalhousie University, 5849 University Ave, Halifax, NS, B3H 4R2, Canada
| | - Christina M Thorpe
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Susan G Walling
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada
| | - Ashlyn Swift-Gallant
- Department of Psychology, Memorial University of Newfoundland, 242 Elizabeth Ave. St. John's, NL, A1B 3X9, Canada.
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10
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Laifer LM, DiLillo D, Brock RL. Prenatal negative affectivity and trauma-related distress predict mindful parenting during toddler age: Examining parent-infant bonding as a mechanism. Dev Psychopathol 2023; 35:1036-1050. [PMID: 34649640 DOI: 10.1017/s0954579421000894] [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] [Indexed: 11/07/2022]
Abstract
Despite findings demonstrating the importance of parental present-centered awareness, factors undermining mindful parenting have received less attention. Increasingly, evidence points to parental psychopathology as a salient risk factor for parenting difficulties. Thus, the goal of the present study was to investigate specific dimensions of parental trauma-related distress and general negative affectivity during pregnancy as predictors of mindful parenting during toddler age. Parental psychopathology, parent-infant bonding, and mindful parenting were assessed in a sample of heterosexual couples (N = 159) across four waves of data collection spanning pregnancy to child age two. Data were analyzed using path analysis within a dyadic framework. Results demonstrated the unique impact of maternal trauma-related distress during pregnancy (e.g., intrusions and avoidance) on facets of mindful parenting more than two years later. Further, among both mothers and fathers, general negative affectivity common across internalizing disorders undermined mindful parenting through impaired parent-infant bonding. Findings highlight the need for early intervention efforts that incorporate mindfulness strategies to reduce subthreshold symptoms of prenatal psychopathology, promote healthy bonding, and improve parental awareness and self-regulation, thereby enhancing the overall parent-child relationship.
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11
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Nillni YI, Baul TD, Paul E, Godfrey LB, Sloan DM, Valentine SE. Written exposure therapy for treatment of perinatal PTSD among women with comorbid PTSD and SUD: A pilot study examining feasibility, acceptability, and preliminary effectiveness. Gen Hosp Psychiatry 2023; 83:66-74. [PMID: 37119780 PMCID: PMC10587907 DOI: 10.1016/j.genhosppsych.2023.04.013] [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] [Received: 12/28/2022] [Revised: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE This pilot open trial examined the feasibility, acceptability, and preliminary effectiveness of Written Exposure Therapy (WET), a 5-session evidence-based intervention for posttraumatic stress disorder (PTSD) during pregnancy. Participants were pregnant women with comorbid PTSD and substance use disorder (SUD) receiving prenatal care in a high risk obstetrics-addictions clinic. METHODS A total of 18 participants with probable PTSD engaged in the intervention, and 10 completed the intervention and were included in outcome analyses. Wilcoxon's Signed-Rank analyses were used to evaluate PTSD and depression symptoms and craving at pre-intervention to post-intervention and pre-intervention to the 6-month postpartum follow-up. Engagement and retention in WET and therapist fidelity to the intervention manual were used to assess feasibility. Quantitative and qualitative measures of patient satisfaction were used to assess acceptability. RESULTS PTSD symptoms significantly decreased from pre-intervention to post-intervention (S = 26.6, p = 0.006), which sustained at the 6-month postpartum follow-up (S = 10.5, p = 0.031). Participant satisfaction at post-intervention was high. Therapists demonstrated high adherence to the intervention and excellent competence. CONCLUSIONS WET was a feasible and acceptable treatment for PTSD in this sample. Randomized clinical trial studies with a general group of pregnant women are needed to expand upon these findings and perform a full-scale test of effectiveness of this intervention.
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Affiliation(s)
- Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Tithi D Baul
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
| | - Emilie Paul
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA; College of Liberal Arts and Sciences, St. John's University, Queens, NY, USA.
| | - Laura B Godfrey
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
| | - Denise M Sloan
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; National Center for PTSD, Behavioral Science Division at VA Boston Healthcare System, Boston, MA, USA.
| | - Sarah E Valentine
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
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Diestel AJ, Price M, Hidalgo JE, Contractor AA, Grasso DJ. Linkages Between Childhood Maltreatment, Intimate Partner Violence, and Posttraumatic Stress Disorder Symptoms in Pregnant Hispanic Women: A Network Analysis. CHILD MALTREATMENT 2023; 28:243-253. [PMID: 35465753 DOI: 10.1177/10775595221092948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pregnant Hispanic women are at increased risk for posttraumatic stress disorder (PTSD) in part due to greater risk of childhood maltreatment, intimate partner violence (IPV), and pregnancy-related vulnerabilities. However, PTSD, is a highly heterogenous diagnosis with numerous presentations. Individual PTSD symptoms may be differentially associated with specific types of maltreatment, IPV. Determining how IPV exposure across the lifespan is associated with specific symptoms of PTSD in pregnant Hispanic women is necessary to develop group-relevant models of this disorder and targeted interventions. The present study examined a network model of PTSD symptoms, childhood maltreatment, and adulthood IPV in a sample of pregnant Hispanic women (N = 198). Childhood emotional abuse and adulthood psychological distress had the highest bridge centrality. These types of exposures were most strongly associated with social isolation. Childhood emotional abuse was associated with more individual PTSD symptoms than any IPV type. These findings suggest that associations between PTSD symptoms and different types of IPV exposure vary. In addition, robust associations between childhood emotional abuse and PTSD symptoms suggest that this domain may be particularly important for the clinical assessment and intervention for pregnant women.
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Affiliation(s)
- Annabel J Diestel
- Department of Psychological Science, Center for Research on Emotion, Stress, and Technology, 2092University of Vermont, Burlington, VT, USA
| | - Matthew Price
- Department of Psychological Science, Center for Research on Emotion, Stress, and Technology, 2092University of Vermont, Burlington, VT, USA
| | - Johanna E Hidalgo
- Department of Psychological Science, Center for Research on Emotion, Stress, and Technology, 2092University of Vermont, Burlington, VT, USA
| | - Ateka A Contractor
- Department of Psychology, 3404University of North Texas, Denton, TX, USA
| | - Damion J Grasso
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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13
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Carney JR, Miller-Graff LE, Napier TR, Howell KH. Elucidating the relations between adverse childhood experiences, age of exposure to adversity, and adult posttraumatic stress symptom severity in pregnant women. CHILD ABUSE & NEGLECT 2023; 136:105995. [PMID: 36566706 DOI: 10.1016/j.chiabu.2022.105995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/04/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are typically assessed within two subscales: child maltreatment (CM) and household dysfunction (HD). More research is needed about how the CM and HD subscales differentially contribute to adult posttraumatic stress symptoms (PTSS), accounting for additional adversities. OBJECTIVE, PARTICIPANTS, AND SETTING In a sample of 137 pregnant women exposed to recent intimate partner violence (IPV) in the United States, this study aimed to (1) explore the contributions of ACEs subscales to pregnant women's PTSS severity, (2) examine the inclusion of the witnessing IPV ACE in the CM subscale, and (3) contextualize the contributions of the ACEs subscales to women's PTSS by examining the moderating effect of age of first ACE exposure. METHODS The study used linear, multiple, and hierarchical regression analyses and the Hotelling-Williams test. RESULTS The CM subscale predicted pregnant women's PTSS significantly better than the HD subscale, controlling for past-year IPV (t(134) = 2.69, p = .008). Adding the witnessing IPV ACE to the CM subscale did not significantly improve the subscale's prediction of PTSS (ΔR2 = 0.07, p = .290). Age of first exposure did not significantly moderate the effects of the CM (β = 0.12, p = .140) or HD (β = -0.10, p = .238) ACEs subscales on PTSS. CONCLUSIONS Results suggest that for pregnant women exposed to high levels of trauma, polyvictimization and particularly experiencing multiple types of CM have stronger predictive validity for PTSS than HD. Cumulative victimization may be more influential than age of exposure to adversity.
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Affiliation(s)
- Jessica R Carney
- Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN 46556, USA.
| | - Laura E Miller-Graff
- Department of Psychology, University of Notre Dame, 390 Corbett Family Hall, Notre Dame, IN 46556, USA; Kroc Institute for International Peace Studies, University of Notre Dame, 1110 Jenkins Nanovic Halls, Notre Dame, IN 46556, USA
| | - Taylor R Napier
- Department of Psychology, The University of Memphis, 400 Innovation Drive, Memphis, TN 38111, USA
| | - Kathryn H Howell
- Department of Psychology, The University of Memphis, 400 Innovation Drive, Memphis, TN 38111, USA
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14
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Patterns and predictors of perinatal posttraumatic stress symptoms: A latent transition analysis. J Affect Disord 2023; 320:108-116. [PMID: 36162665 DOI: 10.1016/j.jad.2022.09.068] [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: 10/08/2021] [Revised: 09/08/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pregnancy is a time of increased risk for intimate partner violence (IPV), yet there is a dearth of prospective research examining the relationship between IPV and posttraumatic stress symptoms (PTSS) in the perinatal period. Further, relationships among different types of IPV and perinatal PTSS remain understudied. METHODS Latent class and transition analyses were used to examine classes of PTSS in pregnancy and postpartum, the longitudinal patterns of transitions across these classes, and the role of IPV types, childhood adversity, and depressive symptoms in PTSS presentation. Participants (N = 238) were drawn from two longitudinal studies of high-risk perinatal women. RESULTS Four latent PTSS classes emerged: High, Avoidant, Hypervigilant, and Low. Childhood adversity (χ2(3) = 13.09, p = .004), prenatal depression (χ2(3) = 17.58, p = .001), and psychological IPV (χ2(3) = 10.51, p = .01) were associated with membership in High, Avoidant, and Hypervigilant classes. Women with low prenatal PTSS continued to have low levels at postpartum. Women in higher severity classes during pregnancy tended to transition into classes with adjacent, and often lower, levels of symptom severity postpartum. Women in the High PTSS class in pregnancy with elevated levels of depression were significantly more likely to remain in the High PTSS class or transition into the Avoidant class at postpartum, compared to the Low PTSS class, χ2(3) = 11.84, p = .008. LIMITATIONS Relatively modest sample size precluded examination of a broader range of symptoms consistent with PTSD. CONCLUSIONS Findings highlight the importance of individualized approaches to assessing, monitoring, and treating perinatal PTSS.
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15
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Gökçe İsbir G, İnci F, Kömürcü Akik B, Abreu W, Thomson G. Birth-related PTSD symptoms and related factors following preterm childbirth in Turkey. CURRENT PSYCHOLOGY 2022; 42:1-12. [PMID: 36340892 PMCID: PMC9616695 DOI: 10.1007/s12144-022-03805-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/03/2022]
Abstract
Objective: To examine factors associated with birth-related post-traumatic stress disorder (PTSD) among women who had preterm birth in their last pregnancy in Turkey.Methods: 304 women were asked to report sociodemographic factors, perinatal factors, birth-related factors, preterm birth/premature infant characteristics, and social support factors and PTSD symptoms. Data were collected using online surveys between November 2020 and February 2021. Hierarchical multiple linear regression was used. Results: The prevalence of birth-related PTSD symptoms following preterm birth was 71.1%. Older age, the woman being positively affected by her own mother's birth experience, not having traumatic experience in pregnancy and in the postnatal period, lower stress level after traumatic events experienced during birth, not feeling that their life/physical integrity was at risk during birth, having amniotomy, feeling psychologically well after childbirth, not being negatively affected by witnessing other parents' happy moments with their babies in friend/family groups, the absence of infant illness and mother's reporting higher positive interactions with healthcare team were associated with decreased likelihood of birth-related PTSD. Except for age and traumatic event in the postnatal period, all the variables explained 43% of the variance with a small effect size (f 2 = 0.04). Stress level after the traumatic events experienced during labor was the strongest predictor of birth-related PTSD symptoms (β = 0.33). Conclusion: Wellbeing of mother and baby, facilitating interventions at labor, and positive communication with the healthcare team was associated with lower birth-related PTSD symptoms. The study findings highlighted on birth-related PTSD symptoms in mothers of preterm infants in Turkey.
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Affiliation(s)
- Gözde Gökçe İsbir
- Midwifery Department, School of Health, Mersin University, Mersin, Turkey
| | - Figen İnci
- Psychiatric Nursing Department, Faculty of Zübeyde Hanım Health Sciences, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Burcu Kömürcü Akik
- Department of Psychology, Faculty of Languages and History-Geography, Ankara University, Ankara, Turkey
| | - Wilson Abreu
- School of Nursing and Research Centre, CINTESIS/ESEP (Center for Research in Health Technologies and Services), University of Porto, Porto, Portugal
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, UK
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16
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Hendrix YMGA, Sier MAT, Baas MAM, van Pampus MG. Therapist perceptions of treating posttraumatic stress disorder in pregnancy: The VIP Study. J Trauma Stress 2022; 35:1420-1431. [PMID: 35535472 DOI: 10.1002/jts.22842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/12/2022] [Accepted: 03/16/2022] [Indexed: 11/06/2022]
Abstract
There is no consensus on the treatment of posttraumatic stress disorder (PTSD) during pregnancy, and therapists' views on the matter are largely unknown. This cross-sectional study aimed to explore therapist beliefs and experiences regarding PTSD treatment during pregnancy. Participants were therapists (N = 301) with experience treating PTSD who completed an online survey. The primary outcome measure was the percentage of therapists who were experienced in treating PTSD symptoms during pregnancy; secondary outcome measures assessed preferred treatments for the general and pregnant populations, perceived reluctance to treat PTSD in pregnancy, and perceived effects and adverse events attributed to treatment for pregnant women and fetuses. The majority of participants (n = 246, 81.7%) had experience with treating PTSD during pregnancy. Eye movement desensitization and reprocessing was the preferred treatment for both the general and the pregnant populations. Almost half of the sample (48.8%) reported hearing that PTSD treatment in pregnancy could be harmful; 30.5% of therapists were reluctant to treat pregnant women with PTSD. Most therapists observed a clinically relevant posttreatment reduction of PTSD symptoms in pregnant women. Perceived adverse maternal and fetal events attributed to treatment were reported by 8.4% and 1.4% of therapists, respectively. Despite reluctance, most therapists reported treating PTSD during pregnancy. The results show that although therapists often reported hearing that treating PTSD during pregnancy was harmful, only a small percentage reported perceived adverse events, and treatment was often viewed as effective. These findings implicate a more positive view on the treatment of PTSD in pregnancy.
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Affiliation(s)
| | - Misha A T Sier
- Department of Surgery, Franciscus Gasthuis, Rotterdam, the Netherlands
| | - Melanie A M Baas
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, the Netherlands.,Department of Obstetrics and Gynecology, Martini Hospital, Groningen, the Netherlands
| | - Maria G van Pampus
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, the Netherlands
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17
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Padin AC, Stevens NR, Che ML, Erondu IN, Perera MJ, Shalowitz MU. Screening for PTSD during pregnancy: a missed opportunity. BMC Pregnancy Childbirth 2022; 22:487. [PMID: 35701731 PMCID: PMC9195376 DOI: 10.1186/s12884-022-04797-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background Prenatal posttraumatic stress disorder (PTSD) is often overlooked in obstetric care, despite evidence that untreated PTSD negatively impacts both mother and baby. OB-GYN clinics commonly screen for depression in pregnant patients; however, prenatal PTSD screening is rare. Although the lack of PTSD screening likely leaves a significant portion of pregnant patients with unaddressed mental health needs, the size of this care gap has not been previously investigated. Methods This retrospective chart review study included data from 1,402 adult, pregnant patients who completed PTSD (PTSD Checklist-2; PCL) and depression (Edinburgh Postnatal Depression Survey; EPDS) screenings during a routine prenatal care visit. Descriptive statistics identified screening rates for PTSD and depression, and logistic regression analyses identified demographic variables associated with screening outcomes and assessed whether screening results (+ PCL/ + EPDS, + PCL/-EPDS, -PCL/ + EPDS, -PCL/-EPDS) were associated with different provider intervention recommendations. Results 11.1% of participants screened positive for PTSD alone, 3.8% for depression alone, and 5.4% for both depression and PTSD. Black (OR = 2.24, 95% CI [1.41,3.54]) and Latinx (OR = 1.64, 95% CI [1.01,2.66]) patients were more likely to screen positive for PTSD compared to White patients, while those on public insurance were 1.64 times (95% CI [1.21,2.22]) more likely to screen positive compared to those with private insurance. Patients who screened positive for both depression and PTSD were most likely to receive referrals for behavioral health services (44.6%), followed by -PCL/ + EPDS (32.6%), + PCL/-EPDS (10.5%), and -PCL/-EPDS (3.6%). A similar pattern emerged for psychotropic medication prescriptions. Conclusions Over ten percent of pregnant patients in the current study screened positive for PTSD without depression, highlighting a critical mental health need left unaddressed by current obstetric standards of care. Routine PTSD screening during prenatal care alongside strategies aimed at increasing referral resources and access to mental health services are recommended.
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Affiliation(s)
- Avelina C Padin
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Chicago, IL, 60612, USA.
| | - Natalie R Stevens
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Chicago, IL, 60612, USA
| | - Mandy L Che
- College of Medicine, Rush University, Chicago, USA
| | | | - Marisa J Perera
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Chicago, IL, 60612, USA
| | - Madeleine U Shalowitz
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd., Chicago, IL, 60612, USA.,College of Medicine, Rush University, Chicago, USA.,Department of Pediatrics, Rush University Medical Center, Chicago, USA
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18
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Davis CE, Lamson AL, Meier EM, Pratt GA. The Intersect of Pregnancy Loss, Trauma, and Spirituality: A Dyadic Perspective. Matern Child Health J 2022; 26:1709-1718. [PMID: 35654999 DOI: 10.1007/s10995-022-03452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Pregnancy loss and trauma are unexpected yet frequent occurrences for females in the United States, however little research exists on the role of pregnancy loss and trauma with both partners in couple relationships. The purpose of this study was to use dyadic analyses to better understand the role of trauma, spirituality, and pregnancy loss in the context of the couple relationship. METHOD Drawn from a secondary data set, the dyadic sample included survey responses from (n = 97) matched, pregnant heterosexual couples. Couples responded to questions related to traumatic experiences, previous pregnancy history, relationship satisfaction, and spirituality. Actor-partner independence models were conducted to explore pregnancy loss, trauma, and spirituality on relationship satisfaction. RESULTS Female partner's experience of trauma and loss predicted relationship satisfaction, but the male partner's experience did not. In addition, spirituality moderated the effects of loss and trauma for female partners but not for male partners. CONCLUSION The outcomes from this study punctuated the importance of learning about relational dynamics (e.g., pregnancy and interpersonal traumas) through dyadic samples and analyses. Implications include research and clinical recommendations to incorporate biopsychosocial-spiritual metrics into research designs with diverse samples and dyads.
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Affiliation(s)
- Corin E Davis
- Department of Human Development & Family Science, College of Health and Human Performance, East Carolina University, 108 Rivers West, Mailstop 505, Greenville, NC, 27858, USA
| | - Angela L Lamson
- Department of Human Development & Family Science, College of Health and Human Performance, East Carolina University, 108 Rivers West, Mailstop 505, Greenville, NC, 27858, USA.
| | - Emily M Meier
- Department of Human Development & Family Science, College of Health and Human Performance, East Carolina University, 108 Rivers West, Mailstop 505, Greenville, NC, 27858, USA
| | - Grace A Pratt
- Great Plains Family Medicine Residency Program, Oklahoma City, OK, USA
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19
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Miranda O, Fan P, Qi X, Yu Z, Ying J, Wang H, Brent DA, Silverstein JC, Chen Y, Wang L. DeepBiomarker: Identifying Important Lab Tests from Electronic Medical Records for the Prediction of Suicide-Related Events among PTSD Patients. J Pers Med 2022; 12:524. [PMID: 35455640 PMCID: PMC9025406 DOI: 10.3390/jpm12040524] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022] Open
Abstract
Identifying patients with high risk of suicide is critical for suicide prevention. We examined lab tests together with medication use and diagnosis from electronic medical records (EMR) data for prediction of suicide-related events (SREs; suicidal ideations, attempts and deaths) in post-traumatic stress disorder (PTSD) patients, a population with a high risk of suicide. We developed DeepBiomarker, a deep-learning model through augmenting the data, including lab tests, and integrating contribution analysis for key factor identification. We applied DeepBiomarker to analyze EMR data of 38,807 PTSD patients from the University of Pittsburgh Medical Center. Our model predicted whether a patient would have an SRE within the following 3 months with an area under curve score of 0.930. Through contribution analysis, we identified important lab tests for suicide prediction. These identified factors imply that the regulation of the immune system, respiratory system, cardiovascular system, and gut microbiome were involved in shaping the pathophysiological pathways promoting depression and suicidal risks in PTSD patients. Our results showed that abnormal lab tests combined with medication use and diagnosis could facilitate predicting SRE risk. Moreover, this may imply beneficial effects for suicide prevention by treating comorbidities associated with these biomarkers.
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Affiliation(s)
- Oshin Miranda
- Department of Pharmaceutical Sciences, Computational Chemical Genomics Screening Center, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15206, USA; (O.M.); (P.F.); (X.Q.)
| | - Peihao Fan
- Department of Pharmaceutical Sciences, Computational Chemical Genomics Screening Center, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15206, USA; (O.M.); (P.F.); (X.Q.)
| | - Xiguang Qi
- Department of Pharmaceutical Sciences, Computational Chemical Genomics Screening Center, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15206, USA; (O.M.); (P.F.); (X.Q.)
| | - Zeshui Yu
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15206, USA;
| | - Jian Ying
- Department of Internal Medicine, University of Utah, Salt Lake City, UT 84132, USA;
| | - Haohan Wang
- Language Technologies Institute, School of Computer Science, Carnegie Mellon University, Pittsburgh, PA 15213, USA;
| | - David A. Brent
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Jonathan C. Silverstein
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Yu Chen
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46225, USA
| | - Lirong Wang
- Department of Pharmaceutical Sciences, Computational Chemical Genomics Screening Center, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA 15206, USA; (O.M.); (P.F.); (X.Q.)
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20
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Antoniou E, Tzanoulinou MD, Stamoulou P, Orovou E. The Important Role of Partner Support in Women's Mental Disorders During the Perinatal Period. A Literature Review. MAEDICA 2022; 17:194-200. [PMID: 35733735 PMCID: PMC9168558 DOI: 10.26574/maedica.2022.17.1.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The arrival of a newborn is often a happy event in a woman's life. However, many women experience perinatal distress such as anxiety disorders and depression during pregnancy or postpartum period. Although the positive interpersonal relationships of women with their wider environment seem to be a support network, research shows that support provided by partners is a very important protective factor in reducing mental health disorders in both prenatal and postnatal period in a woman's life. for this reason, more research needs to be done in the field of perinatal distress in order to clarify the causes that lead to mental disorders and to strengthen the partner's role in the management of perinatal mental disorders of women.
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Affiliation(s)
- Evangelia Antoniou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | | | - Pinelopi Stamoulou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Eirini Orovou
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
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21
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Filippetti ML, Clarke ADF, Rigato S. The mental health crisis of expectant women in the UK: effects of the COVID-19 pandemic on prenatal mental health, antenatal attachment and social support. BMC Pregnancy Childbirth 2022; 22:68. [PMID: 35081906 PMCID: PMC8790719 DOI: 10.1186/s12884-022-04387-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/04/2022] [Indexed: 12/14/2022] Open
Abstract
Background Pregnancy has been shown to be times in a woman’s life particularly prone to mental health issues, however a substantial percentage of mothers report subclinical perinatal mental health symptoms that go undetected. Experiences of prenatal trauma, such as the COVID-19 pandemic, may exacerbate vulnerability to negative health outcomes for pregnant women and their infants. We aimed to examine the role of: 1) anxiety, depression, and stress related to COVID-19 in predicting the quality of antenatal attachment; 2) perceived social support and COVID-19 appraisal in predicting maternal anxiety and depression. Methods A sample of 150 UK expectant women were surveyed during the COVID-19 pandemic. Questions included demographics, pregnancy details, and COVID-19 appraisal. Validated measures were used to collect self-reported maternal antenatal attachment (MAAS), symptoms of anxiety (STAI), depression (BDI-II), and stress related to the psychological impact of COVID-19 (IES-r). Results We found that the pandemic has affected UK expectant mothers’ mental health by increasing prevalence of depression (47%), anxiety (60%) and stress related to the psychological impact of COVID-19 (40%). Women for whom COVID-19 had a higher psychological impact were more likely to suffer from depressive (95% HDPI = [0.04, 0.39]) and anxiety symptoms (95% HPDI = [0.40, 0.69]). High depressive symptoms were associated with reduced attachment to the unborn baby (95% HPDI [-0.46, -0.1]). Whilst women who appraised the impact of COVID-19 to be more negative showed higher levels of anxiety (HPDI = [0.15, 0.46]), higher social support acted as a protective factor and was associated with lower anxiety (95% HPDI = [-0.52, -0.21]). Conclusions The current findings demonstrate that direct experience of prenatal trauma, such as the one experienced during the COVID-19 pandemic, significantly amplifies mothers’ vulnerability to mental health symptoms and impairs the formation of a positive relationship with their unborn baby. Health services should prioritise interventions strategies aimed at fostering support for pregnant women. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04387-7.
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Affiliation(s)
- Maria Laura Filippetti
- Centre for Brain Science, Department of Psychology, University of Essex, Colchester, UK.
| | - Alasdair D F Clarke
- Centre for Brain Science, Department of Psychology, University of Essex, Colchester, UK
| | - Silvia Rigato
- Centre for Brain Science, Department of Psychology, University of Essex, Colchester, UK
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22
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Garon-Bissonnette J, Bolduc MÈG, Lemieux R, Berthelot N. Cumulative childhood trauma and complex psychiatric symptoms in pregnant women and expecting men. BMC Pregnancy Childbirth 2022; 22:10. [PMID: 34983417 PMCID: PMC8725451 DOI: 10.1186/s12884-021-04327-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women and men having been exposed to childhood trauma would be at high risk of various mental health symptoms while awaiting a child. This study aimed to evaluate the association between cumulative childhood trauma and the accumulation of symptoms belonging to different psychiatric problems in pregnant women and expecting men. METHODS We first examined prevalence rates of childhood trauma across our samples of 2853 pregnant women and 561 expecting men from the community. Second, we evaluated the association between cumulative childhood trauma and symptom complexity (i.e., the simultaneous presentation of symptoms belonging to multiple psychiatric problems) using subsamples of 1779 pregnant women and 118 expecting men. Participants completed self-reported measures of trauma (Childhood Trauma Questionnaire) and psychiatric symptoms (PTSD Checklist for DSM-5; Kessler Psychological Distress Scale; State-Trait Anger Expression Inventory-2; Self and Interpersonal Functioning Scale). RESULTS Trauma was more frequent in pregnant women than in expecting men and in participants reporting sociodemographic risk factors than in those not reporting any. A dose-response relationship was observed between the number of different traumas reported by pregnant women and expecting men and the complexity of their psychiatric symptoms, even when controlling for the variance explained by other risk factors. Women having been exposed to cumulative childhood trauma were 4.95 times more at risk of presenting comorbid psychiatric problems during pregnancy than non-exposed women. CONCLUSIONS Childhood trauma is frequent in the general population of pregnant women and expecting men and is associated with symptom complexity during the antenatal period. These findings call for delivering and evaluating innovative trauma-informed antenatal programs to support mental health and adaptation to parenthood in adults having been exposed to childhood trauma.
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Affiliation(s)
- Julia Garon-Bissonnette
- Department of Psychology, Université du Québec à Trois-Rivières, Québec, Canada
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Québec, Canada
- CERVO Brain Research Center, Québec, Canada
- Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Québec, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Québec, Canada
| | - Marie-Ève Grisé Bolduc
- Department of Psychology, Université du Québec à Trois-Rivières, Québec, Canada
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Québec, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Québec, Canada
| | - Roxanne Lemieux
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Québec, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Québec, Canada
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, PO Box 500, Québec, Canada
| | - Nicolas Berthelot
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Québec, Canada.
- CERVO Brain Research Center, Québec, Canada.
- Interdisciplinary Research Center on Intimate Relationship Problems and Sexual Abuse, Québec, Canada.
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Québec, Canada.
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, PO Box 500, Québec, Canada.
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23
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Zhao Q, Han Y, Hu XY, Zhang S, Zhang L, Wang J, Zhang QQ, Tao MS, Fang JX, Yang J, Liu RG, Sun X, Zhou J, Li X, Mannan-Abdul, Zhang H, Liu H, Cao JL. Transcranial Electrical Stimulation for Relief of Peripartum Mental Health Disorders in Women Undergoing Cesarean Section With Combined Spinal-Epidural Anesthesia: A Pilot Randomized Clinical Trial. Front Psychiatry 2022; 13:837774. [PMID: 35444569 PMCID: PMC9013841 DOI: 10.3389/fpsyt.2022.837774] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aimed to explore transcranial electrical stimulation (tES) to relieve peripartum anxiety and depressive symptoms in women undergoing cesarean section with combined spinal-epidural anesthesia. METHODS This double-blind, randomized, sham-controlled trial was conducted in the Affiliated Hospital of Xuzhou Medical University from March 2021 and May 2021. One hundred and forty-eight full-term parturients giving birth by elective cesarean section were selected, and 126 were included in the intent-to-treat analysis. Parturients were provided standardized anesthesia and randomized to the active-tES (a-tES) group and sham-tES group. Parturients and outcome assessors were blinded to treatment allocation. The primary outcome was the changes in peripartum mental health disorders, including anxiety, assessed by the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2). Secondary outcomes included peripartum depressive symptoms, assessed by the Edinburgh Postnatal Depression Scale (EPDS), maternal satisfaction, fatigue level, sleep quality index, and pain score during and after operation. Data were collected before entering the operating room (T0), between post-anesthesia and pre-surgery (T1), before leaving the operating room (T2), and at 24 h post-surgery (T3). RESULTS One hundred and twenty-six eligible parturients were enrolled in the two groups: a-tES group (N = 62) and sham-tES group (N = 64). Treatment with tES resulted in significantly lower scores of anxiety compared with sham-tES (T2: P < 0.001; T3: P = 0.001). Moreover, the a-tES groups showed a significant reduction in depression scores (T2: P = 0.003; T3: P = 0.032). CONCLUSION In this randomized pilot study, tES treatment is efficacious in alleviating peripartum anxiety and depressive symptoms in women undergoing cesarean section and has been demonstrated to be a novel strategy for improving peripartum mental health disorders. CLINICAL TRIAL REGISTRATION [www.chictr.org.cn], identifier [ChiCTR2000040963].
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Affiliation(s)
- Qiu Zhao
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology and NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Yuan Han
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Shanghai, China
| | - Xiao-Yi Hu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology and NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Song Zhang
- Department of Anesthesiology, Renji Hospital School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Long Zhang
- Insititute of Nervous System Diseases, Xuzhou Medical University, Xuzhou, China
| | - Jun Wang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology and NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Qian-Qian Zhang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology and NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Ming-Shu Tao
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology and NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Jia-Xing Fang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology and NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Jie Yang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology and NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Rong-Guang Liu
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology and NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Xun Sun
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology and NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Jian Zhou
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology and NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Xiang Li
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology and NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Mannan-Abdul
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology and NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Hongxing Zhang
- Jiangsu Province Key Laboratory of Anesthesiology and NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - He Liu
- Department of Anesthesiology, The Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou Central Hospital, Huzhou, China
| | - Jun-Li Cao
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology and NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
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Mantler T, Jackson KT, Walsh EJ, Jackson B, Baer JR, Davidson CA, Shillington KJ, Parkinson S. Promoting Attachment Through Healing (PATH): Results of a retrospective feasibility study providing trauma-and-violence-informed care to pregnant women. J Adv Nurs 2021; 78:557-568. [PMID: 34837410 DOI: 10.1111/jan.15117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/01/2021] [Accepted: 11/04/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the impact of a trauma and violence-informed cognitive behavioural therapy (TVICBT) intervention, compared with standard care on mental health, coping, bonding and maternal-infant attachment among pregnant women with a history of intimate partner violence and who displayed symptomatology consistent with anxiety, depression or post-traumatic stress disorder (PTSD). DESIGN A mixed-methods case study design was employed, where women either received standard perinatal care or were referred to a specialized TVICBT program. METHODS Data were collected through a retrospective obstetric medical chart audit in 2017 at an Ontario hospital in a large urban centre. Multiple choice and 'yes/no' questions were analysed using measures of central tendency and dispersion, in addition to frequency counts. Qualitative data from clinical notes were subjected to an inductive content analysis approach to identify key concepts. RESULTS In total, 69 women participated (intervention group = 37, standard care group = 32). Prevalence of mental illness between groups was consistent, apart from the TVICBT group having a significant increase in PTSD. In the TVICBT group, 83.8% of women (n = 31) expressed perinatal concerns, compared with only 37.5% (n = 12) of the standard care group. More women in the intervention group (94.6%, n = 35) coped successfully in the intrapartum period than the standard care group (78.1%, n = 25). However, more women in the standard care group (97.0%, n = 31) exhibited appropriate bonding behaviours than the TVICBT group (88.6%, n = 31). CONCLUSION The TVICBT intervention was effective in assisting women to identify triggers during their pregnancy journey, develop appropriate coping strategies and advocate for their needs to best cope. IMPACT TVICBT offers an effective, individualized, trauma and violence-informed approach to optimize the health outcomes of perinatal women and their infants by promoting positive coping and maternal-infant bonding, thus filling an existing practice gap of a lack of individualized, trauma-informed care.
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Affiliation(s)
- Tara Mantler
- School of Health Studies, Western University, London, ON, Canada
| | - Kimberley T Jackson
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Edmund J Walsh
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Brianna Jackson
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Jessi R Baer
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Cara A Davidson
- School of Health Studies, Western University, London, ON, Canada
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25
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Holzhauer CG, Kroll-Desrosiers A, Kinney RL, Copeland LA, Bastian LA, Mattocks KM. Prenatal Stress Exposure and Post-traumatic Stress Disorder Associated With Risk of Postpartum Alcohol Misuse Among Women Veterans. Womens Health Issues 2021; 31:596-602. [PMID: 34148828 PMCID: PMC10500562 DOI: 10.1016/j.whi.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Maternal alcohol misuse during the postpartum period is associated with negative maternal and infant outcomes. This study examined whether greater stress exposure in the year before the baby's birth and maternal post-traumatic stress disorder (PTSD) were associated with postpartum alcohol misuse among a sample of women veterans. Maternal PTSD was also examined as a moderator of the association between stress exposure and postpartum alcohol misuse. METHODS Data were drawn from the Center for Maternal and Infant Outcomes Research in Translation study, a multisite prospective cohort study of pregnant and postpartum women veterans. Interviews were conducted within 12 weeks after birth. At this post-birth interview, women reported whether they experienced stressful events (e.g., loss of job, military deployment, separation/divorce) in the year before birth. PTSD diagnosis and postpartum scores on the Alcohol Use Disorders Identification Test (AUDIT-C) were derived from the Department of Veterans Affairs medical records. RESULTS Models testing main and interaction effects showed a statistically significant association of both PTSD (p = .02) and stress exposure (p = .04), as well as significant interaction of PTSD and stress exposure (p = .03) with AUDIT-C scores postpartum, after controlling for marital status, age, and race. Specifically, compared with women without PTSD, those with PTSD had higher overall AUDIT-C scores postpartum, regardless of stress exposure. For women without PTSD, more stress exposure before birth was associated with higher AUDIT-C scores during the postpartum phase. CONCLUSIONS PTSD diagnosis and life stressors before infant birth predicted maternal alcohol misuse during the postpartum period. Identifying such risk factors is an initial step in preventing alcohol misuse, with the goal of enhancing postpartum health for the birthing parent and infant.
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Affiliation(s)
- Cathryn Glanton Holzhauer
- Division of Research & Education, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Psychiatry & Division of Addiction, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Aimee Kroll-Desrosiers
- Division of Research & Education, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Rebecca L Kinney
- Division of Research & Education, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts
| | - Laurel A Copeland
- Division of Research & Education, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lori A Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut; Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Kristin M Mattocks
- Division of Research & Education, VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Psychiatry & Division of Addiction, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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26
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Miller-Graff LE, Howell KH, Paulson JL, Jamison LE. I'll catch you when you fall: Social safety nets and housing instability in IPV-exposed pregnant women. J Affect Disord 2021; 291:352-358. [PMID: 34087631 DOI: 10.1016/j.jad.2021.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) has significant consequences for women's mental health, and it also compromises women's economic security and livelihood, including housing stability. There is a dearth of research, however, on protective factors in the link between housing instability and psychopathology in IPV-exposed women. METHODS The current study examines the protective role of social support in the association between housing instability and mental health (depression, posttraumatic stress) in a sample of pregnant, IPV-exposed women (N = 137). RESULTS Overall models for both depression and posttraumatic stress were significant (F = 6.42, p<.001; R2=16.3%; F = 15.09, p<.001; R2=31.0%, respectively). Housing instability was significantly associated with higher levels of depressed mood (β=0.20, p<.016), but not posttraumatic stress symptoms. Social support was significantly associated with lower levels of depressed mood (β=-0.17, p<.036) and posttraumatic stress (β=-0.38, p =0.001). The addition of the interaction term (housing instability*social support) resulted in a significant improvement in variance explained from the main effects model for depression (F = 4.90, p<.028, ∆R2=3.0%) and the interaction term was significant (β=-0.60, p=.029). An interaction effect of housing instability and social support on posttraumatic stress was not identified. LIMITATIONS Although the current study is the first to examine protective factors in the relationship between housing instability and psychopathology in IPV-exposed pregnant women, data were cross-sectional and therefore directionality and temporality cannot be inferred. CONCLUSIONS Results suggest that housing instability may play a greater role in women's depressed mood than in their experience of posttraumatic stress symptoms, and the presence of social support may substantially ameliorate the effect of this adversity.
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Affiliation(s)
- Laura E Miller-Graff
- Associate Professor of Psychology and Peace Studies Department of Psychology Kroc Institute for International Peace Studies 390 Corbett Family Hall Notre Dame, IN 46556, USA.
| | - Kathryn H Howell
- Associate Professor, Department of Psychology University of Memphis Psychology Building, Room 356 Memphis, TN 38152, Egypt.
| | - Julia L Paulson
- Doctoral Student, Clinical Psychology University of Notre Dame, 390 Corbett Family Hall Notre Dame, IN 46556, US.
| | - Lacy E Jamison
- Doctoral Student, Clinical Psychology University of Memphis Psychology Building, Room 356 Memphis, TN 38152, Egypt.
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27
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Davidson AD, Bhat A, Chu F, Rice JN, Nduom NA, Cowley DS. A systematic review of the use of prazosin in pregnancy and lactation. Gen Hosp Psychiatry 2021; 71:134-136. [PMID: 33840480 DOI: 10.1016/j.genhosppsych.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Ashley D Davidson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
| | - Frances Chu
- University of Washington Health Sciences Library, Seattle, WA, USA
| | - Jessie N Rice
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - N Aba Nduom
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Deborah S Cowley
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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28
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Johnson AM, Menke R, Handelzalts JE, Green K, Muzik M. Reimagining Racial Trauma as a Barrier to Breastfeeding Versus Childhood Trauma and Depression Among African American Mothers. Breastfeed Med 2021; 16:493-500. [PMID: 33691474 PMCID: PMC8215412 DOI: 10.1089/bfm.2020.0304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: Although breastfeeding provides benefits for mothers and infants, multiple factors prevent women from breastfeeding. This article aims to explore the role of mothers' personal and contextual risk factors to breastfeeding rates with a special emphasis on understanding breastfeeding among African American mothers at 6 months postpartum. Design: This secondary analysis was capitalizing on previously collected postpartum data from a longitudinal cohort study on the consequences of maternal childhood trauma on mother and infant outcomes. Postpartum mothers (n = 188) completed questionnaires on demographics, childhood trauma history, postpartum depression, social support, and breastfeeding status at 6 months postpartum. Results: All risk factors (i.e., demographic and social support risk, childhood trauma history, and postpartum depression) were associated with lower breastfeeding at 6 months postpartum. When risk factors were examined in a single comprehensive model, only cumulative demographic risk emerged as significant. When partialing-out by race, being African American was the only variable associated with lower breastfeeding at 6 months postpartum. Conclusions: Our study confirms that African American mothers report lower breastfeeding rates at 6 months postpartum than non-African American mothers. This association held even when controlling for demographic and social support risk, childhood trauma history, and postpartum depression. We discuss our findings from an intergenerational and historical trauma, racism, chronic discrimination perspective that considers the multifactorial nature of past and current impacts on breastfeeding among African American women in the United States.
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Affiliation(s)
- Angela Marie Johnson
- Program for Multicultural Health, Department Community Health Services, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Rena Menke
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jonathan Eliahu Handelzalts
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
- School of Behavioral Sciences, The Academic College of Tel-Aviv Yaffo, Tel-Aviv, Israel
| | - Kiddada Green
- Black Mothers' Breastfeeding Association, Detroit, Michigan, USA
| | - Maria Muzik
- Department of Psychiatry, Michigan Medicine, Ann Arbor, Michigan, USA
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, Michigan, USA
- Address correspondence to: Maria Muzik, MD, MSc, Department of Psychiatry, Michigan Medicine, Rachel Upjohn Building, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
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29
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Lowe SR, Ratanatharathorn A, Lai BS, van der Mei W, Barbano AC, Bryant RA, Delahanty DL, Matsuoka YJ, Olff M, Schnyder U, Laska E, Koenen KC, Shalev AY, Kessler RC. Posttraumatic stress disorder symptom trajectories within the first year following emergency department admissions: pooled results from the International Consortium to predict PTSD. Psychol Med 2021; 51:1129-1139. [PMID: 32008580 PMCID: PMC8318129 DOI: 10.1017/s0033291719004008] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics. METHODS This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course. RESULTS Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory. CONCLUSIONS The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.
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Affiliation(s)
| | - Andrew Ratanatharathorn
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Betty S Lai
- Lynch School of Education and Human Development, Boston College, Chestnut Hill, USA
| | | | | | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW2052, Australia
- Brain Dynamics Centre, Westmead Institute of Medical Research, University of Sydney, Westmead, Australia
| | | | - Yutaka J Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Miranda Olff
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | | | - Eugene Laska
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University School of Medicine
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Arieh Y Shalev
- Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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30
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Factors Associated with Postpartum Post-Traumatic Stress Disorder (PTSD) Following Obstetric Violence: A Cross-Sectional Study. J Pers Med 2021; 11:jpm11050338. [PMID: 33923164 PMCID: PMC8145360 DOI: 10.3390/jpm11050338] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
To determine the association between experiencing obstetric violence and the incidence of postpartum post-traumatic stress disorder (PTSD). A cross-sectional study with puerperal women was conducted in Spain following ethical approval. The Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ) was administered online. Sociodemographic, clinical, and obstetric violence variables and the risk of dichotomized PTSD (low/high) were studied by bivariate and multivariate analysis with binary logistic regression. 955 women were invited to participate. 53 women refused to participate, three did not complete all survey questions and, finally, 899 women were included. The risk of PTSD (score ≥ 19) using the PPQ was 12.7% (114). The mean score was 9.10 points (SD = 8.52). Risk factors identified were having a delivery plan that was not respected (aOR: 2.85, 95% CI 1.56–5.21), elective caesarean delivery (aOR: 2.53, 95% CI 1.02–2.26), emergency caesarean section (aOR: 3.58, 95% CI 1.83–6.99), admission of the newborn to the neonatal intermediate care unit (aOR: 4.95, 95% CI 2.36–10.36), admission to the intensive care unit (aOR: 2.25, 95% CI 1.02–4.97), formula feeding on discharge (aOR: 3.57, 95% CI 1.32–9.62), verbal obstetric violence (aOR: 5.07, 95% CI 2.98–8.63), and psycho-affective obstetric violence (aOR: 2.61, 95% CI 1.45–4.67). Various clinical practices were identified with the risk of PTSD, highlighting various types of obstetric violence. Partner support and early breastfeeding were identified as protective factors. Sensitizing professionals is essential to prevent the risk of PTSD.
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31
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Narayan AJ, Lieberman AF, Masten AS. Intergenerational transmission and prevention of adverse childhood experiences (ACEs). Clin Psychol Rev 2021; 85:101997. [PMID: 33689982 DOI: 10.1016/j.cpr.2021.101997] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 12/29/2022]
Abstract
In recent years, research and practice on adverse childhood experiences (ACEs) have shifted from delineating effects of ACEs on adulthood health problems to preventing ACEs in children. Nonetheless, little attention has focused on how parents' own childhood experiences, adverse or positive, may influence the transmission of ACEs across generations. Children's risk for ACEs and potential for resilience may be linked to the early child-rearing experiences of their parents carried forward into parenting practices. Additionally, parents with multiple ACEs may have PTSD symptoms, an under-recognized mediator of risk in the intergenerational transmission of ACEs. Guided by developmental psychopathology and attachment theory with an emphasis on risk and resilience, we argue that a more comprehensive understanding of parents' childhood experiences is needed to inform prevention of ACEs in their children. Part I of this review applies risk and resilience concepts to pathways of intergenerational ACEs, highlighting parental PTSD symptoms as a key mediator, and promotive or protective processes that buffer children against intergenerational risk. Part II examines empirical findings indicating that parents' positive childhood experiences counteract intergenerational ACEs. Part III recommends clinically-sensitive screening of ACEs and positive childhood experiences in parents and children. Part IV addresses tertiary prevention strategies that mitigate intergenerational ACEs and promote positive parent-child relationships.
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Affiliation(s)
- Angela J Narayan
- Department of Psychology, University of Denver, United States of America; Department of Psychiatry and Child Trauma Research Program, University of California, San Francisco, United States of America.
| | - Alicia F Lieberman
- Department of Psychiatry and Child Trauma Research Program, University of California, San Francisco, United States of America
| | - Ann S Masten
- Institute of Child Development, University of Minnesota, Twin Cities, United States of America
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32
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Weigl T, Beck-Hiestermann FML, Stenzel NM, Benson S, Schedlowski M, Garthus-Niegel S. Assessment of Childbirth-Related PTSD: Psychometric Properties of the German Version of the City Birth Trauma Scale. Front Psychiatry 2021; 12:731537. [PMID: 34690839 PMCID: PMC8527008 DOI: 10.3389/fpsyt.2021.731537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background: About 3-4% of women in community samples suffer from childbirth-related posttraumatic stress disorder (PTSD). Surprisingly, the recently developed City Birth Trauma Scale (City BiTS) was the first diagnostic tool for childbirth-related PTSD covering DSM-5 criteria for PTSD. Since no questionnaire on childbirth-related PTSD is available in German, we aimed to validate a German translation of the City BiTS and to provide information on its psychometric properties. Methods: A community sample of 1,072 mothers completed an online survey, which included questions on sociodemographic and obstetric characteristics, the German version of the City BiTS, the Impact of Event Scale-Revised (IES-R), the PTSD Checklist for DSM-5 (PCL-5), Edinburgh Postnatal Depression Scale (EPDS), and the anxiety subscale of the Depression, Anxiety, and Stress Scale (DASS-Anxiety). Results: Exploratory factor analysis (EFA) on a random split-half sample confirmed the previously reported two-factorial structure of the City BiTS. The factors "Childbirth-related symptoms" and "General symptoms" explained about 53%, 52% of variance. Internal consistency was good to excellent for the subscales and the total scale (Cronbach's Alpha = 0.89-0.92). In a confirmatory factor analysis (CFA) in the holdout sample the two-factorial solution reached the best model fit out of three models. Correlation analyses showed convergent validity of the City BiTS (total scale and subscales) with the IES-R and PCL-5 and divergent validity with the EPDS and the DASS-Anxiety. Limitations: Data were acquired in a community sample and prevalence rates might not be representative for mothers of high-risk groups, e.g., after preterm birth. Conclusions: The German version of the City BiTS is the first German questionnaire which allows to assess symptoms of childbirth-related PTSD according to DSM-5 criteria. Besides an improvement in clinical routine it will help to make data on prevalence of childbirth-related PTSD internationally comparable. In addition, this work provides a basis to assess childbirth-related PTSD in studies conducted with a longitudinal study design or in high-risk samples.
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Affiliation(s)
- Tobias Weigl
- Psychology School, Hochschule Fresenius - University of Applied Sciences Düsseldorf, Düsseldorf, Germany
| | | | - Nikola Maria Stenzel
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Sven Benson
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Susan Garthus-Niegel
- Institute for Systems Medicine (ISM), Faculty of Human Medicine, Medical School Hamburg, Hamburg, Germany.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway.,Faculty of Medicine, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
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33
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Zhang S, Zhou Y, Ge LK, Zeng L, Liu Z, Qian W, Yang J, Zhou X, Wei GX, Zhang X. Interaction of Insomnia and Somatization with Post-Traumatic Stress Disorder in Pregnant Women During the COVID-19 Pandemic. Neuropsychiatr Dis Treat 2021; 17:2539-2547. [PMID: 34393483 PMCID: PMC8354733 DOI: 10.2147/ndt.s310300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) has an adverse impact on the emotional health of prenatal maternal women and their offspring. During the Coronavirus Disease 2019 (COVID-19) pandemic, pregnant women are vulnerable to traumatic events and are prone to PTSD symptoms. The aim of the study was to explore the predictive effects of insomnia and somatization on PTSD in pregnant women by utilizing generalized additive model (GAM). MATERIALS AND METHODS A total of 1638 pregnant women from three local cities in China underwent online survey on sleep quality, somatization, and PTSD symptoms tested by the Insomnia Severity Index (ISI), the subscale somatization of Symptom Checklist-90 (SCL-90-S) and the Checklist for DSM-5 (PCL-5), respectively. RESULTS Insomnia was positively correlated with PTSD symptoms in pregnant women (p = 1.79×10-5). Interestingly, insomnia and somatization showed a complex non-primary linear interaction in predicting PTSD (p = 2.00×10-16). CONCLUSION Our results suggest that insomnia is a prominent predictor of PTSD symptoms in pregnant women in the context of public emergencies. In addition, the effects of insomnia and somatization on PTSD symptoms are characterized by complex non-primary linear relationships.
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Affiliation(s)
- Shu Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Yongjie Zhou
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, Guangdong, People's Republic of China.,Shenzhen Kangning Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Li-Kun Ge
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, People's Republic of China
| | - Lingyun Zeng
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Wei Qian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Jiezhi Yang
- Shenzhen Health Development Research Center, Shenzhen, People's Republic of China
| | - Xin Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, People's Republic of China
| | - Gao-Xia Wei
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, People's Republic of China
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
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Esfeh BK, Kazemi A, Shamsaie A. Designing architecture of soothing labor-delivery-recovery-postpartum unit: a study protocol. Reprod Health 2020; 17:196. [PMID: 33302950 PMCID: PMC7731737 DOI: 10.1186/s12978-020-01055-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background The physical environment profoundly affects women's well-being during childbirth in family-centered unit. A LDRP, which is an acronym for labor, delivery, recovery, and postpartum that describes a maternity unit designed for family-centered care. This study aimed to design soothing LDRP healing architecture based on recognizing the emotional elements of Iranian women. Methods This study will be conducted in four consecutive phases; including review of literature to provide documentation based on architectural knowledge and the effects of each architectural component on the parturient psychological conditions, qualitative study to extract women's needs and suggestions for physiological childbirth, architectural designing of the soothing LDRP based on the results of the first and second phases and qualitative study for evaluation of the designed program. Discussion Designing soothing LDRP architecture based on safe child birth unit standards and favorable psychological environment will provide a positive childbirth experience for Iranian women and their family. But, the preferences and demands of families will be based on Iranian socio-cultural context, therefore the using of this design will be limited in other societies with different cultures.
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Affiliation(s)
| | - Ashraf Kazemi
- Reproductive Health Department, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Hezarjerib AV, Isfahan, Iran.
| | - Aida Shamsaie
- Scene Design Department, School of Cinema and Theater, University of Art, Tehran, Iran
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Nillni YI, Shayani DR, Finley E, Copeland LA, Perkins DF, Vogt D. The Impact of Posttraumatic Stress Disorder and Moral Injury on Women Veterans' Perinatal Outcomes Following Separation From Military Service. J Trauma Stress 2020; 33:248-256. [PMID: 32291816 PMCID: PMC7864116 DOI: 10.1002/jts.22509] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 12/18/2019] [Accepted: 01/05/2020] [Indexed: 01/08/2023]
Abstract
Posttraumatic stress disorder (PTSD) has been found to lead to several adverse perinatal outcomes in the general population. Preliminary research has found that women veterans with PTSD have an increased prevalence of preterm birth, gestational diabetes, and preeclampsia. Less research has examined the role of moral injury (MI) in perinatal outcomes. This longitudinal survey study examined the impact of PTSD symptoms and MI on prospectively assessed adverse perinatal outcomes among women who became pregnant in the first 3 years after separating from U.S. military service (N = 318). The Moral Injury Events Scale was used to assess the degree to which individuals experienced distress related to transgressions of deeply held moral beliefs, and the Primary Care PTSD Screen for DSM-5 (PC-PTSD) was used to assess PTSD symptoms. Perinatal outcomes included experiencing an adverse pregnancy outcome (e.g., preterm birth, gestational diabetes), postpartum depression and/or anxiety, and perceived difficult pregnancy. Although both PTSD symptoms, adjusted odds ratio (aOR) = 1.16, 95% CI [1.00, 1.35]; and MI, aOR = 1.27, 95% CI [1.06, 1.41], emerged as significant predictors of adverse pregnancy outcomes, only PTSD symptoms were a significant predictor of postpartum depression and/or anxiety, aOR = 1.43, 95% CI [1.22, 1.68], and perception of a difficult pregnancy, β = .31, when controlling for lifetime trauma exposure, age, socioeconomic status, and ethnic/racial minority status. The results indicate that both PTSD symptoms and MI are associated with adverse perinatal outcomes, supporting the potential need to screen for both PTSD and MI during the perinatal period.
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Affiliation(s)
- Yael I. Nillni
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
| | - Danielle R. Shayani
- Department of Psychiatry, Boston University School of Medicine,Northeastern University
| | - Erin Finley
- Veterans Evidence-based Research Dissemination and Implementation Center, South Texas Veterans Health Care System,Departments of Medicine and Psychiatry, UT Health San Antonio
| | - Laurel A. Copeland
- VA Central Western Massachusetts Healthcare System,Department of Population and Quantitative Health Science, University of Massachusetts Medical School
| | - Daniel F. Perkins
- Clearinghouse for Military Family Readiness, and Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University
| | - Dawne Vogt
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System,Department of Psychiatry, Boston University School of Medicine
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Linares DE, Azuine RE, Singh GK. Social Determinants of Health Associated with Mental Health Among U.S. Mothers with Children Aged 0-5 Years. J Womens Health (Larchmt) 2020; 29:1039-1051. [PMID: 32456536 DOI: 10.1089/jwh.2019.8111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Maternal mental illness is a significant public health problem during the perinatal period and beyond. Little is known about how social determinants of health (SDOH) affect maternal mental health. Materials and Methods: We used cross-sectional data from the 2016 to 2017 National Survey of Children's Health with 19,127 mothers of a nationally representative sample of U.S. children aged 0-5. We estimated the prevalence of poor reported mental health (reported as "fair"/"poor") among mothers with children aged 0-5 by SDOH. Multivariable logistic regression was used to examine factors associated with poor maternal mental health. Results: Approximately 4.5% of mothers with children aged 0-5 reported having poor mental health in 2016-2017. Postadjustment and mothers' poor mental health were significantly associated with age (adjusted odds ratio [AOR]: 18-20 years: 2.77, 95% confidence interval [CI]: 1.35-5.67; 21-24 years AOR: 2.14, 95% CI: 1.22-3.73, and 30-34 years AOR: 1.97, 95% CI: 1.13-3.43), U.S.-born status (AOR: 2.31, 95% CI: 1.48-3.63), poor physical health (AOR: 8.69, 95% CI: 5.81-13.02), having a child with a special health care need (AOR: 1.65, 95% CI: 1.03-2.64), experiencing food insecurity (afford enough food, yet, unhealthy [AOR: 2.74, 95% CI: 1.59-4.70] and sometimes/often not afford enough food [AOR: 3.20, 95% CI: 1.76-5.84]), and low social capital (AOR: 1.97, 95% CI: 1.04-3.73). Conclusion: Mothers with children aged 0-5 who had poor physical health and experienced food insecurity were at the greatest risk for poor mental health. Integrated perinatal and behavioral health models, screening, and referrals may help identify and treat mothers experiencing these issues.
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Affiliation(s)
- Deborah E Linares
- Division of Research, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
| | - Romuladus E Azuine
- Division of Research, Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
| | - Gopal K Singh
- Office of Health Equity, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Maryland, USA
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Romero G, Huth-Bocks A, Puro-Gallagher E, Riggs J. Maternal prenatal depression, PTSD, and problematic parenting: the mediating role of maternal perceptions of infant emotion. J Reprod Infant Psychol 2020; 39:125-139. [PMID: 32320277 DOI: 10.1080/02646838.2020.1754371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Perinatal illness is alarmingly common and has negative effects on maternal and infant well-being. Depression and posttraumatic stress disorder (PTSD), specifically, are characterised by negative views of the self and others, which may impact a mother's perceptions of herself and her child. Objective: This study examined the relationship between depression and PTSD symptoms, maternal perceptions of infant emotions, and parenting behaviours. Methods: 120 pregnant, mostly low-income women and their infants (after birth) participated in a longitudinal study. Maternal depression and PTSD symptoms were assessed during pregnancy and 1 year postpartum; maternal perceptions of infant emotions and parenting quality were assessed at 1 year. Results: Correlation analyses revealed significant, negative associations between prenatal (but not postnatal) psychiatric symptoms and positive perceptions of infant emotions, as well as between positive perceptions of infant emotions and negative parenting. Results also revealed significant indirect effects of prenatal depressive and PTSD symptoms on negative parenting via perceptions of infant emotion (95% CIs:.0013 -.0200 and.0008 -.0083, respectively). Conclusion: Findings highlight that mothers should be routinely screened for psychiatric symptoms during the perinatal period, and perceptions of infant emotions may be an important target for parent-infant mental health interventions.
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Affiliation(s)
- Gloria Romero
- Department of Psychology, University of Tennessee-Knoxville , Knoxville, TN, USA
| | - Alissa Huth-Bocks
- Department of Pediatrics/Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center , Cleveland, OH, USA
| | | | - Jessica Riggs
- Department of Psychiatry, Michigan Medicine , Ann Arbor, MI, USA
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Maguire J, McCormack C, Mitchell A, Monk C. Neurobiology of maternal mental illness. HANDBOOK OF CLINICAL NEUROLOGY 2020; 171:97-116. [PMID: 32736761 DOI: 10.1016/b978-0-444-64239-4.00005-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This chapter provides an overview of current research discoveries beginning to uncover the neurobiology of maternal mental illness. Results are described according to standard diagnostic categories (specifically, perinatal depression, perinatal anxiety and OCD, postpartum psychosis and bipolar disorder, and trauma and posttraumatic stress disorder), yet we aim to put this approach in context with the introduction of a classification model for psychiatric research, the research domain criteria, gaining traction in basic and clinical translational fields. We first review a new area of study, the neuroplasticity of the pregnant and postpartum brain, as work here has relevance for understanding the pathophysiology of mental disorders and may provide clues to changes in brain functioning that are related to compromised parenting in the context of postpartum depression. We next provide background information on neuroendocrine and immune changes during pregnancy and, to a lesser extent, the postpartum period, as alterations in these systems are significantly implicated in underlying neurobiology of mental illness for peripartum women. Our discussion of the major mental illnesses for pregnant and postpartum women includes neuroendocrine changes, neuroinflammation, and neurotransmitter alterations, as well as circuit dysfunction. Overall, remarkable progress has been made in identifying variations in neurobiology (and related systems) involved in maternal mental illness; yet, it is clear that, as classified with standard diagnostic systems, these are heterogeneous disorders and there is individual variability in the alterations in neurobiology for the same illness.
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Affiliation(s)
- Jamie Maguire
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA, United States
| | - Clare McCormack
- Center for Science and Society, Columbia University, New York, NY, United States
| | - Anika Mitchell
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States.
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Pregnancy-related anxiety during COVID-19: a nationwide survey of 2740 pregnant women. Arch Womens Ment Health 2020; 23:757-765. [PMID: 32989598 PMCID: PMC7522009 DOI: 10.1007/s00737-020-01073-5] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023]
Abstract
The aim of this study is to explore the impact of the COVID-19 pandemic on pregnant women's anxiety and identify factors most strongly associated with greater changes in anxiety. An anonymous, online, survey of pregnant women (distributed April 3-24, 2020) included a modified pregnancy-related anxiety scale (PRAS) reflecting respondents' perception of pregnancy anxiety before COVID-19 and a current assessment of pregnancy-related anxiety. The difference between these scores was used as the outcome variable. Data were analyzed using bivariate and multivariate linear regression analyses. Two thousand seven hundred forty pregnant women from 47 states completed the survey. 25.8% (N = 706) stopped in-person visits, 15.2% used video visits (N = 415), and 31.8% (N = 817) used phone visits for prenatal care as a result of COVID-19. Those planning a hospital birth dropped from 2641 (96.4%) to 2400 (87.7%) following COVID-19. More than half of women reported increased stress about food running out (59.2%, N = 1622), losing a job or household income (63.7%, N = 1745), or loss of childcare (56.3%, N = 1543). More than a third reported increasing stress about conflict between household members (37.5%, N = 1028), and 93% (N = 2556) reported increased stress about getting infected with COVID-19. Slightly less than half of respondents (either selves or family members) were healthcare workers (41.4%, N = 1133) or worked in essential services (45.5%, N = 1246). In multivariate analysis, those reporting higher agreement with COVID-19-related stressors had greater changes in pre- to post-COVID-19 pregnancy-related anxiety. The COVID-19 pandemic is profoundly affecting pregnant women's mental health, and factors independent of pregnancy appear to be driving changes in pregnancy-specific anxiety.
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40
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An alternative theory for hormone effects on sex differences in PTSD: The role of heightened sex hormones during trauma. Psychoneuroendocrinology 2019; 109:104416. [PMID: 31472433 DOI: 10.1016/j.psyneuen.2019.104416] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/05/2019] [Accepted: 08/22/2019] [Indexed: 02/08/2023]
Abstract
Women are at least twice as susceptible to developing post-traumatic stress disorder (PTSD) compared to men. Although most research seeking to explain this discrepancy has focussed on the role of oestradiol during fear extinction learning, the role of progesterone has been overlooked, despite relatively consistent findings being reported concerning the role of progesterone during consolidation of emotional and intrusive memories. In this review article, we outline literature supporting the role of progesterone on memory formation, with particular emphasis on potential memory-enhancing properties of progesterone when subjects are placed under stress. It is possible that progesterone directly and indirectly exerts memory-enhancing effects at the time of trauma, which is an effect that may not be necessarily captured during non-stressful paradigms. We propose a model whereby progesterone's steroidogenic relationship to cortisol and brain-derived neurotrophic factor in combination with elevated oestradiol may enhance emotional memory consolidation during trauma and therefore present a specific vulnerability to PTSD formation in women, particularly during the mid-luteal phase of the menstrual cycle.
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Berthelot N, Lemieux R, Garon-Bissonnette J, Muzik M. Prenatal Attachment, Parental Confidence, and Mental Health in Expecting Parents: The Role of Childhood Trauma. J Midwifery Womens Health 2019; 65:85-95. [PMID: 31566890 DOI: 10.1111/jmwh.13034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/11/2019] [Accepted: 07/17/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Exposure to childhood abuse or neglect may lead to negative outcomes during pregnancy in expecting parents, which may contribute to a negative experience of childbearing and have consequences for the developing fetus. This study examined the associations between exposure to childhood abuse or neglect, psychological symptoms, prenatal attachment, and perception of parental competence in expectant parents. METHODS Individuals at low sociodemographic risk were recruited in community perinatal care settings and completed self-report assessment measures of depression, posttraumatic stress disorder, dissociation, personality disorders, perception of parental competence, and prenatal attachment. RESULTS There were 322 participants (78% women), including 91 adults with a history of childhood abuse or neglect, Participants who were exposed to childhood abuse or neglect reported significantly higher levels of symptoms on all indices of mental health than nonexposed adults, even when controlling for sociodemographic risks. However, both groups reported similar levels of prenatal attachment and parental confidence. The impact of childhood maltreatment was similar in men and women. Structural equation modeling showed that childhood abuse or neglect leads to poor mental health and that poor mental health, but not childhood maltreatment, is associated with low parental confidence and prenatal attachment. DISCUSSION Psychological symptoms are frequent in expectant parents who experienced maltreatment during their childhood. However, childhood abuse or neglect is not associated with their attitude regarding parenthood and the child in the absence of psychopathology. Supporting mental health may be an important target of parental programs offered during pregnancy to women and men with a history of childhood abuse or neglect.
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Affiliation(s)
- Nicolas Berthelot
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Roxanne Lemieux
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Julia Garon-Bissonnette
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Chamberlain C, Gee G, Brown SJ, Atkinson J, Herrman H, Gartland D, Glover K, Clark Y, Campbell S, Mensah FK, Atkinson C, Brennan SE, McLachlan H, Hirvonen T, Dyall D, Ralph N, Hokke S, Nicholson J. Healing the Past by Nurturing the Future-co-designing perinatal strategies for Aboriginal and Torres Strait Islander parents experiencing complex trauma: framework and protocol for a community-based participatory action research study. BMJ Open 2019; 9:e028397. [PMID: 31189682 PMCID: PMC6575864 DOI: 10.1136/bmjopen-2018-028397] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Child maltreatment and other traumatic events can have serious long-term physical, social and emotional effects, including a cluster of distress symptoms recognised as 'complex trauma'. Aboriginal and Torres Strait Islander (Aboriginal) people are also affected by legacies of historical trauma and loss. Trauma responses may be triggered during the transition to parenting in the perinatal period. Conversely, becoming a parent offers a unique life-course opportunity for healing and prevention of intergenerational transmission of trauma. This paper outlines a conceptual framework and protocol for an Aboriginal-led, community-based participatory action research (action research) project which aims to co-design safe, acceptable and feasible perinatal awareness, recognition, assessment and support strategies for Aboriginal parents experiencing complex trauma. METHODS AND ANALYSIS This formative research project is being conducted in three Australian jurisdictions (Northern Territory, South Australia and Victoria) with key stakeholders from all national jurisdictions. Four action research cycles incorporate mixed methods research activities including evidence reviews, parent and service provider discussion groups, development and psychometric evaluation of a recognition and assessment process and drafting proposals for pilot, implementation and evaluation. Reflection and planning stages of four action research cycles will be undertaken in four key stakeholder workshops aligned with the first four Intervention Mapping steps to prepare programme plans. ETHICS AND DISSEMINATION Ethics and dissemination protocols are consistent with the National Health and Medical Research Council Indigenous Research Excellence criteria of engagement, benefit, transferability and capacity-building. A conceptual framework has been developed to promote the application of core values of safety, trustworthiness, empowerment, collaboration, culture, holism, compassion and reciprocity. These include related principles and accompanying reflective questions to guide research decisions.
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Affiliation(s)
- Catherine Chamberlain
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
- Intergenerational Health Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Graham Gee
- Intergenerational Health Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephanie Janne Brown
- Intergenerational Health Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | | | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Deirdre Gartland
- Intergenerational Health Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Karen Glover
- Intergenerational Health Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Yvonne Clark
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
- Women and Kids Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Sandra Campbell
- Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia
- Centre for Indigenous Health Equity Research, Central Queensland University, Rockhampton, Queensland, Australia
| | - Fiona K Mensah
- Intergenerational Health Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology & Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | | | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helen McLachlan
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Tanja Hirvonen
- Centre for Remote Health, Flinders University, Darwin, Northern Territory, Australia
| | - Danielle Dyall
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Northern Territory, Australia
| | - Naomi Ralph
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Stacey Hokke
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Jan Nicholson
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
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Furtado M, Van Lieshout RJ, Van Ameringen M, Green SM, Frey BN. Biological and psychosocial predictors of anxiety worsening in the postpartum period: A longitudinal study. J Affect Disord 2019; 250:218-225. [PMID: 30870771 DOI: 10.1016/j.jad.2019.02.064] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/21/2019] [Accepted: 02/25/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND As many as 20% of women will experience an anxiety disorder during the perinatal period. Women with pre-existing anxiety disorders are at increased risk of worsening during this time, yet little is known about its predictors. STUDY AIM To investigate the psychosocial and biological risk factors for anxiety worsening in the postpartum in women with pre-existing anxiety disorders. METHODS Thirty-five (n = 35) pregnant women with pre-existing DSM-5 anxiety disorders were enrolled in this prospective study investigating the psychosocial (e.g., childhood trauma, intolerance of uncertainty, depression) and biological risk factors (e.g. C-reactive protein, interleukin-6, tumor necrosis factor-α) for anxiety worsening in the postpartum period. Anxiety worsening was defined as an increase of ≥50% or greater on Hamilton Anxiety Rating Scale scores from the third trimester of pregnancy (32.94 ± 3.35 weeks) to six weeks postpartum. RESULTS Intolerance of uncertainty, depressive symptom severity, and obsessive-compulsive disorder symptoms present in pregnancy were significant predictors of anxiety worsening in the postpartum. LIMITATIONS Sample heterogeneity and limited sample size may affect study generalizability. CONCLUSIONS To our knowledge, this is the first longitudinal study to investigate psychosocial and biological risk factors for anxiety worsening in the postpartum in women with pre-existing anxiety disorders. Continued research investigating these risk factors is needed to elucidate whether they differ from women experiencing new-onset anxiety disorders in the perinatal period, and those in non-puerperal groups. Identifying these risk factors can guide the development of screening measures for early and accurate symptom detection. This can lead to the implementation of appropriate interventions aimed at decreasing the risk of perinatal anxiety worsening.
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Affiliation(s)
- Melissa Furtado
- Neuroscience Graduate Program, McMaster University, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Ryan J Van Lieshout
- Neuroscience Graduate Program, McMaster University, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Ontario, Canada
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Ontario, Canada
| | - Sheryl M Green
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Ontario, Canada
| | - Benicio N Frey
- Neuroscience Graduate Program, McMaster University, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Ontario, Canada.
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Erickson N, Julian M, Muzik M. Perinatal depression, PTSD, and trauma: Impact on mother-infant attachment and interventions to mitigate the transmission of risk. Int Rev Psychiatry 2019; 31:245-263. [PMID: 30810410 DOI: 10.1080/09540261.2018.1563529] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Early interactions between infants and their caregivers are fundamental to child development, and the parent-infant relationship is believed to provide the foundation for healthy and secure attachment relationships and for infant mental health. Over time, these secure attachment relationships become the backbone for positive child outcomes across development. Abundant research to date confirms that parental mental illness, including depression and PTSD following trauma exposure, may have a detrimental impact on parenting quality and subsequent early child relationship formations. This review paper summarizes the literature on the role of sensitive parenting and a healthy mother-infant relationship in establishing a secure mother-infant attachment bond, which in turn is critical for the child's healthy socioemotional and cognitive development. The review also highlights the roles of maternal perinatal depression, PTSD, and/or exposure to interpersonal violence or childhood maltreatment onto parenting, bonding, and child attachment style towards the caregiver. The final section discusses existing therapeutic interventions and approaches that bolster early parenting practices and early maternal-child relationships. Specific emphasis is placed on relational interventions that address bonding and attachment disturbances in the context of maternal perinatal mental health risk and trauma.
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Affiliation(s)
- Nora Erickson
- a Women and Infants Mental Health Program & Zero To Thrive Program, Department of Psychiatry , University of Michigan, Psychiatry , Ann Arbor , MI , USA
| | - Megan Julian
- a Women and Infants Mental Health Program & Zero To Thrive Program, Department of Psychiatry , University of Michigan, Psychiatry , Ann Arbor , MI , USA
| | - Maria Muzik
- a Women and Infants Mental Health Program & Zero To Thrive Program, Department of Psychiatry , University of Michigan, Psychiatry , Ann Arbor , MI , USA
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Prenatal sleep quality and mental health symptoms across the perinatal period: A longitudinal study of high-risk women. J Psychosom Res 2019; 116:31-36. [PMID: 30654991 DOI: 10.1016/j.jpsychores.2018.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Trauma-exposed women may be at magnified risk for posttraumatic stress (PTSS) and depression symptoms in the perinatal period, but few studies have examined symptomatology across the perinatal period in high-risk samples. Further, the role of sleep in perinatal symptomatology has been largely neglected in the violence literature, despite its well-established associations to mental health in other samples. This study aimed to examine the trajectory of PTSS and depression symptoms across the perinatal period and the effects of childhood adversity, intimate partner violence and prenatal sleep impairment on PTSS and depression symptoms across the perinatal period. METHOD In a longitudinal, prospective study, 101 low-income pregnant women were interviewed during pregnancy, at 6-weeks postpartum, and 4 months postpartum. N = 83 women completed at least 2 interviews and were included in the analyses. Prenatal sleep, childhood adversity, and IPV exposure were assessed at the prenatal interview; PTSS and depression were assessed at all interviews. RESULTS Past year IPV was associated with elevated prenatal mental health symptoms and prenatal sleep difficulties were associated with a worsening trajectory in perinatal PTSS. CONCLUSIONS Screening for IPV and prenatal sleep difficulties may be paramount in identifying those at risk for the development or exacerbation of mental health symptoms in the perinatal period.
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Ghosn F, Almansa B, Moreno-Giménez A, Sahuquillo-Leal R, Serrano-Lozano E, Hervás D, Diago V, Cháfer-Pericás C, Vento M, García Blanco A. Trajectories of stress biomarkers and anxious-depressive symptoms from pregnancy to postpartum period in women with a trauma history. Eur J Psychotraumatol 2019; 10:1601990. [PMID: 31069025 PMCID: PMC6493226 DOI: 10.1080/20008198.2019.1601990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/11/2019] [Accepted: 03/15/2019] [Indexed: 01/14/2023] Open
Abstract
Background: Cross-sectional studies have found that a trauma history can be associated with anxious-depressive symptomatology and physiological stress dysregulation in pregnant women. Methods: This prospective study examines the trajectories of both anxiety and depressive symptoms and salivary cortisol and α-amylase biomarkers from women with (n = 42) and without (n = 59) a trauma history at (i) 38th week of gestation (T1), (ii) 48 hours after birth (T2), and (iii) three months after birth (T3). Results: The quantile regression model showed that trauma history was associated with higher cortisol levels at T1 and this difference was sustained along T2 and T3. Conversely, there were no significant differences in α-amylase levels between groups across the three time points and both groups showed an increase in α-amylase levels from T2 to T3. The ordinal mixed model showed that trauma history was associated with higher anxiety symptoms at T1 and this remained constant from T1 to T2 but was reversed from T2 to T3. In contrast, both groups showed similar depressive symptoms across the three time points. Conclusions: Whereas physiological stress dysregulation (in terms of higher cortisol levels) was maintained from pregnancy to postpartum period, pregnancy and childbirth were the most vulnerable stages for developing anxious symptoms in mothers with trauma history.
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Affiliation(s)
- Farah Ghosn
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Belén Almansa
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Alba Moreno-Giménez
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Rosa Sahuquillo-Leal
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Elena Serrano-Lozano
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - David Hervás
- Biostatistics Unit, Health Research Institute La Fe, Valencia, Spain
| | - Vicente Diago
- Division of Obstetrics and Gynaecology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Máximo Vento
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
| | - Ana García Blanco
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain.,Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain
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MacKinnon AL, Houazene S, Robins S, Feeley N, Zelkowitz P. Maternal Attachment Style, Interpersonal Trauma History, and Childbirth-Related Post-traumatic Stress. Front Psychol 2018; 9:2379. [PMID: 30618902 PMCID: PMC6279867 DOI: 10.3389/fpsyg.2018.02379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 11/12/2018] [Indexed: 12/18/2022] Open
Abstract
Childbirth-related post-traumatic stress has potentially negative and enduring consequences for the well-being of women and their families. Although research to date has identified attachment style and trauma history as individual risk factors, they have yet to be examined as integrative processes in the development and maintenance of childbirth-related post-traumatic stress. The current investigation aimed to examine whether attachment style may moderate the impact of a history of interpersonal trauma on initial levels and the rate of change in post-traumatic stress symptomatology across the first 6 months of the postpartum period. A large community sample of women were recruited from two Canadian urban hospitals. Childbirth-related post-traumatic stress symptoms were assessed longitudinally at 5 weeks, 2 months, and 6 months postpartum. Latent growth curve modeling (n = 251) revealed that attachment style moderated the impact of a history of interpersonal trauma on initial levels and the rate of change in post-traumatic stress symptomatology, while controlling for other well-established psychosocial (e.g., trait anxiety, previous psychopathology, lack of perceived support) and childbirth-related (e.g., mode of birth, labor pain, subjective experience) risk factors. More secure attachment conferred resiliency and more fearful attachment conferred vulnerability among women without a history of interpersonal trauma, while more preoccupied and more dismissing attachment conferred resiliency among women with a history of interpersonal trauma. These findings highlight the importance of understanding the integrative processes among risk and protective factors underlying the development of and ability to cope with childbirth-related post-traumatic stress. Attachment style and trauma history, which can be quickly measured, should be considered as targets in antenatal screening.
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Affiliation(s)
- Anna L. MacKinnon
- Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Sarah Houazene
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Stephanie Robins
- Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Nancy Feeley
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Centre for Nursing Research, Jewish General Hospital, Montreal, QC, Canada
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Phyllis Zelkowitz
- Department of Psychiatry, Jewish General Hospital, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
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Furtado M, Chow CHT, Owais S, Frey BN, Van Lieshout RJ. Risk factors of new onset anxiety and anxiety exacerbation in the perinatal period: A systematic review and meta-analysis. J Affect Disord 2018; 238:626-635. [PMID: 29957480 DOI: 10.1016/j.jad.2018.05.073] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/29/2018] [Accepted: 05/28/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Even though more than 20% of women meet diagnostic criteria for an anxiety disorder during the perinatal period, very little is known about the predictors of these problems. As a result, we systematically reviewed the literature on risk factors for new onset anxiety and maternal anxiety exacerbation in the perinatal period. METHODS PubMed, MEDLINE, PsycINFO, CINAHL, Ovid, ProQuest Portal, and Web of Science were searched for studies assessing risk factors for the development of new onset anxiety or anxiety worsening in women during pregnancy and the postpartum period. RESULTS 11,759 citations were identified, with 11 studies meeting eligibility criteria. New onset anxiety was assessed in 7 studies, anxiety worsening in 3, and 1 assessed both. Lower educational attainment, living with extended family members, multiparity, a family history of psychiatric disorders, hyperemesis gravidarum, comorbid sleep disorders, and prenatal oxytocin exposure were risk factors for new onset perinatal anxiety, while presence of comorbid psychiatric disorders and prenatal oxytocin were risk factors for anxiety worsening. LIMITATIONS Studies not explicitly stating whether participants had pre-existing anxiety disorders were excluded. As a result, meta-analysis was not possible for several risk factors. CONCLUSIONS Risk factors for new onset anxiety and anxiety worsening during the perinatal period include psychological, social, and biological exposures. Given the lack of studies differentiating women with and without pre-existing anxiety disorders, additional research is required in order to determine whether these factors differ from the non-puerperal population, as well as from each other.
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Affiliation(s)
- Melissa Furtado
- Neuroscience Graduate Program, McMaster University, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Cheryl H T Chow
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Ontario, Canada
| | - Sawayra Owais
- Neuroscience Graduate Program, McMaster University, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Benicio N Frey
- Neuroscience Graduate Program, McMaster University, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Ontario, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Ontario, Canada
| | - Ryan J Van Lieshout
- Neuroscience Graduate Program, McMaster University, Ontario, Canada; Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Ontario, Canada.
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Vignato J, Connelly CD, Bush RA, Georges JM, Semino-Asaro S, Calero P, Horwitz SM. Correlates of Perinatal Post-Traumatic Stress among Culturally Diverse Women with Depressive Symptomatology. Issues Ment Health Nurs 2018; 39:840-849. [PMID: 30277842 PMCID: PMC6397067 DOI: 10.1080/01612840.2018.1488313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Abstract
Post-traumatic stress disorder (PTSD) is an important and often neglected comorbidity of pregnancy; left untreated, it can lead to serious health complications for the mother and developing fetus. Structured interviews were conducted to identify risk factors of PTSD among culturally diverse women with depressive symptomatology receiving perinatal services at community obstetric/gynecologic clinics. Women abused as adults, with two or more instances of trauma, greater trauma severity, insomnia, and low social support were more likely to present perinatal PTSD symptoms. Perinatal PTSD is prevalent and has the potential for chronicity. It is imperative healthcare providers recognize salient risk factors and integrate culturally sensitive screening, appropriate referral, and treatment services for perinatal PTSD.
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Affiliation(s)
- Julie Vignato
- College of Nursing, University of Iowa, 305 College of Nursing Building, 50 Newton Road, Iowa City, IA 52242, USA
| | - Cynthia D. Connelly
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Ruth A. Bush
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Jane M. Georges
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Semira Semino-Asaro
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Patricia Calero
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, 1 Park Avenue, 8 Floor, New York, NY 10016, USA
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Nillni YI, Mehralizade A, Mayer L, Milanovic S. Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review. Clin Psychol Rev 2018; 66:136-148. [PMID: 29935979 DOI: 10.1016/j.cpr.2018.06.004] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 06/05/2018] [Accepted: 06/07/2018] [Indexed: 12/15/2022]
Abstract
Women with psychiatric disorders during pregnancy and the postpartum period (i.e., perinatal period) are at increased risk for adverse maternal and child outcomes. Effective treatment of psychiatric disorders during the perinatal period is imperative. This review summarizes the outcomes of 78 studies focused on the treatment of depression, anxiety, and trauma-related disorders during the perinatal period. The majority of studies focused on perinatal depression (n = 73). Of the five studies focused on anxiety or trauma-related disorders, only one was a randomized controlled trial (RCT). The most studied treatment was cognitive behavioral therapy (CBT; n = 22), followed by interpersonal psychotherapy (IPT; n = 13). Other interventions reviewed include other talk therapies (n = 5), collaborative care models (n = 2), complementary and alternative medicine approaches (n = 18), light therapy (n = 3), brain stimulation (n = 2), and psychopharmacological interventions (n = 13). Eleven studies focused specifically on treatment for low-income and/or minority women. Both CBT and IPT demonstrated a significant benefit over control conditions. However, findings were mixed when these interventions were examined in low-income and/or minority samples. There is some support for complementary and alternative medicine approaches (e.g., exercise). Although scarce, SSRIs demonstrated good efficacy when compared to a placebo. However, SSRIs did not outperform another active treatment condition (e.g., CBT). There is a tremendous need for more studies focused on treatment of perinatal anxiety and trauma-related disorders, as well as psychopharmacological effectiveness studies. Limitations and future directions of perinatal treatment research, particularly among low-income and/or minority populations, are discussed.
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Affiliation(s)
- Yael I Nillni
- National Center for PTSD, Women's Health Sciences Division at VA Boston Healthcare System, United States; Department of Psychiatry, Boston University School of Medicine, United States.
| | | | - Laura Mayer
- Department of Psychiatry, Boston University School of Medicine, United States
| | - Snezana Milanovic
- Department of Psychiatry, Boston University School of Medicine, United States
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