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Bete T, Ali T, Misgana T, Negash A, Abraham T, Teshome D, Sirtsu A, Nigussie K, Amano A. Suicidal ideation and associated factors among pregnant women attending antenatal care at public hospitals of Harari regional state, eastern Ethiopia: A cross-sectional study. PLoS One 2024; 19:e0300417. [PMID: 38547179 PMCID: PMC10977762 DOI: 10.1371/journal.pone.0300417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Suicide is a global issue. It is the third responsible for death among the reproductive age group. Pregnancy is a complicated event and crucial in the life of a woman with considerable physiological, hormonal changes, social, and mental changes. However, third-world countries like Ethiopia have not been investigated well. Therefore, the study planned to assess the magnitude and factors associated with suicidal ideation. Furthermore, it will identify the role of hyperemesis gravidarum on suicidal ideation. METHOD A Cross-sectional study was employed for 543 pregnant participants attending antenatal care at Hiwot Fana Specialized University Hospital and Jugal General Hospital, Harari regional state, eastern Ethiopia from June 1 to August 1, 2022. The recruited participants were selected by systematic random sampling method. Suicide was assessed using Composite International Diagnostic by interview methods data collection. Epi data and STATA version 14.1 were used for data entry and analysis respectively. Candidate variables were entered into a multivariate logistic regression then those variables that have p-value < 0.05 were considered as significantly associated. RESULTS The magnitude of suicidal ideation in this study was found to be 11.15% at (95% CI: 8.75-14.11). Regarding the associated factor, unwanted pregnancy (AOR = 3.39: at 95% CI = 1.58-7.27), Hyperemesis gravidarum (AOR = 3.65: at 95% CI = 1.81-7.34), having depressive symptoms (AOR = 2.79: at 95% CI = 1.49-5.23), having anxiety symptoms (AOR = 3.37; at 95% CI = 1.69-6.68), experiencing intimate partner violence (AOR = 2.88: at 95% CI = 1.11-7.46), and having stress (AOR = 3.46; at 95% CI = 1.75-6.86) were significantly associated variable with suicidal ideation among pregnant women. CONCLUSION AND RECOMMENDATION This study revealed that suicidal ideation is common among pregnant women. Regarding the associated factors unwanted pregnancy, hyperemesis gravidarum, having depressive and anxiety symptoms, experiencing intimate partner violence, and stress were significantly associated with suicidal ideation. Thus, giving awareness and early screening and interferences for antenatal suicide should be warranted.
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Affiliation(s)
- Tilahun Bete
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Ali
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Misgana
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abraham Negash
- Department of Midwifery, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teklu Abraham
- Department of Psychiatry, School Medicine, College of Health and Medical Sciences, Arsi University, Assella, Ethiopia
| | - Dekeba Teshome
- Department of Psychiatry, School Medicine, College of Health and Medical Sciences, Arsi University, Assella, Ethiopia
| | - Addisu Sirtsu
- Department of Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Nigussie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdulkerim Amano
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Chrzan-Dętkoś M, Murawska N, Łockiewicz M, de la Fe Rodriguez Muñoz M. Self-harm thoughts among postpartum women - associated factors. J Reprod Infant Psychol 2024:1-14. [PMID: 38319751 DOI: 10.1080/02646838.2024.2313487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Even though in many countries suicide is the leading cause of maternal deaths during the postpartum period, the prevalence of thoughts of self-harm (SHTs), an important risk factor for suicide attempts, is still not well documented. AIM We aimed to investigate the prevalence of SHTs in a Polish cohort of postpartum women and identify socio-demographic and maternal mental health factors associated with experiencing SHTs. METHOD 1545 women took part in a midwife-led postpartum depression (PPD) screening. 337 of them reported SHTs. The Edinburgh Postpartum Depression Scale (EPDS) was administered. Specifically, we used an abbreviated 5-item version to assess depression symptoms, item 10 to assess SHTs, a composite score of items 1 and 2 - anhedonia, and a composite score of items 3, 4, and 5 - anxiety. Logistic regression analyses were performed to examine associations between variables. RESULTS Approximately 2% (n = 337) of women self-reported experiencingSHTs. Within the group of postpartum mothers who self-reported SHTs, 65.60% (n = 221) manifested the symptoms of PPD, and 56.40% (n = 190) - of anxiety. The symptoms of PPD, a mood disorder diagnosed in the past, and younger age were predictors of SHTs. CONCLUSION The results of this study can contribute to the development of prevention strategies: analysing separately items from PPD screening questionnaires focusing on SHTs can be an important part of prevention. The lack of the symptoms of PPD and anxiety risk does notexclude experiencing SHTs.
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Affiliation(s)
| | - Natalia Murawska
- Institute of Psychology, the University of Gdansk, Gdansk, Poland
| | - Marta Łockiewicz
- Institute of Psychology, the University of Gdansk, Gdansk, Poland
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Behl R. Judicial interface with perinatal depression in India: an empirical analysis and thematic review of published judgments. Arch Womens Ment Health 2023:10.1007/s00737-023-01391-4. [PMID: 37987837 DOI: 10.1007/s00737-023-01391-4] [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: 08/31/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023]
Abstract
In the absence of health law policies focused on perinatal depression (PND) in India, it has primarily remained a biomedical research matter instead of being understood from the human rights perspective. Also, the interplay between PND and the Indian justice delivery system remains unexplored. Hence, it is imperative to understand the medico-legal milieu of PND through the lens of judicial interface with the facet of PND. Most popular Indian electronic legal databases were used to identify the judgments pronounced by the Indian Courts where the PND quotient was involved. The text of the resultant judgments was individually read to evaluate if if the subject claim were affected by PND quotient to fit the inclusion criteria. Using the inductive and latent thematic approach, the different emergent themes from the subject claims of every single judgment were used for developing codes. Myriad themes emerged out of the analysis, which helped identify how PND vastly impacts the justice delivery system in varied types of cases in India. Obliviousness and lack of awareness in Indian judiciary regarding PND, and its consequences was largely observed. Human rights violations were discerned owing to absence of perinatal mental health (PMH) services. This policy gap, in turn, results in absence of data regarding women affected by PND and about administered treatment (if any) for managing PND, and reduced empathy by the law enforcement agencies. The resultant themes depict the urgent and multidimensional benefits of introducing policies for PMH services, which will help create awareness about the human rights dimension of PND amongst the law enforcement agencies including the Indian judiciary, and police.
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Affiliation(s)
- Ritika Behl
- Symbiosis International (Deemed) University, Pune, India.
- Alliance School of Law, Alliance University, Bengaluru, India.
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Fellmeth G, Kanwar P, Sharma D, Chawla K, DasGupta N, Chhajed S, Chandrakant, Jose EC, Thakur A, Gupta V, Bharti OK, Singh S, Desai G, Thippeswamy H, Kurinczuk JJ, Chandra P, Nair M, Verma A, Kishore MT, Alderdice F. Women's awareness of perinatal mental health conditions and the acceptability of being asked about mental health in two regions in India: a qualitative study. BMC Psychiatry 2023; 23:829. [PMID: 37957589 PMCID: PMC10644637 DOI: 10.1186/s12888-023-05323-5] [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: 03/27/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Mental health conditions are common during pregnancy and the first year after childbirth. Early detection allows timely support and treatment to be offered, but identifying perinatal mental health conditions may be challenging due to stigma and under-recognition of symptoms. Asking about symptoms of mental health conditions during routine antenatal and postnatal appointments can help to identify women at risk. This study explores women's awareness of perinatal mental health conditions, their views on the acceptability of being asked about mental health and any preference for specific assessment tools in two regions in India. METHODS Focus group discussions (FGDs) were conducted with pregnant, post-partum and non-perinatal women in Kangra, Himachal Pradesh (northern India) and Bengaluru, Karnataka (southern India). Settings included a hospital antenatal clinic and obstetric ward, Anganwadi Centres and Primary Health Centres. FGDs were facilitated, audio-recorded and transcribed. Narratives were coded for emerging themes and analysed using thematic analysis. RESULTS Seven FGDs including 36 participants were conducted. Emerging themes were: manifestations of and contributors to mental health conditions; challenges in talking about mental health; and the acceptability of being asked about mental health. Difficult familial relationships, prioritising the needs of others and pressure to have a male infant were cited as key stressors. Being asked about mental health was generally reported to be acceptable, though some women felt uncomfortable with questions about suicidality. No preference for any specific assessment tool was reported. CONCLUSIONS Women face many stressors during the perinatal period including difficult familial relationships and societal pressure to bear a male infant. Being asked about mental health was generally considered to be acceptable, but questions relating to suicidality may be challenging in a community setting, requiring sensitivity by the interviewer. Future studies should assess the acceptability of mental health assessments in 'real world' antenatal and postnatal clinics and explore ways of overcoming the associated challenges in resource-constrained settings.
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Affiliation(s)
- Gracia Fellmeth
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Pankaj Kanwar
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Diksha Sharma
- Department of Obstetrics and Gynaecology, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | | | - Neha DasGupta
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Shreyash Chhajed
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Chandrakant
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Emily C Jose
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Anita Thakur
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Vikesh Gupta
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Omesh Kumar Bharti
- State Institute of Health and Family Welfare, Department of Health and Family Welfare, Government of Himachal Pradesh, Shimla, India
| | - Sukhjit Singh
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Prabha Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ashok Verma
- Department of Obstetrics and Gynaecology, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - M Thomas Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, India
| | - Fiona Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
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Xiao M, Fu B, Huang S, Hu Y, Tang G, Lei J. Trajectories of perinatal suicidal ideation from early pregnancy to six weeks postpartum and their influencing factors: A prospective longitudinal study. Psychiatry Res 2023; 328:115467. [PMID: 37690191 DOI: 10.1016/j.psychres.2023.115467] [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: 06/20/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Abstract
Few studies focused on the trajectory of perinatal suicidal ideation from early pregnancy and covered whole routine perinatal periods. This study aimed to investigate the prevalence of suicidal ideation from early pregnancy to six weeks postpartum, and further explore the trajectories of perinatal suicidal ideation and their risk factors. A prospective longitudinal study was conducted in a comprehensive tertiary hospital in Hunan province, China among 1089 participants. Perinatal suicidal ideation and depression were assessed by item 9 of Patient Health Questionnaire 9 and the remaining eight items. Sociodemographic and psychological factors were collected by self-reported comprehensive questionnaires. Latent Growth Curve and Growth Mixture Modeling were used to identify the trajectories of suicidal ideation and logistic regression was used to explore risk factors of trajectories. A total of 629 participants were included. The prevalence of suicidal ideation was 16.4% from early pregnancy to six weeks postpartum, with 12.1% in pregnancy and 7.8% in postpartum. Two trajectories were identified: "persistent low levels of suicidal ideation" (92.9%) and "persistent high levels of suicidal ideation" (7.1%). 40.63% of women who screened positive for suicidal ideation during early pregnancy were in the "persistent high level of suicidal ideation" trajectory. A low level of neuroticism and anxiety symptoms during early pregnancy was associated with "persistent high levels of suicidal ideation". In conclusion, suicidal ideation of women during the perinatal period was dynamic, Suicidal ideation screening and identification in early pregnancy should be addressed for perinatal women to facilitate timely early interventions.
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Affiliation(s)
- Meili Xiao
- Department of Nursing, Hunan Normal University School of Medicine, 371 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Bing Fu
- Department of Nursing, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Sasa Huang
- Department of Nursing, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Ying Hu
- Department of Nursing, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China
| | - Guanxiu Tang
- Department of Nursing, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China; Department of Geriatrics, The Third Xiangya Hospital of Central South University, China
| | - Jun Lei
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital of Central South University, Tongzipo Road, Yuelu District, Changsha, Hunan 410013, China.
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Votruba N, Praveen D, Mellers L, Rajan E, Thout SR, Arora V, Malik Y, Kashyap A, Majumdar S, Hirst J, Maulik PK. SMARThealth PRegnancy And Mental Health study: protocol for a situational analysis of perinatal mental health in women living in rural India. Front Glob Womens Health 2023; 4:1143880. [PMID: 37575961 PMCID: PMC10416114 DOI: 10.3389/fgwh.2023.1143880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction The situation for women experiencing mental health problems during pregnancy and postpartum in rural India is critical: a high burden of disease, a high estimated number of women are undiagnosed and untreated with mental health problems, a substantial gap in research on women's perinatal health, and severe stigma and discrimination. The SMARThealth Pregnancy study is a cluster randomised trial using a digital intervention to identify and manage anaemia, hypertension, and diabetes in the first year after birth in rural India. Within this study, the SMARThealth Pregnancy and Mental Health (PRAMH) study is a situational analysis to understand mental health problems during pregnancy and in the first year following birth in this population. Methods/design This situational analysis aims to analyse and to assess the context of perinatal mental health, health services, barriers, facilitators, and gaps in Siddipet district of Telangana state in India, to develop an implementation framework for a future intervention. A tested, standardised situational analysis tool will be adapted and applied to perinatal mental health in rural India. A desktop and policy review will be conducted to identify and analyse relevant mental health and pregnancy care policies at the national and state levels. We will conduct in-depth interviews with policymakers, planners, mental health professionals and other experts in perinatal mental health (n = 10-15). We will also conduct focus group discussions with key stakeholders, including women with perinatal mental health problems, their families and carers, and community health workers (n = 24-40). A theory of change workshop with key stakeholders will be conducted which will also serve as a priority setting exercise, and will clarify challenges and opportunities, priorities, and objectives for a pilot intervention study. The analysis of qualitive data will be done using thematic analysis. Based on the data analysis and synthesis of the findings, an implementation framework will be developed to guide development, testing and scale up of a contextually relevant intervention for perinatal mental health. Discussion The situational analysis will help to establish relationships with all relevant stakeholders, clarify the context and hypotheses for the pilot intervention and implementation.
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Affiliation(s)
- Nicole Votruba
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Devarsetty Praveen
- The George Institute for Global Health India, New Delhi, India
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Lucy Mellers
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Eldho Rajan
- The George Institute for Global Health India, New Delhi, India
| | | | - Varun Arora
- Post Graduate Institute of Medical Science, Rohtak, India
| | - Yogender Malik
- Department of Psychiatry, Institute of Mental Health (IMH), University of Health Sciences PGIMS, Rohtak, India
| | - Aditya Kashyap
- SVS Institute of Neurosciences, Government Medical College, Siddipet, India
| | - Sreya Majumdar
- The George Institute for Global Health India, New Delhi, India
| | - Jane Hirst
- Department of Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Pallab K. Maulik
- The George Institute for Global Health India, New Delhi, India
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Sahoo S, Gill G, Sikka P, Nehra R. Antenatal depression and anxiety in Indian women: A systematic review. Ind Psychiatry J 2023; 32:222-233. [PMID: 38161466 PMCID: PMC10756614 DOI: 10.4103/ipj.ipj_156_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/31/2023] [Accepted: 02/14/2023] [Indexed: 01/03/2024] Open
Abstract
There is good evidence to suggest that high prevalence of depression and anxiety in the postpartum period. However, very few studies have focused on antenatal depression and anxiety disorders and their associated risk factors. Further, there are only a handful of studies from India on common antenatal mental health disorders. With this background, we reviewed the existing evidence on antenatal depression and anxiety from the studies conducted in Indian pregnant women during the antenatal period and to explore the associated risk factors. All the major databases were searched systematically for English language studies on prevalence and risk factors for antenatal depression and anxiety in Indian pregnant females, published during the period January 2000 to May 2022. Quality assessment of studies was done with the modified version of Newcastle Ottawa Scale for cross-sectional studies. We found the overall prevalence of antenatal depression was ranged from 3.8% to 65% and antenatal anxiety from 13 to 55%. The most relevant risk factors associated with antenatal depression and anxiety during pregnancy were preference to have a male child, intimate partner violence, history of abortions, marital conflict, poor relationship with the husband/in-laws and lack of social support. To conclude, the systematic review suggests that depressive and anxiety disorders are quite common in Indian pregnant women in antepartum period with varying prevalence depending on various settings and scales used. Steps should be taken to promote obstetricians for regular mental health screening during the antenatal visits and prompt referral to mental health professionals when suspected.
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Affiliation(s)
- Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Gursahiba Gill
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritu Nehra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Bright AM, Doody O, Tuohy T. Women with perinatal suicidal ideation–A scoping review of the biopsychosocial risk factors to inform health service provision and research. PLoS One 2022; 17:e0274862. [PMID: 36170289 PMCID: PMC9518889 DOI: 10.1371/journal.pone.0274862] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives This review aims to map the existing evidence on perinatal suicidal ideation, identify biopsychosocial risk factors associated with suicidal ideation and make recommendations for service provision and future research. Methods Scoping review guided by Arskey’s and O’Malley’s (2005) framework. Five academic databases (PsycINFO, MEDLINE, CINAHL, ASSIA and Academic Search Complete) were searched from 1st January 2009 to 1st April 2022. Studies were screened by title, abstract and full text against inclusion and exclusion criteria. Primary qualitative, quantitative and mixed-methods studies, written in English pertaining to perinatal suicidal ideation were included. Forty-one studies met the eligibility criteria, data were extracted and narratively synthesised. Findings are reported in accordance with the PRISMA-SR extension. Key conclusions Findings were mapped onto the biopsychosocial framework and include sleep deprivation, maternal age, pregnancy complications, mood disorders, intimate partner violence, childhood maltreatment/abuse, low socioeconomic status, alcohol and tobacco misuse, miscarriage/perinatal loss, birth trauma and sleep deprivation. The findings demonstrate that the biopsychosocial risk factors for perinatal suicidal ideation are varied and complex. Implications for practice The minimisation of women’s experiences may lead to detrimental consequences and there is a need for increased knowledge of mental health problems by those working with women in the perinatal period to ensure safety planning conversations occur with every woman meeting ‘at risk’ criteria.
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Affiliation(s)
- Ann-Marie Bright
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- * E-mail:
| | - Owen Doody
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Teresa Tuohy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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Legazpi PCC, Rodríguez-Muñoz MF, Olivares-Crespo ME, Izquierdo-Méndez N. Review of suicidal ideation during pregnancy: risk factors, prevalence, assessment instruments and consequences. PSICOLOGIA-REFLEXAO E CRITICA 2022; 35:13. [PMID: 35606474 PMCID: PMC9127017 DOI: 10.1186/s41155-022-00220-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/12/2022] [Indexed: 01/20/2023] Open
Abstract
Background Pregnancy is a period when women are particularly vulnerable to suicidal ideation and a great opportunity for suicide risk prevention. Aims This study aimed to establish a comprehensive understanding of suicidal ideation prevalence, risk factors, screening tools, consequences and management during pregnancy. Method A literature search was performed in MEDLINE and PsycInfo databases from 2016 to 2021. A narrative synthesis of the literature and a critical overview of the current issues/questions to be addressed within the topic of suicidal ideation during pregnancy was performed. Results The prevalence of suicidal ideation during pregnancy was between 2.73 and 18% internationally. The risk factors identified were major depressive disorder, anxiety disorder, difficulties with sleep, previous suicide attempts, high rumination, low incomes, being black, being young, low educational level, partner violence, having poor support, food insecurity, history of child abuse, high obstetric risk, multiparity, previous induced abortion and exposure to tobacco or human immunodeficiency virus diagnosis. The screening tools used for suicidal ideation during pregnancy were item 10 of the Edinburgh Postpartum Depression Scale and item 9 of the Patient Health Questionnaire. Results showed that suicidal ideation during pregnancy is associated with poor cognitive development in children and low birth weight. No case management studies on suicidal ideation were found. Limitations The main limitation of the available studies was the lack of articles with a high degree of methodological rigour on this subject. Conclusions This narrative review is a state-of-the-art paper about suicidal ideation during pregnancy. Further research is needed, and researchers should carry out systematic reviews and meta-analyses, leading to Clinical Practice Guidelines in this area. This effort would improve our evidence-based practice in Perinatal Psychology and prevent associated suicidal behaviour.
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Affiliation(s)
| | - María F Rodríguez-Muñoz
- Department of Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain.
| | - María Eugenia Olivares-Crespo
- Deparment of Gynecology and Obstetrics, Hospital Clínico San Carlos & Faculty of Medicine Universidad Complutense de Madrid, Madrid, Spain
| | - Nuria Izquierdo-Méndez
- Deparment of Gynecology and Obstetrics, Hospital Clínico San Carlos & Faculty of Medicine Universidad Complutense de Madrid, Madrid, Spain
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Reid HE, Pratt D, Edge D, Wittkowski A. Maternal Suicide Ideation and Behaviour During Pregnancy and the First Postpartum Year: A Systematic Review of Psychological and Psychosocial Risk Factors. Front Psychiatry 2022; 13:765118. [PMID: 35401283 PMCID: PMC8987004 DOI: 10.3389/fpsyt.2022.765118] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Suicide is a leading cause of maternal death during pregnancy and up to a year after birth (perinatal period). Many psychological and psychosocial risk factors for maternal suicidal ideation and behaviour have been investigated. Despite this, there have been no attempts to systematically search the literature on these risk factors. Additionally, few studies have described how the risk factors for suicidal ideation, attempted suicides and suicide deaths differ, which is essential for the development of tools to detect and target suicidal ideation and behaviour. Seven databases were searched up to June 2021 for studies that investigated the association between suicidal ideation and/or suicidal behaviour and psychological/psychosocial risk factors in pregnant and postpartum women. The search identified 17,338 records, of which 59 were included. These 59 studies sampled a total of 49,929 participants and investigated 32 different risk factors. Associations between abuse, experienced recently or during childhood, and maternal suicide ideation, attempted suicide and death were consistently reported. Social support was found to be less associated with suicide ideation but more so with suicide attempts. Identifying women who have experienced domestic violence or childhood abuse and ensuring all women have adequate emotional and practical support during the perinatal period may help to reduce the likelihood of suicidal behaviour.
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Affiliation(s)
- Holly E. Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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11
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Behera C, Sikary AK. Suicidal deaths in pregnancy at an apex institute in India: A retrospective analysis of autopsy cases. Asian J Psychiatr 2022; 68:102979. [PMID: 34973633 DOI: 10.1016/j.ajp.2021.102979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Suicidal behavior in pregnancy is a known fact worldwide. However, the published literature is still debating whether pregnancy is associated with an increase in the risk of suicide. Nonetheless, this is an important phenomenon that should not be ignored as the life of an unborn fetus is involved. The present study is a retrospective analysis of suicide death in pregnancy for the years 2011-2020 to study the different parameters. METHODS The cases were collected from the archives of the department with due permission from the authority. Data were analyzed according to the age of the victim, duration of pregnancy, and time and cause of death. RESULT The commonest age group was 21-25 years, the time of death was mostly during the daytime, and most of the deaths were due to hanging. These findings are not unusual in comparison to the general population. The pregnancy duration of most of the cases was first and second trimester, and third-trimester pregnancy accounted for far less number. In contrast, some studies showed that suicidal ideation and depression were more common during the first trimester and third trimester. Most of the pregnant women were pregnant with male fetuses. CONCLUSION Though suicidal ideation is more during the first and third trimester, suicide occurs mostly in the first and second trimester, with third-trimester suicide deaths being far less. Being pregnant with a male fetus might be a risk factor in comparison to having female fetuses. These are two aspects that need to be explored further.
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Affiliation(s)
- Chittaranjan Behera
- Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Asit Kumar Sikary
- Department of Forensic Medicine, Rama Medical College Hospital and Research Centre, Kanpur, India.
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Faisal-Cury A, Oliveira Rodrigues DM, Matijasevich A, Tarpinian F, Tabb K. Prevalence and Associated Risk Factors of Suicidal Ideation Among Brazilian Pregnant Women: A Population-Based Study. Front Psychiatry 2022; 13:779518. [PMID: 35392386 PMCID: PMC8981206 DOI: 10.3389/fpsyt.2022.779518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Suicide is a leading cause of death during the perinatal period in high-income countries (HIC). There remains a lack of population-based studies about suicidal ideation (SI) during pregnancy among low and middle income countries (LMIC). OBJECTIVES Using the case of Brazil, we aim to estimate the prevalence of SI during pregnancy and its association with antenatal depression (AD) and sociodemographic factors in a LMIC. METHOD We used data from the Brazilian National Survey (PNS-2019), a population-based study, with a complex and probabilistic sampling method. Of the 27,136 women of reproductive age (15 to 49 years old) who participated in the PNS, a total of 769 women reported being pregnant at the time of the interview. All PNS participants answered the Patient Health Questionnaire-9 (PHQ-9) and a questionnaire with sociodemographic data. SI was defined as any answer to the PHQ-9 item 9 other than 0 (not at all). Logistic regression models were performed to obtain crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for the association between explanatory variables and SI during pregnancy. RESULTS Among 769 women, 33 (3.9%, 95% CI: 3.0-5.1%) reported SI during pregnancy. In the adjusted analysis, higher odds of SI were associated with being 20 to 34 years old (aOR:0.24, 95% CI: 0.08-0.74) or 35 to 49 years old (aOR:0.15; 95% CI: 0.04-0.50), having 9 to 11 years of education (aOR 0.23, 95% CI: 0.61-0.86), acheiving the highest family income category (aOR:0.08, 95% CI: 0.01-0.58), not living in the South/Southeast regions of Brazil (aOR:5.52, 95% CI: 2.36-12.9), and having probable mild AD (aOR:10.5 95% CI: 2.3-47.9) or moderate AD (aOR:241.3, 95% CI: 58.4-996.7). CONCLUSIONS In Brazil, SI affects almost 4% of pregnant women and is associated with sociodemographic vulnerability. Clinically, women with mild symptoms of depression may also experience SI during pregnancy. These findings are important for designing effective perinatal mental health interventions in LMICs.
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Affiliation(s)
- Alexandre Faisal-Cury
- Departamento de Medicina Preventiva da, Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | | | - Alicia Matijasevich
- Departamento de Medicina Preventiva da, Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | | | - Karen Tabb
- University of Illinois at Urbana-Champaign, Champaign, IL, United States
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13
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Arditi-Arbel B, Hamdan S, Winterman M, Gvion Y. Suicidal ideation and behavior among perinatal women and their association with sleep disturbances, medical conditions, and known risk factors. Front Psychiatry 2022; 13:987673. [PMID: 36741562 PMCID: PMC9893018 DOI: 10.3389/fpsyt.2022.987673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Suicide is considered one of the leading causes of maternal mortality, especially among women with postpartum depression. In the current systematic review, we conducted a qualitative data synthesis of recent studies exploring novel risk factors including sleep disturbances and medical conditions, alongside known and significant risk factors for perinatal suicidality. EVIDENCE ACQUISITION We conducted a systematic search of the literature according to PRISMA guidelines on PubMed, PsycNET, and Scopus databases. Search terms were "pregnancy" "OR" "postpartum" "OR" "peripartum" "OR" "perinatal" "OR" "postnatal" combined with the Boolean "AND" operator with "suicide" "OR" "suicidality" "OR" "suicidal ideation" "OR" "suicidal behavior." EVIDENCE SYNTHESIS The initial search yielded 1,458 records, of which 51 research reports that met inclusion criteria were analyzed. These 51 studies sampled a total of 45,942 participants. Clinically, sleep disturbance, psychopathology, and social support have been identified as dominant risk factors for suicidal behavior among pregnant and postpartum women, as well as medical conditions and aversive life events. CONCLUSION Monitoring sleep disturbance, depression, and perceived social support is critical given that they are significant risk factors for suicide among perinatal women. Early identification of perinatal women who may be at risk of suicide, although not depressed, is crucial. LIMITATIONS The use of tools designed to identify depression to identify suicidal risk, fail to identify women who are at risk but who do not suffer from depression. Other methodological limitations are the lack of longitudinal studies and the complexity of examining suicidal behavior in sample studies.
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Affiliation(s)
- Bar Arditi-Arbel
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Sami Hamdan
- Department of Psychology, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yafo, Israel
| | - May Winterman
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Yari Gvion
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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14
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Agarwal N, Abdalla SM, Cohen GH. Marital rape and its impact on the mental health of women in India: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000601. [PMID: 36962419 PMCID: PMC10021972 DOI: 10.1371/journal.pgph.0000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/16/2022] [Indexed: 11/18/2022]
Abstract
This systematic review aims to describe the prevalence of marital rape in India, the analytic methods employed in its study, and its implications on mental health of victims. Online databases, PubMed, Embase, Web of Science and APA Psych, were systematically searched for articles published up until November 2020. Selected articles included those published from or studies conducted in India where the primary exposure was marital rape. The primary outcomes of interest are Post Traumatic Stress Disorder (PTSD) and Depression. Secondary outcomes related to PTSD and depression (e.g., suicidality) included in identified studies were also described. 11 studies were included after excluding studies based on our selection criteria: 9 quantitative studies and 2 qualitative studies. Sexual coercion by intimate partner was highly prevalent, ranging from 9%-80% and marital rape ranged from 2%-56%. Many of the studies reported statistically significant associations between marital rape and mental health outcomes, including clinical depression (7 of 8); PTSD (1 of 3). Quantitative studies were assessed for quality and risk of bias using the NIH Quality Assessment Scale and the modified Newcastle Ottawa Scale for cross-sectional and observational cohort studies, and most exhibited a low risk of bias. Qualitative studies identified a broad range of exposures and psychological sequlae of marital rape not captured by quantitative studies. Included publications exhibit a low to moderate association between marital rape and adverse mental health outcomes. Qualitative data also supplements these findings and provide relevant context. Further research on marital rape, its prevalence and consequences, is needed to advance policy, and health infrastructure on the subject.
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Affiliation(s)
- Nandini Agarwal
- Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Salma M Abdalla
- Epidemiology Department, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Gregory H Cohen
- Epidemiology Department, Boston University School of Public Health, Boston, Massachusetts, United States of America
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15
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Prevalence of suicidal ideation in pregnancy and the postpartum: A systematic review and meta-analysis. J Affect Disord 2022; 296:322-336. [PMID: 34600967 DOI: 10.1016/j.jad.2021.09.083] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 09/13/2021] [Accepted: 09/26/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Suicidal ideation, a significant risk factor of suicide, is considered a potential trigger for intervention prior to self-harm or suicide; however, the prevalence of maternal suicidal ideation varied widely between studies. This review aims to synthesis the available evidence to estimate the prevalence of maternal suicidal ideation before and after pregnancy. METHODS We searched six English databases (PubMed, Web of Science, Embase, the Cochrane Library, PsycINFO, CINAHL) and three Chinese databases (China National Knowledge Infrastructure, Wang Fang, Chinese Biomedical Literature Databases) from database inceptions before August 31, 2020; and checked the reference list for relevant studies. Data in the included studies were used to calculate the prevalence of maternal suicidal ideation. Subgroup analysis and meta-regression were performed to detect the potential sources of heterogeneity. RESULTS 6094 potentially studies were identified. 71 studies, including 23 cohort studies, 47 cross-sectional studies, and 1 RCT study, were included for final analysis. The total participants were 92146, with sample size ranged from 23 to 22118. The included studies were from 23 different countries distributing on six continents, most of the studies were conducted in Asia (n = 18), North America (n = 16), and South America (n = 15). The pooled prevalence of maternal suicidal ideation reported by eligible studies was 8% (95% CI 7-10%), with 10% in antenatal and 7% in postpartum. Prevalence significantly varied based on measuring tools, study design, study countries, and publication year, while prevalence was not conditional on the time-point assessment, sample size, and maternal age. LIMITATION Obvious heterogeneity and no standardization tools for measuring suicidal ideation may limit the results' interpretation. CONCLUSION Our systematic review reported the prevalence of suicidal ideation in pregnancy and postpartum was 8%. Future studies should establish standardization tools for measuring suicidal ideation and identify strategies of prevention and treatment.
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16
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Fellmeth G, Kishore MT, Verma A, Desai G, Bharti O, Kanwar P, Singh S, Thippeswamy H, Chandra PS, Kurinczuk JJ, Nair M, Alderdice F. Perinatal mental health in India: protocol for a validation and cohort study. J Public Health (Oxf) 2021; 43:ii35-ii42. [PMID: 34622290 PMCID: PMC8498097 DOI: 10.1093/pubmed/fdab162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/07/2021] [Accepted: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Common mental disorders (CMD) are among the largest contributors to global maternal morbidity and mortality. Although research on perinatal mental health in India has grown in recent years, important evidence gaps remain, especially regarding CMD. Our study aims to improve understanding of CMD among perinatal and non-perinatal women of reproductive age across two settings in India: Bangalore (Karnataka) and Tanda (Himachal Pradesh). METHODS The study is embedded within the Maternal and Perinatal Health Research Collaboration India (MaatHRI). This mixed-methods observational study comprises three consecutive phases: (i) focus group discussions and individual interviews to explore women's knowledge and seek feedback on CMD screening tools; (ii) validation of CMD screening tools; and (iii) prospective cohort study to identify CMD incidence, prevalence and risk factors among perinatal and non-perinatal women. Results of the three phases will be analyzed using inductive thematic analysis, psychometric analysis and multivariable regression analysis, respectively. CONCLUSION Improving understanding, detection and management of CMD among women is key to improving women's health and promoting gender equality. This study will provide evidence of CMD screening tools for perinatal and non-perinatal women in two diverse Indian settings, produce data on CMD prevalence, incidence and risk factors and enhance understanding of the specific contribution of the perinatal state to CMD.
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Affiliation(s)
- G Fellmeth
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M T Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - A Verma
- Department of Obstetrics and Gynaecology, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - G Desai
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - O Bharti
- State Institute of Health and Family Welfare, Department of Health and Family Welfare, Government of Himachal Pradesh, India
| | - P Kanwar
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - S Singh
- Department of Psychiatry, Dr Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - H Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - P S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - J J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - F Alderdice
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
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Pasricha M, Kochhar S, Shah A, Bhatia A. Sense of Coherence, Social Support, Maternal-Fetal Attachment, and Antenatal Mental Health: A Survey of Expecting Mothers in Urban India. Front Glob Womens Health 2021; 2:714182. [PMID: 34816240 PMCID: PMC8594014 DOI: 10.3389/fgwh.2021.714182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Pregnancy is associated with psychological, physiological and social shifts, and can be a vulnerable time in a woman's life. Despite a growing understanding of the importance of antenatal mental health, there is a paucity of research on psychosocial factors relevant to this phase, especially in developing countries. The aim of the present study was to investigate the associations of expecting mothers' sense of coherence, perceived social support, and maternal-fetal attachment with mental health outcomes. Method: Participants (N = 122) were nulliparous expectant mothers residing in urban India. Cross-sectional data was collected using an online questionnaire. Results: Participant reports of perceived social support and sense of coherence were negatively correlated with symptoms of antenatal depression, while reports of maternal-fetal attachment, sense of coherence, and social support were positively associated with antenatal well-being. In a multilinear regression model, perceived social support and sense of coherence uniquely contributed to symptoms of antenatal depression, while maternal-fetal attachment and sense of coherence uniquely contributed to antenatal well-being. Discussion: The findings of this study highlight the role of perceived social support, sense of coherence and maternal-fetal attachment in contributing to expecting mothers' mental health and well-being in urban India. These findings have implications for clinical practice and research, intending to the subjective experiences of pregnant women to improve antenatal mental health. Future research investigating these psychosocial factors using longitudinal designs is warranted and would help clinicians and practitioners identify women at risk for perinatal mental health concerns.
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Affiliation(s)
| | - Suhaavi Kochhar
- Department of Psychology, Ashoka University, Sonipat, India
- Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Ashumi Shah
- Department of Psychology, Ashoka University, Sonipat, India
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Anbesaw T, Negash A, Mamaru A, Abebe H, Belete A, Ayano G. Suicidal ideation and associated factors among pregnant women attending antenatal care in Jimma medical center, Ethiopia. PLoS One 2021; 16:e0255746. [PMID: 34432799 PMCID: PMC8386870 DOI: 10.1371/journal.pone.0255746] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/22/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Suicidal ideation (SI) among pregnant women is a major public health concern worldwide and is associated with a higher risk of completed suicide. However, there are limited studies that determined the prevalence and the potential determinants of suicidal ideation in Sub-Saharan Africa, including Ethiopia. Therefore, this study aimed to explore the prevalence of suicidal ideation and associated factors among pregnant women attending antenatal care in Jimma, Ethiopia. METHODS An institutional-based cross-sectional study was conducted among 423 pregnant women attending Jimma medical center in Southwest, Ethiopia. A systematic random sampling technique was used to select the study participants. Suicidal ideation assessed using the Suicidality Module of the World Mental Health survey initiative version of the World Health Organization Composite International Diagnostic Interview (CIDI). Other tools used are EPDS, Abuse Assessment Scale (AAS), DASS -21, PSS, Maternity Social Support Scale (MSSS), and Pittsburgh Sleep Quality Index (PSQI). A multivariable logistic regression analysis was used to explore the potential determinants of suicidal ideation among the participants. RESULT The prevalence of SI among women who are on antenatal care was found to be 13.3% (95% CI (10.1,16.4). In multivariable analysis, marital status with lack of cohabiting partners (AOR = 2.80,95%CI:1.23,6.37), history of abortion (AOR = 2.45,95% CI:1.03,5.93), having depression (AOR = 4.28,95% CI:1.75,10.44),anxiety(AOR = 2.99,95% CI:1.24,7.20), poor sleep quality (AOR = 2.85,95% CI:1.19,6.79), stress (AOR = 2.50, 95% CI:1.01,5.67), and intimate partner violence (AOR = 2.43, 95% CI:1.07,5.47) were found to be significant predictors of suicidal ideation. CONCLUSION The prevalence of SI among pregnant women was found to be huge. Lack of cohabiting partners, previous history of abortion, depression, anxiety, intimate partner violence, poor sleep quality, and stress were variables that are independent predictors of suicidal ideation. Screening and interventions of antenatal SI are needed.
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Affiliation(s)
- Tamrat Anbesaw
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Alemayehu Negash
- Department of Psychiatry, Institute of Health Sciences, Faculty of Medical Science, Jimma University, Jimma, Ethiopia
| | - Almaz Mamaru
- Department of Psychiatry, Faculty of Medical Science, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Habtamu Abebe
- Department of Epidemiology and Biostatistics, Faculty of Medical Science, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Asmare Belete
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
- School of Public Health, Curtin University, Bentley, Australia
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Salihu HM, Dongarwar D, Oduguwa E, Atkinson JO, Harris TB. Racial/Ethnic Disparity in Suicidal Ideation, Suicide Attempt and Non-suicidal Intentional Self-harm Among Pregnant Women in the United States. J Immigr Minor Health 2021; 24:588-596. [PMID: 34346025 DOI: 10.1007/s10903-021-01260-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/25/2022]
Abstract
We examined the prevalence of suicidal ideation, suicide attempt and non-suicidal intentional self-harm among pregnant women in the United States stratified by race/ethnicity. Data on hospital admissions among pregnant women 15-49 years during 2016-2017 compiled in the Nationwide Inpatient Sample were used for this study. We assessed the prevalence and factors of suicidal ideation, suicide attempt and non-suicidal intentional self-harm among different race/ethnicities. The prevalence of suicidal ideation, suicide attempt and non-suicidal intentional self-harm was greatest among hospitalized Non-Hispanic (NH) Black pregnant women. As compared to pregnant women who were routinely discharged, those who died during the course of hospitalization had about eight times the odds for NH-Whites, four times the odds for NH-Blacks and five times the odds for Hispanics of suicidal ideation or attempt. Appropriate measures are needed for prompt diagnosis and management of mental health issues in pregnant women belonging to vulnerable sub-groups.
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Affiliation(s)
- Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, 3701 Kirby Drive, Houston, TX, 77098, USA
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, 3701 Kirby Drive, Houston, TX, 77098, USA.
| | - Emmanuella Oduguwa
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, 3701 Kirby Drive, Houston, TX, 77098, USA
| | - Jonnae O Atkinson
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Toi B Harris
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, 3701 Kirby Drive, Houston, TX, 77098, USA
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20
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Fellmeth G, Nosten S, Khirikoekkong N, Oo MM, Gilder ME, Plugge E, Fazel M, Fitzpatrick R, McGready R. Suicidal ideation in the perinatal period: findings from the Thailand-Myanmar border. J Public Health (Oxf) 2021; 44:e514-e518. [PMID: 34343323 PMCID: PMC9715289 DOI: 10.1093/pubmed/fdab297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/12/2021] [Accepted: 07/05/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Suicide is a leading cause of maternal death globally. Migrant and refugee populations may experience higher risk of suicide. We report data on suicidal ideation from migrant and refugee women living on the Thailand-Myanmar border. METHODS Women were recruited in their first trimester of pregnancy. Depression status was assessed by diagnostic interview in the first, second and third trimesters and at 1 month post-partum. We calculated prevalence of suicidal ideation and used logistic regression to identify associated socio-demographic factors. RESULTS During the perinatal period, 5.3% (30/568) women experienced suicidal ideation. Refugee women were more likely to experience suicidal ideation than migrant women (8.0 versus 3.1%; P = 0.01). Most women with suicidal ideation did not have severe depression. Previous trauma (OR 2.32; 95% CI: 1.70-3.15) and unplanned pregnancy (OR 2.74; 95% CI: 1.10-6.86) were significantly associated with suicidal ideation after controlling for all other variables. CONCLUSIONS Suicidal ideation represents an important symptom among migrant and refugee women on the Thailand-Myanmar border. Screening only those with severe depression may be insufficient to identify women at risk of suicide. Community-level interventions addressing social and gender inequalities and prioritization of family planning programmes are needed alongside targeted suicide prevention initiatives to help lower the rates of people dying by suicide.
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Affiliation(s)
- G Fellmeth
- Address correspondence to Gracia Fellmeth, E-mail:
| | - S Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
| | - N Khirikoekkong
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
| | - M M Oo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mae Sot, Thailand
| | - M E Gilder
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - E Plugge
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - M Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - R Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mae Sot, Thailand,Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Patil DM, Bajaj A, Supraja TA, Chandra P, Satyanarayana VA. Lifetime traumatic experiences and postpartum depressive symptoms in a cohort of women in South India. Arch Womens Ment Health 2021; 24:687-692. [PMID: 33641004 DOI: 10.1007/s00737-021-01111-w] [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: 10/27/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
Studies in western cultures have proposed mechanisms by which adverse childhood experiences can affect mental health, including mediating variables such as social support and resilience. However, research replicating these findings in perinatal populations are sparse in Asia. This study assessed the association between lifetime trauma and postpartum depressive symptoms. Additionally, the study examined the mediating role that resilience and social support can play in this association. This study was conducted on 458 women participating in the PRAMMS cohort in urban Bangalore. Information on lifetime trauma was collected through a culturally appropriate trauma interview and postpartum depressive symptoms (8 weeks) were assessed using the Edinburgh Postnatal Depression Scale (EPDS). Resilience was assessed using the Connor-Davidson Resilience Scale-10 and social support was assessed through the Zimet's Multidimensional Scale of Perceived Social Support. A linear model was used to measure the association between lifetime trauma and postpartum depression and mediation analysis was used to assess the role of resilience and social support in the primary association. All analyses were conducted using SPSS. In this cohort, 254 women reported at least one trauma and 204 reported no trauma. A higher number of lifetime traumatic events was associated with higher EPDS scores (β = 0.487, 95%CI: 0.267-0.707). Social support was found to have a negative association between the predictor and the outcome; however, resilience was not a statistically significant mediator. Lifetime trauma was associated with postpartum depressive symptoms in our study and social support negatively mediated the association between lifetime trauma and postpartum depressive symptoms.
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Affiliation(s)
- Divya M Patil
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Aakash Bajaj
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - T A Supraja
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Prabha Chandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Veena A Satyanarayana
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore, India.
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Bedaso A, Adams J, Peng W, Sibbritt D. The relationship between social support and mental health problems during pregnancy: a systematic review and meta-analysis. Reprod Health 2021; 18:162. [PMID: 34321040 PMCID: PMC8320195 DOI: 10.1186/s12978-021-01209-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 07/19/2021] [Indexed: 01/11/2023] Open
Abstract
Background Pregnancy is a time of profound physical and emotional change as well as an increased risk of mental illness. While strengthening social support is a common recommendation to reduce such mental health risk, no systematic review or meta-analysis has yet examined the relationship between social support and mental problems during pregnancy. Methods The PRISMA checklist was used as a guide to systematically review relevant peer-reviewed literature reporting primary data analyses. PubMed, Psych Info, MIDIRS, SCOPUS, and CINAHL database searches were conducted to retrieve research articles published between the years 2000 to 2019. The Newcastle–Ottawa Scale tool was used for quality appraisal and the meta-analysis was conducted using STATA. The Q and the I2 statistics were used to evaluate heterogeneity. A random-effects model was used to pool estimates. Publication bias was assessed using a funnel plot and Egger’s regression test and adjusted using trim and Fill analysis. Result From the identified 3760 articles, 67 articles with 64,449 pregnant women were part of the current systematic review and meta-analysis. From the total 67 articles, 22 and 45 articles included in the narrative analysis and meta-analysis, respectively. From the total articles included in the narrative analysis, 20 articles reported a significant relationship between low social support and the risk of developing mental health problems (i.e. depression, anxiety, and self-harm) during pregnancy. After adjusting for publication bias, based on the results of the random-effect model, the pooled odds ratio (POR) of low social support was AOR: 1.18 (95% CI: 1.01, 1.41) for studies examining the relationship between low social support and antenatal depression and AOR: 1.97 (95% CI: 1.34, 2.92) for studies examining the relationship between low social support and antenatal anxiety. Conclusion Low social support shows significant associations with the risk of depression, anxiety, and self-harm during pregnancy. Policy-makers and those working on maternity care should consider the development of targeted social support programs with a view to helping reduce mental health problems amongst pregnant women. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01209-5. Pregnancy is a significant event for reproductive-age women. It is supplemented by hormonal changes and can represent a time of increased risk for the occurrence of mental illness like depression, anxiety and self-harm. Providing good social support for the pregnant mother reduce this risk and prevent pregnancy complication and adverse birth outcome. However, no systematic review and/or meta-analysis has explored the associations between social support and mental illness (depression, anxiety, self-harm) among pregnant women. Therefore, this systematic review and meta-analysis aimed to examine the association between social support and mental illness (anxiety, depression, and self-harm) during pregnancy. The review identified 67 relevant articles with 64,449 pregnant women, from PubMed, Psych Info, MIDIRS, SCOPUS, and CINAHL database. Of the total 67 articles, 22 articles included in the narrative review and 45 articles included in the meta-analysis. Among studies included in the narrative synthesis, a majority of them reported significant positive associations between low social support and antenatal depression, antenatal anxiety and self-harm during pregnancy. Further, the pooled estimates of the meta-analysis show that low social support had a significant positive association with antenatal depression (AOR: 1.18 (95% CI: 1.01, 1.41)) and antenatal anxiety (AOR: 1.97 (95% CI: 1.34, 2.92)). Therefore, maternal health professionals need to have discussions with pregnant women regarding the level and source of social support they receive. Maternal health professionals may also need to consider encouraging the social network of pregnant women to improve social support being given. Policy-makers and those working on maternity care should consider the development of targeted social support programs with a view to helping reduce mental health problems amongst pregnant women.
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Affiliation(s)
- Asres Bedaso
- College of Medicine and Health Sciences, School of Nursing, Hawassa University, Hawassa, Ethiopia. .,Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Jon Adams
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Wenbo Peng
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - David Sibbritt
- Australian Centre for Public and Population Health Research, School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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Belete K, Kassew T, Demilew D, Amare Zeleke T. Prevalence and Correlates of Suicide Ideation and Attempt among Pregnant Women Attending Antenatal Care Services at Public Hospitals in Southern Ethiopia. Neuropsychiatr Dis Treat 2021; 17:1517-1529. [PMID: 34040377 PMCID: PMC8140917 DOI: 10.2147/ndt.s309702] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/23/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Suicide ideation and attempt are common among pregnant women, risk factors for completed suicide, and associated adverse maternal and fetal outcomes. It is under-recognized and has not been investigated well in low-income countries like Ethiopia. This study aimed to assess the prevalence and factors associated with suicide ideation and attempt among pregnant women attending antenatal care services at public hospitals in southern Ethiopia. METHODS A group of 762 pregnant women who were attending the antenatal service at public hospitals in Hawassa, southern Ethiopia, selected by a systematic random sampling technique, took part in an interview. A Composite International Diagnostic Interview (CIDI) was used to measure suicide ideation and attempt. Chi-square and binary logistic regression analyses were performed to identify the associated factors. An adjusted odds ratio with a 95% confidence interval was used for reporting the result with a p-value<0.05 statistical significance level. RESULTS The prevalence of suicide ideation and attempt among pregnant women was 11.8% and 2.7%, respectively. Unplanned pregnancy (AOR=2.01, 95% CI=1.04-3.88), poor social support (AOR=3.29, 95% CI=1.62-6.68), common mental disorders (AOR=2.77, 95% CI=1.50-5.09), and lifetime suicide ideation (AOR=4.63, 95% CI=2.63-8.16) were factors significantly associated with suicide ideation. Social support was the only correlated factor with suicide attempt among pregnant mothers. CONCLUSION The prevalence of suicide ideation and attempt among pregnant women was found to be high. Intervention strategies towards suicidal ideation and attempt should consider improving social support and antenatal related common mental disorders with a primary focus on women with unplanned pregnancy and prior history of suicide ideation.
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Affiliation(s)
- Kenean Belete
- Yirgalem Hospital Medical College, Yirgalem, Sidama, Ethiopia
| | - Tilahun Kassew
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Demeke Demilew
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Amare Zeleke
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Worldwide prevalence of suicide attempt in pregnant and postpartum women: a meta-analysis of observational studies. Soc Psychiatry Psychiatr Epidemiol 2021; 56:711-720. [PMID: 33191455 DOI: 10.1007/s00127-020-01975-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 10/24/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Past suicide attempts (SA) are a major contributor to suicide. The prevalence of SA in pregnant and postpartum women varied significantly across studies. Therefore, this meta-analysis was conducted to examine the prevalence of SA and its mediating factors in this population. METHODS Relevant articles published in PubMed, EMBASE, Web of Science, PsycINFO, Medline complete, Chinese National Knowledge Infrastructure database (CNKI), Chinese Wanfang and Chongqing VIP database were systematically searched from inception to March 28, 2019. Titles, abstracts and full texts were reviewed independently by three researchers. Studies were included if they reported data on SA prevalence or provided relevant data that enabled the calculation of SA prevalence. Data were extracted by two researchers and checked by one senior researcher. The random-effects model was used to analyze data by the CMA 2.0 and Stata 12.0, with the high degree of statistical heterogeneity present. The primary outcomes were prevalence of SA with 95% CI during pregnancy and during the first-year postpartum. RESULTS Fourteen studies covering 6,406,245 pregnant and postpartum women were included. The pooled prevalence of SA was 680 per 100,000 (95% confidence interval 0.10-4.69%) during pregnancy and 210 per 100,000 (95% confidence interval 0.01-3.21%) during the first-year postpartum. Data source was significantly associated with prevalence of SA in the subgroup analysis (pregnancy, p < 0.001; the first-year postpartum, p = 0.013). CONCLUSION The prevalence of SA is not high in pregnant and postpartum women. Due to the potential loss of life and negative impact of SA on health outcomes, however, careful screening and effective preventive measures should be implemented for this population.
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Kalra H, Tran TD, Romero L, Chandra P, Fisher J. Prevalence and determinants of antenatal common mental disorders among women in India: a systematic review and meta-analysis. Arch Womens Ment Health 2021; 24:29-53. [PMID: 32055988 DOI: 10.1007/s00737-020-01024-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/26/2020] [Indexed: 02/06/2023]
Abstract
To review the available evidence about the prevalence and determinants of antenatal common mental disorders (antenatal CMDs) among women in India. We searched Ovid Medline, Embase and Psyinfo systematically from date of inception to Oct. 31, 2019 for publications in English language on the prevalence of antenatal CMDs and their determinants among women in India. All study designs were included. Quality was assessed with Standard Quality Assessment Criteria for Evaluating Primary Research Papers. We performed a meta-analysis using a random effects model. Twenty-seven studies involving 7780 women were analysed. There was a high degree of heterogeneity ((I2 = 97.53%). Publication bias [Egger bias = 0.65 (95% CI: 0.36; .94)] was evident. The overall pooled estimate of the prevalence of antenatal CMDs was 21.87% (95% CI: 17.46; 26.29). Significant risk factors reported in the 18 studies which examined them were negative reaction of husband or in-laws to the dowry, difficult relationship with husband/in-laws, lack of support or experiencing violence perpetrated by an intimate partner and preference for or feeling pressured to have a male child. Protective factors were having more education and being employed, having a supportive husband and opportunities for recreation during pregnancy. Antenatal CMDs are highly prevalent among women in India. There is an urgent need for locally developed policies and programmes for mental health promotion during pregnancy, preventive and early intervention for antenatal CMDs among women to be integrated into maternity care in India.
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Affiliation(s)
- Harish Kalra
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, 3004, Melbourne, VIC, Australia. .,Ballarat Rural Clinical School, University of Notre Dame Australia, 01 Drummond St Nth, 3350, Ballarat Central, VIC, Australia. .,Raphael Services, Ballarat, St John of God Health Care Social Outreach, 105 Webster St, 3350, Ballarat Central, VIC, Australia. .,Ballarat Health Services-Mental Health Services, Sturt St, 3350, Ballarat Central, VIC, Australia.
| | - Thach Duc Tran
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, 3004, Melbourne, VIC, Australia
| | - Lorena Romero
- The Ian Potter Library, The Alfred Hospital, 55 Commercial Rd, 3004, Melbourne, VIC, Australia
| | - Prabha Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, 560029, Karnataka, India
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, 3004, Melbourne, VIC, Australia
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Palfreyman A. Addressing Psychosocial Vulnerabilities Through Antenatal Care-Depression, Suicidal Ideation, and Behavior: A Study Among Urban Sri Lankan Women. Front Psychiatry 2021; 12:554808. [PMID: 34108890 PMCID: PMC8180592 DOI: 10.3389/fpsyt.2021.554808] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/22/2021] [Indexed: 12/24/2022] Open
Abstract
An absence of data persists for common perinatal mental disorders and suicidal ideation and/or behaviors (SIB), particularly from low- and middle-income countries and from the antenatal period. Capitalizing on Sri Lanka's strong antenatal platform, we identify the prevalence of antenatal depressive symptomology, lifetime- and current-pregnancy SIB and their risk factors in women in urbanizing Sri Lanka, and present opportunities for improved antenatal detection of psychosocial vulnerabilities. One thousand antenatal women in Gampaha District from all trimesters of pregnancy were screened in 2016 using a novel three-part instrument, including the validated Edinburgh Postnatal Depression Scale, a modified Columbia-Suicide Severity Rating Scale for first ever use among a perinatal and South Asian population, and an original Life Circumstances questionnaire (with validated subscales). Prevalence and risk factors associated with depressive symptomology and SIB were explored using univariate, bivariate and logistic regression analyses. Women ranged from 16 to 42 years; 46% were nulliparous. Past-week prevalence of antenatal depressive symptomology was high (29.6%). One in four women reported a lifetime history of SIB, while SIB during the current pregnancy was reported at 7.4%. Exposure to intimate partner violence and lifetime SIB emerged as the strongest correlates of both depressive and current-pregnancy SIB outcomes (p < 0.05). This study evidences the high prevalence of multiple psychosocial vulnerabilities in pregnant women in Sri Lanka and underscores the need for their improved comprehensive assessment. Given antenatal care's high rates of use in Sri Lanka and in low- and middle-income countries in general, this study presents it as a promising mechanism through which to effectively screen for multiple psychosocial vulnerabilities, supporting early identification and intervention for at-risk women and their families.
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Affiliation(s)
- Alexis Palfreyman
- Institute for Global Health, University College London, London, United Kingdom
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Do HP, Baker PRA, Vo TV, Luong-Thanh BY, Nguyen LH, Valdebenito S, Eisner M, Tran BX, Hoang TD, Dunne MP. Brief screening for maternal mental health in Vietnam: Measures of positive wellbeing and perceived stress predict prenatal and postnatal depression. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2020.100047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Jyothi Kantipudi S, Kannan GK, Viswanathan S, Ranganathan S, Menon J, Ramanathan S. Antenatal Depression and Generalized Anxiety Disorder in a Tertiary Hospital in South India. Indian J Psychol Med 2020; 42:513-518. [PMID: 33354075 PMCID: PMC7735237 DOI: 10.1177/0253717620928440] [Citation(s) in RCA: 7] [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: 11/07/2019] [Accepted: 03/31/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Antenatal depression is associated with several adverse maternal outcomes, perinatal outcomes, lower academic achievements in adolescence, and future mental health problems for the mothers. Early identification and effective treatment of depression in antenatal women can also improve perinatal outcomes. AIM This study aims to understand the prevalence of antenatal depression and anxiety disorder, along with associated factors, among antenatal women attending the outpatient clinic of the obstetrics department in a tertiary care hospital. METHODS A cross-sectional design was employed for determining the prevalence, while a case-control framework was used for analysis of the associated factors. Semi-structured sociodemographic pro forma, Patient Health Questionnaire (PHQ-9) Tamil version, and Generalised Anxiety Disorder (GAD-7) Tamil version were administered to antenatal women after obtaining informed consent. Those who scored above 10 points on the PHQ-9 or above 9 points on the GAD-7 were interviewed using the Mini-International Neuropsychiatric Interview (MINI) diagnostic interview schedule, by a psychiatrist, for confirming the diagnosis. RESULTS In our sample, 22% of the participants were diagnosed with depression, and 23% with generalized anxiety disorder (GAD). Twenty-eight participants (13.4%) had both depression and GAD. Antenatal depression was associated with alcohol use in the spouse (P < 0.015), physical violence (P < 0.026), low perceived social support from the in-laws (P < 0.039), and pressure to have a male child (0.001). Antenatal GAD was associated with low perceived social support from the in-laws (P < 0.039) and pressure to have a male child (P < 0.041). CONCLUSION The occurrence of depression and generalized anxiety disorder is high in antenatal women. Our study identified relevant psychosocial factors that may be potential targets to develop effective interventions.
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Affiliation(s)
| | - G K Kannan
- Mind Space Clinic, Chennai, Tamil Nadu, India
| | - Sushma Viswanathan
- Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
| | - Sumathi Ranganathan
- Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
| | - Jayakumar Menon
- Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
| | - Sathianathan Ramanathan
- Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
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du Toit E, Niehaus D, Jordaan E, Koen L, Jones R, Leppanen J. Perinatal suicidality: Risk factors in South African women with mental illness. S Afr J Psychiatr 2020. [DOI: 10.4102/sajpsychiatry.v26i0.1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Ganjekar S, Thekkethayyil AV, Chandra PS. Perinatal mental health around the world: priorities for research and service development in India. BJPsych Int 2020; 17:2-5. [PMID: 34287425 PMCID: PMC8277535 DOI: 10.1192/bji.2019.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/19/2019] [Accepted: 10/10/2019] [Indexed: 11/23/2022] Open
Abstract
Maternal mental health disorders are a significant problem for mother-infant dyads in India, but have not received the attention that they should. However, recent major developments hold promise: the increase in coverage of the District Mental Health Programme; the growing emphasis in public health systems on newborn health; integration of maternal mental health into the Reproductive and Child Health Programme in the state of Kerala; and the Mental Health Care Act 2017, which mandates mother-infant joint care when a mother is admitted for mental illness, will lead to policy changes in services. Innovative implementation and translational research is needed to generate knowledge to strengthen maternal mental healthcare systems and improve maternal and child outcomes. Valuable 'research rupees' should be spent on ensuring equity of resources for physical and mental healthcare of mothers and providing optimal environments for every mother-infant dyad.
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Affiliation(s)
- Sundarnag Ganjekar
- Associate Professor, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Prabha S Chandra
- Professor, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
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Kubota C, Inada T, Shiino T, Ando M, Sato M, Nakamura Y, Yamauchi A, Morikawa M, Okada T, Ohara M, Aleksic B, Murase S, Goto S, Kanai A, Ozaki N. The Risk Factors Predicting Suicidal Ideation Among Perinatal Women in Japan. Front Psychiatry 2020; 11:441. [PMID: 32499731 PMCID: PMC7242750 DOI: 10.3389/fpsyt.2020.00441] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 04/29/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The aim of the present study was to elucidate the foreseeable risk factors for suicidal ideation among Japanese perinatal women. METHODS This cohort study was conducted in Nagoya, Japan, from July 2012 to March 2018. The Edinburgh Postnatal Depression Scale (EPDS) questionnaire was conducted at four time points: early pregnancy, late pregnancy, 5 days postpartum, and 1 month postpartum. A total of 430 women completed the questionnaires. A logistic regression analysis was performed using the presence of suicidal ideation on the EPDS as an objective variable. The explanatory variables were age, presence of physical or mental disease, smoking and drinking habits, education, hospital types, EPDS total score in early pregnancy, bonding, and quality and amount of social support, as well as the history of major depressive disorder (MDD). RESULTS The rate of participants who were suspected of having suicidal ideation at any of the four time points was 11.6% (n=52), with the highest (n=25, 5.8%) at late pregnancy. For suicidal ideation, education level (OR: 1.19; 95% CI: 1.00-1.41; p=0.047), EPDS total points in the pregnancy period (OR: 1.25; 95% CI: 1.16-1.34; p < 0.000), a history of MDD (OR: 2.16; 95% CI: 1.00-4.79; p=0.049), and presence of mental disease (OR: 2.39; 95% CI: 1.00-5.70; p=0.049) were found to be risk factors for suicidal ideation. Age [odds ratio (OR): 0.88; 95% confidence interval (CI): 0.80-0.95; p=.002] and quality of social support (OR: 0.77; 95% CI: 0.60-0.99; p=.041) were found to be protective factors. CONCLUSION Based on these results, effective preventive interventions, such as increasing the quality of social support and confirming the history of depression, should be carried out in pregnant depressive women at the early stage of the perinatal period.
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Affiliation(s)
- Chika Kubota
- Department of Psychiatry, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiya Inada
- Department of Psychiatry and Psychobiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Shiino
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Division of Developmental Emotional Intelligence Research Center for Child Mental Development, University of Fukui, Fukui, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Maya Sato
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukako Nakamura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Aya Yamauchi
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mako Morikawa
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Okada
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masako Ohara
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Branko Aleksic
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satomi Murase
- Department of Psychiatry, Liaison Medical Marunouchi, Nagoya, Japan
| | - Setsuko Goto
- Department of Obstetrics and Gynecology, Goto Setsuko Ladies Clinic, Nagoya, Japan
| | - Atsuko Kanai
- Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Takegata M, Takeda S, Sakanashi K, Tanaka T, Kitamura T. Perinatal self-report of thoughts of self-harm, depressive symptoms, and personality traits: Prospective study of Japanese community women. Psychiatry Clin Neurosci 2019; 73:707-712. [PMID: 31347220 DOI: 10.1111/pcn.12917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/29/2019] [Accepted: 07/21/2019] [Indexed: 12/22/2022]
Abstract
AIM The aim of this study was to identify women with thoughts of self-harm preceded by suicidal ideation, during the perinatal period, on cluster analysis and to clarify their psychological correlates. METHODS A secondary analysis was conducted using the data from a longitudinal study involving 18 obstetric clinics between 2011 and 2012 in Kumamoto Prefecture (Japan). Self-administered questionnaires including demographic data, Edinburgh Postnatal Depression Scale, Temperament and Character Inventory, and the Postnatal Bonding Questionnaire were distributed during the third trimester of pregnancy (wave 1), at 5 days (wave 2), and 1 month postpartum (wave 3). RESULTS On cluster analysis using the data of participants who answered all observational points, the participants were divided into two groups: cluster 1, normal (n = 201); and cluster 2, thoughts of self-harm (n = 42). Low self-directedness, low cooperativeness, higher anxiety, depression, and lack of affection and anger and rejection towards the baby were associated with cluster 2. CONCLUSIONS The finding that low self-directedness and low cooperativeness were related to the cluster 2 group suggests that immature personality traits may work as a predisposing factor mediating between anxiety, depression and thoughts of self-harm.
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Affiliation(s)
- Mizuki Takegata
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Satoru Takeda
- Department of Obstetrics and Gynaecology, School of Medicine, Juntendo University, Tokyo, Japan
| | - Kyoko Sakanashi
- Department of Women's Health/Mother-Child Nursing, Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | | | - Toshinori Kitamura
- Kitamura Institute of Mental Health Tokyo, Tokyo, Japan.,Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Suicide by hanging is a priority for suicide prevention: method specific suicide in India (2001-2014). J Affect Disord 2019; 257:1-9. [PMID: 31299398 DOI: 10.1016/j.jad.2019.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND India accounts for over a quarter of the global burden of suicide. One of the most effective population level suicide prevention strategies has been restricting access to suicide means. METHOD Trends in method specific suicide rates (2001-14) were calculated using National Crime Records Bureau data stratified by sex, age-group, and geographical region. Multilevel negative binomial regression models stratified by sex and suicide method were specified to investigate associations between state-level indicators of economic development, education, agricultural pesticide use and religious factors. RESULTS Suicide by hanging increased by 56% (from 3.9 to 6.1 per 100,000) among males and by 24% (from 2.1 to 2.6 per 100,000) among females over the study period while incidence of insecticide poisoning decreased by 44% (from 2.7 to 1.5 per 100,000) among males and by 52% (from 1.7 to 0.8 per 100,000) among females. In general, states with higher levels of development, higher agricultural employment and higher literacy had higher rates of suicide for each suicide method. States with higher levels of agricultural pesticide use had higher rates of insecticide poisoning suicides. LIMITATION Reported rates might be an underestimation of the true rates as the official data used for the analysis likely underestimates the actual number of suicide deaths in India. CONCLUSION Responsible reporting of suicide by hanging in the media, and limiting fictional portrayals of this method may be useful areas for prevention. Further restrictions on production and sales of highly hazardous pesticides may also help with further reductions in suicide by pesticide poisoning.
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Vijayakumar L, Lamech N. Suicide and Suicidal Behavior in Women. MENTAL HEALTH AND ILLNESS OF WOMEN 2019. [DOI: 10.1007/978-981-10-0371-4_3-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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35
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Halim N, Beard J, Mesic A, Patel A, Henderson D, Hibberd P. Intimate partner violence during pregnancy and perinatal mental disorders in low and lower middle income countries: A systematic review of literature, 1990–2017. Clin Psychol Rev 2018; 66:117-135. [DOI: 10.1016/j.cpr.2017.11.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/27/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
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Kishore MT, Satyanarayana V, Ananthanpillai ST, Desai G, Bhaskarapillai B, Thippeswamy H, Chandra PS. Life events and depressive symptoms among pregnant women in India: Moderating role of resilience and social support. Int J Soc Psychiatry 2018; 64:570-577. [PMID: 30024292 DOI: 10.1177/0020764018789193] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Recent life events may be significant risk factors for depression during pregnancy. However, its association with the individual's resilience and social support is not clear. AIMS To understand the association between life events and depression during pregnancy and whether the association is moderated by resilience and social support. METHODS This study is part of a prospective cohort study on perinatal mental health in an urban antenatal clinic, which included 589 women recruited in the first and early second trimester. Participants were administered the Life Events Checklist adapted from the Social Readjustment Rating Scale by the authors to assess life events; Edinburgh Postnatal Depression Scale (EPDS) and Connor-Davidson Resilience Scale-10 to assess depression and resilience, respectively. The relationship between life events (12 months prior to the time of assessment) and antenatal depression and the moderating role of resilience and social support was analysed. RESULTS Thirty-eight women (6.5%) who had depression (EPDS score ⩾ 11) had significantly higher number of life events (i.e. on average three; U = 3,826; p < .01), lower resilience scores ( U = 4,053; p < .01) and lower perceived social support ( U = 2,423; p < .01) as compared to those who were negative for depression on EPDS. Life events predicted depression during pregnancy; however, the relationship was moderated by social support but not by resilience. CONCLUSION The pregnant women who experienced life events may experience depression during the first trimester of pregnancy, but the effect could possibly be reduced by enhancing the social support.
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Affiliation(s)
- M Thomas Kishore
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Veena Satyanarayana
- 1 Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | | | - Geetha Desai
- 3 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Binukumar Bhaskarapillai
- 4 Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Harish Thippeswamy
- 3 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Prabha S Chandra
- 3 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
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Bagadia A, Chandra PS. Starting the conversation - Integrating mental health into maternal health care in India. Indian J Med Res 2018; 145:267-269. [PMID: 28749389 PMCID: PMC5555055 DOI: 10.4103/ijmr.ijmr_910_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ashlesha Bagadia
- Consultant Perinatal Psychiatrist, Fortis La Femme, Bengaluru 560 102, Karnataka, India
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru 560 102, Karnataka, India
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Abstract
PURPOSE OF REVIEW India has experienced rapid urbanization in the last few decades. This review focuses on recent research related to the effects of urbanization on mental health with a specific focus on various population groups in urban India. RECENT FINDINGS With a specific focus on recent research undertaken amongst special populations such as youth, women and the elderly, the findings demonstrate increasing rates of substance use and technology addiction among youth; high self-harm rates in various groups such as adolescents and women; the effects of violence and abuse on the mental health of women; psychological distress among the elderly in modern urban India. SUMMARY The article highlights the direct and indirect effects of urbanization on mental health of various populations and emphasizes the need to develop individual-level and policy-level strategies to manage problems arising out of the same.
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