1
|
Gilbert L, Raubenheimer D, Hibbert EJ, Nanan R. PsyNBIOsis: Investigating the Association between Maternal Gestational Diabetes, Mental Health, Diet and Childhood Obesity Risk: Protocol for a Prospective, Longitudinal, Observational Study. Nutrients 2023; 16:124. [PMID: 38201953 PMCID: PMC10781001 DOI: 10.3390/nu16010124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with poorer maternal mental health (depression and anxiety). Maternal mental health and GDM are likely to influence diet, which in turn impacts the course of GDM. Maternal diet may also be directly or indirectly associated with changes in infant anthropometry. The aims of this study are to (1) examine the associations between maternal GDM, mental health and diet, and (2) evaluate the associations between these maternal factors, breastmilk composition and infant anthropometry. METHODS This prospective, observational, longitudinal cohort study compares a cohort of women with and without GDM. Maternal mental health and diet are assessed using validated questionnaires. Breastmilk composition is measured with the Human Milk Analyzer, and infant body composition is measured with air displacement plethysmography. SIGNIFICANCE AND IMPACT Once data have been collected, PsyNBIOsis will provide evidence for the associations between maternal mental health, GDM status and diet, and their impact on breastmilk composition and early infant growth. The results may inform the Developmental Origins of Health and Disease framework and provide data on which to build cost-effective interventions to prevent both the development of mental health issues in mothers and adverse growth patterns in infants.
Collapse
Affiliation(s)
- Leah Gilbert
- Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Penrith, NSW 2751, Australia
| | - David Raubenheimer
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2003, Australia
- School of Life and Environmental Science, University of Sydney, Sydney, NSW 2003, Australia
| | - Emily J. Hibbert
- Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Penrith, NSW 2751, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2003, Australia
- Nepean Hospital, Penrith, NSW 2747, Australia
| | - Ralph Nanan
- Charles Perkins Centre, University of Sydney, Sydney, NSW 2003, Australia
| |
Collapse
|
2
|
Marphatia AA, Busert-Sebela LK, Gram L, Cortina-Borja M, Reid AM, Manandhar DS, Wells JCK, Saville NM. Maternal mental health and economic autonomy in lowland rural Nepal: Do parents-in-law provide constraint or support? Evol Med Public Health 2023; 11:229-243. [PMID: 37475838 PMCID: PMC10355796 DOI: 10.1093/emph/eoad020] [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: 07/13/2022] [Revised: 04/28/2023] [Indexed: 07/22/2023] Open
Abstract
Background and objectives In patrilocal societies, married women typically co-reside with their parents-in-law, who may act in their son's reproductive interests. These relationships may shape maternal mental health and autonomy. Few studies have examined these dynamics from an evolutionary perspective. Theoretically, marital kin may increase their fitness by increasing maternal investment or by reducing paternity uncertainty. We explored how co-residence with parents-in-law and husband is associated with maternal outcomes to evaluate whether marital kin provide support or constraint. Methodology We analysed data from 444 households in rural lowland Nepal. Maternal mental health was assessed by General Health Questionnaire. Logistic regression models investigated whether, relative to mothers living with both husband and parents-in-law, those co-resident with other combinations of relatives had poorer mental health and lower household economic autonomy (decision-making, bargaining power), adjusting for socio-economic confounders. Results Co-residence with husband only, or neither husband nor parents-in-law, was associated with higher odds of mothers reporting feeling worthless and losing sleep but also earning income and making household expenditure decisions. Husband co-residence was associated with overall maternal distress but also with less unpaid care work and greater decision-making responsibility. There were no differences in maternal outcomes for mothers living with parents-in-law only, relative to those living with both husbands and parents-in-law. Conclusions and implications Co-residence of parents-in-law and husbands was associated with contrasting patterns of maternal mental health and economic autonomy. We suggest that different marital kin place different economic demands on mothers, while restricting their autonomy in different ways as forms of 'mate-guarding'.
Collapse
Affiliation(s)
| | | | - Lu Gram
- Institute for Global Health, University College London, London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Alice M Reid
- Department of Geography, University of Cambridge, Cambridge, UK
| | | | - Jonathan C K Wells
- Corresponding author. Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK. Tel: +44 020 7905 2104; E-mail:
| | | |
Collapse
|
3
|
Van den Branden L, Van de Craen N, Van Leugenhaege L, Bleijenbergh R, Mestdagh E, Timmermans O, Van Rompaey B, Kuipers YJ. On cloud nine? Maternal emotional wellbeing six weeks up to one year postpartum - A cross-sectional study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 36:100856. [PMID: 37229926 DOI: 10.1016/j.srhc.2023.100856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/31/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Little is known about the full scope of emotional wellbeing of mothers up to one year postpartum, to adequately support women during transition to motherhood. Reduced emotional wellbeing (REW) affects women's adaption to the changes and challenges in becoming a mother. We aimed to increase the knowledge and understanding of mothers' emotional wellbeing and the influencing factors. METHODS This cross-sectional study includes 385 Flemish mothers up to one year postpartum. Online data were collected with the General Health Questionnaire-12, Postpartum Bonding Questionnaire, Personal Well-Being Index-Adult, The Basic Psychological Needs Scale, Sense of Coherence-13 and Coping Operations Preference Enquiry. RESULTS A total of 63.9% of the participants reported REW. Mothers with REW more often had (a history of) psychological problems compared to mothers with healthy emotional wellbeing (p = 0.007). Multiple linear regression analysis showed negative associations between emotional wellbeing and satisfaction (p = 0.002; p < 0.001), comprehensibility (p = 0.013) and positive associations between emotional wellbeing and bonding (p < 0.001), manageability (p = 0.033), problem solving (p = 0.030) and avoidance (p = 0,011) - with an explained variance of 55.5%. LIMITATIONS Some limitations of our study are the GHQ-12 cut-off value, the nature and implication of (a history of) psychological problems and the self-selected population. CONCLUSION It would be of worth for midwives to discuss with mothers (to be) what to expect. This - to support mothers in making sense of their life as a mother and how various factors might influence their emotional wellbeing. The high prevalence of REW is worrying, but needs to be interpreted with caution.
Collapse
Affiliation(s)
- Laura Van den Branden
- AP University of Applied Sciences, Department of Health and Social Care, School of Midwifery, Noorderplaats 2, 2000 Antwerp, Belgium; University of Antwerp, Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Natacha Van de Craen
- AP University of Applied Sciences, Department of Health and Social Care, School of Midwifery, Noorderplaats 2, 2000 Antwerp, Belgium
| | - Luka Van Leugenhaege
- AP University of Applied Sciences, Department of Health and Social Care, School of Midwifery, Noorderplaats 2, 2000 Antwerp, Belgium; University of Antwerp, Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Roxanne Bleijenbergh
- AP University of Applied Sciences, Department of Health and Social Care, School of Midwifery, Noorderplaats 2, 2000 Antwerp, Belgium; University of Antwerp, Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Eveline Mestdagh
- AP University of Applied Sciences, Department of Health and Social Care, School of Midwifery, Noorderplaats 2, 2000 Antwerp, Belgium; University of Antwerp, Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Olaf Timmermans
- University of Antwerp, Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, Universiteitsplein 1, 2610 Wilrijk, Belgium; Professorship Healthy Region, HZ University of Applied Sciences, Edisonweg 4, 4382 NW Vlissingen, the Netherlands
| | - Bart Van Rompaey
- University of Antwerp, Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Yvonne J Kuipers
- AP University of Applied Sciences, Department of Health and Social Care, School of Midwifery, Noorderplaats 2, 2000 Antwerp, Belgium; University of Antwerp, Faculty of Medicine & Health Sciences, Department of Nursing and Midwifery, Universiteitsplein 1, 2610 Wilrijk, Belgium; Edinburgh Napier University, School of Health & Social Care, Sighthill Court, Edinburgh EH11 4BN, Scotland, UK
| |
Collapse
|
4
|
Orsolini L, Pompili S, Mauro A, Volpe U. Foreign Nationality, Family Psychiatry History and Pregestational Neoplastic Disease as Predictors of Perinatal Depression in a Cohort of Healthy Pregnant and Puerperal Women during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11030428. [PMID: 36767003 PMCID: PMC9914901 DOI: 10.3390/healthcare11030428] [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: 12/30/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Background: Perinatal depression (PND) represents one of the most common mental disorders in the pregnancy and/or postpartum period, with a 5-25% prevalence rate. Our aim was to investigate predictors associated with PND in a cohort of pregnant and puerperal women based in an Italian setting during the COVID-19 pandemic. Methods: We retrospectively recruited 199 (55 pregnant and 144 puerperal) women, afferent to our Perinatal Mental Outpatient Service of Ancona (Italy). Participants were administered an ad hoc case-report form, Whooley Questions (WQ), the General Health Questionnaire-12 (GHQ-12), the Stress Holmes-Rahe scale (HR) and the Edinburgh Postnatal Depression Scale (EPDS). Results: Around 10% of the sample had a confirmed PND. Being a foreigner woman (RR = 3.8), having a positive psychiatric family history (RR = 5.3), a pre-pregnancy medical comorbidity (RR = 1.85) and a comorbid medical illness occurring during the pregnancy (RR = 2) were much likely associated with PND. Multiple linear regression analysis demonstrated that GHQ, medium- and high-risk at the HR, foreign nationality, positive family psychiatric history, and neoplastic disease before conception significantly predicted EPDS [F(1, 197) = 10.086, R2 = 0.324, p < 0.001]. Limitations: The sample size, poor heterogeneity in terms of socio-demographic, clinical and gynecological-obstetric characteristics, the cross-sectional design of the study. Conclusions: Our study showed a set of predictors associated with a higher risk for the PND onset, including gestational and pregestational medical disease. Our findings outline the need to screen all fertile women, particularly in gynecological and medical settings, in order to identify at-risk women for PND and promptly suggest a psychiatric consultation.
Collapse
|
5
|
Kemppinen L, Mattila M, Ekholm E, Huolila L, Pelto J, Karlsson H, Mäkikallio K, Karlsson L. Gestational anemia and maternal antenatal and postpartum psychological distress in a prospective FinnBrain Birth Cohort Study. BMC Pregnancy Childbirth 2022; 22:704. [PMID: 36100878 PMCID: PMC9469542 DOI: 10.1186/s12884-022-05032-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gestational anemia, most commonly caused by iron deficiency, may increase the risk of maternal anxiety and depression and have a potentially far-reaching impact on mother's and newborn's health. Several mechanisms, such as effects of iron deficiency on cerebral neurotransmitter metabolism, have been suggested. None of the earlier studies have assessed the association between gestational anemia and depression, anxiety and pregnancy-related anxiety simultaneously. METHODS Women, participating in the FinnBrain Birth Cohort Study and attending maternity welfare clinics in Turku, whose hemoglobin (Hb) values during pregnancy were available were included in this study (n = 1273). The study group consisted of 301 women with Hb levels < 11.0 g/dL at any time during pregnancy, and 972 women with Hb ≥ 11.0 g/dL were included in the control group. Symptoms of depression, anxiety, and pregnancy-related anxiety were assessed using the Edinburgh Postnatal Depression Scale (EPDS), Symptom Checklist-90 (SCL), and Pregnancy-Related Anxiety Questionnaire (PRAQ) questionnaires at 14, 24, and 34 gestational weeks, and EPDS and SCL were also performed 3 and 6 months postpartum. RESULTS Gestational anemia was not associated with an increased risk of depression either prenatally or postpartum when the analyses were adjusted for maternal age at birth, parity, smoking during pregnancy, maternal education, and gestational age. However, a weak connection was found between gestational anemia and prenatal anxiety in the early pregnancy. Furthermore, the analysis between women with Hb < 10.0 g/dL and those with Hb ≥ 10.0 g/dL showed an association between gestational anemia and anxiety in the late pregnancy, but otherwise no difference in psychological distress was found. CONCLUSIONS No evidence supporting the association between gestational anemia and antenatal or postpartum depression was found. However, a weak connection between gestational anemia and antenatal anxiety was observed. This finding needs further investigation to establish timing and investigate causality.
Collapse
Affiliation(s)
- Lotta Kemppinen
- Department of Obstetrics and Gynecology, Turku University Hospital, U-Hospital, Savitehtaankatu 5, 20520, Turku, Finland. .,University of Turku, Turku, Finland.
| | - Mirjami Mattila
- Department of Obstetrics and Gynecology, Turku University Hospital, U-Hospital, Savitehtaankatu 5, 20520, Turku, Finland.,University of Turku, Turku, Finland
| | - Eeva Ekholm
- Department of Obstetrics and Gynecology, Turku University Hospital, U-Hospital, Savitehtaankatu 5, 20520, Turku, Finland.,University of Turku, Turku, Finland
| | - Linda Huolila
- Department of Obstetrics and Gynecology, Turku University Hospital, U-Hospital, Savitehtaankatu 5, 20520, Turku, Finland.,University of Turku, Turku, Finland
| | - Juho Pelto
- Department of Clinical Medicine, University of Turku, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland
| | - Hasse Karlsson
- Department of Clinical Medicine, University of Turku, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland.,Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
| | - Kaarin Mäkikallio
- Department of Obstetrics and Gynecology, Turku University Hospital, U-Hospital, Savitehtaankatu 5, 20520, Turku, Finland.,University of Turku, Turku, Finland
| | - Linnea Karlsson
- Department of Clinical Medicine, University of Turku, Turku Brain and Mind Center, FinnBrain Birth Cohort Study, Turku, Finland.,Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.,Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Department of Paediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
6
|
Schneider MO, Pretscher J, Goecke TW, Häberle L, Engel A, Kornhuber J, Eichler A, Ekici AB, Beckmann MW, Fasching PA, Schwenke E. Genetic variants in the genes of the sex steroid hormone metabolism and depressive symptoms during and after pregnancy. Arch Gynecol Obstet 2022; 307:1763-1770. [PMID: 35680688 DOI: 10.1007/s00404-022-06644-8] [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: 02/10/2022] [Accepted: 05/23/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE The aim of this study was to conduct an association analysis of depressive symptoms and polymorphisms in the ESR1, PGR, CYP19A1, and COMT genes in pregnant and postpartum women. METHODS The Franconian Maternal Health Evaluation Study (FRAMES) recruited healthy pregnant women prospectively for assessment of maternal and fetal health. The German version of the 10-item Edinburgh Postnatal Depression Scale (EPDS) was completed at three time points in this prospective cohort study. Visit 1 was at study entry in the third trimester of pregnancy, visit 2 was shortly after birth, and visit 3 was 6-8 months after birth. Germline DNA and depression measurements from 361 pregnant women were available for analysis. Six single nucleotide polymorphisms (SNPs) in the above-mentioned genes were genotyped. After reconstruction of haplotypes for PGR (rs1042838 and rs10895068) and CYP19A1 (rs10046 and rs4646), a multifactorial linear mixed model was applied to the data to describe the association between haplotypes and depression values. The single SNPs for ESR1 (rs488133) and COMT (rs4680) were analyzed separately using linear mixed models analogously. RESULTS The mean antepartum EPDS measurement was 5.1, the mean postpartal measurement after 48-72 h was 3.5, and the mean value 6-8 months postpartum was 4.2. The SNPs in PGR were reconstructed into three haplotypes. The most common haplotype was GG, with 63.43% of patients carrying two copies and 33.52% carrying one copy. For haplotype GA, the group of carriers of two copies (0.28%) was combined with the carriers of one copy (9.70%). Haplotype reconstruction using CYP19A1 SNPs resulted in three haplotypes. The most common haplotype was TC, with 25.48% of patients carrying two copies and 51.52% one copy. None of the haplotype blocks and neither of the two single SNPs showed any significant associations with EPDS values. CONCLUSIONS The candidate haplotypes analyzed in PGR and CYP19A1 and single SNPs in ESR1 and COMT did not show any association with depression scores as assessed by EPDS in this cohort of healthy unselected pregnant women.
Collapse
Affiliation(s)
- Michael O Schneider
- Erlangen University Perinatal Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Jutta Pretscher
- Erlangen University Perinatal Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Tamme W Goecke
- Erlangen University Perinatal Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.,Department of Obstetrics, RoMed Clinic Rosenheim, Rosenheim, Germany
| | - Lothar Häberle
- Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anne Engel
- Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Anna Eichler
- Department of of Child and Adolescent Mental Health, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias W Beckmann
- Erlangen University Perinatal Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Peter A Fasching
- Erlangen University Perinatal Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Eva Schwenke
- Erlangen University Perinatal Center, Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| |
Collapse
|
7
|
Dosani A, Yim IS, Shaikh K, Lalani S, Alcantara J, Letourneau N, Premji SS. Psychometric analysis of the Edinburgh Postnatal Depression Scale and Pregnancy Related Anxiety Questionnaire in Pakistani pregnant women. Asian J Psychiatr 2022; 72:103066. [PMID: 35334284 DOI: 10.1016/j.ajp.2022.103066] [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: 02/17/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Edinburgh Postnatal Depression Scale (EPDS) and the Pregnancy-Related Anxiety Scale (PRAQ) are frequently used perinatal mental health scales. OBJECTIVE To identify the factor structure of the Urdu language versions of EPDS and PRAQ in 280 Pakistani pregnant women. METHOD The tools were administered at 12-19 weeks' and 22-29 weeks' gestational age (GA). Exploratory factor analyses were undertaken on data collected at 12-19 weeks' GA, to assess both scales. Results obtained at the second time point were used to examine test-retest reliability. The correlation between the scales was computed. RESULTS A two-factor model yielded the best fit for both scales, which is consistent with findings from previous studies. For the EPDS, acceptable reliability was attained for the overall score (α = 0.77) and for the factor related to depressive symptoms (α = 0.73), but not for the factor related to anhedonia/suicide (α = 0.64). For the PRAQ, acceptable reliability was attained for the overall score (α = 0.83) and for the factor related to pregnancy concerns (α = 0.84), but not for the factor related to childbirth (α = 0.64). Test-retest reliability was acceptable for both overall scales EPDS: r = 0.50; PRAQ: r = 0.45; both p < .001). The Pearson correlation between the EPDS and PRAQ were r = 0.145, p < .05. CONCLUSION Analysis of the tools confirmed a two-factor structure for both depression and anxiety among Pakistani pregnant women. A weak correlation was found between the EPDS and PRAQ. Further research is required to develop screening instruments for perinatal mental disorders that are applicable to cultural contexts.
Collapse
Affiliation(s)
- Aliyah Dosani
- School of Nursing and Midwifery, Mount Royal University, 4825 Mount Royal Gate S.W., Calgary, Alberta, T3E 6K6 Canada; Department of Community Health Sciences, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6 Canada; O'Brien Institute for Public Health, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive N.W., Calgary, Alberta, T2N 4Z6 Canada.
| | - Ilona S Yim
- Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA, USA
| | - Kiran Shaikh
- School of Nursing and Midwifery, Aga Khan University, Stadium Road, P/O Box 3500, Karachi 74800, Pakistan
| | - Sharifa Lalani
- School of Nursing and Midwifery, Aga Khan University, Stadium Road, P/O Box 3500, Karachi 74800, Pakistan
| | - Jade Alcantara
- School of Nursing and Midwifery, Mount Royal University, 4825 Mount Royal Gate S.W., Calgary, Alberta, T3E 6K6 Canada
| | - Nicole Letourneau
- Department of Community Health Sciences, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6 Canada; Faculty of Nursing, University of Calgary, 2500 University Drive N.W., Calgary, Alberta, T2N 1N4 Canada; Departments of Pediatrics and Psychiatry, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta,T2N 4N1 Canada
| | - Shahirose S Premji
- School of Nursing, Faculty of Health, York University, Health, Nursing & Environmental Studies Building, Room 313, 4700 Keele St, Toronto, M3J 1P3 Canada
| |
Collapse
|
8
|
Waechter R, Evans R, Fernandes M, Bailey B, Holmes S, Murray T, Isaac R, Punch B, Cudjoe N, Orlando L, Landon B. A Community-based Responsive Caregiving Program Improves Neurodevelopment in Two-year Old Children in a Middle-Income Country, Grenada, West Indies. PSYCHOSOCIAL INTERVENTION 2022; 31:97-107. [PMID: 37360060 PMCID: PMC10268546 DOI: 10.5093/pi2022a6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/08/2022] [Indexed: 06/28/2023]
Abstract
Many young children in low- and middle-income countries (LMICs) are at risk of developmental delays. Early child development (ECD) interventions have been shown to improve outcomes, but few interventions have targeted culturally normative violence such as corporal punishment (CP). We partnered with an existing community-based ECD organization in the LMIC of Grenada to implement a parallel controlled-trial single-blind responsive caregiving intervention that educates parents about the developing brain and teaches alternatives to corporal punishment while building parental self-regulation skills and strengthening social-emotional connections between parent and child. Parents and primary caregivers with children under age two were eligible. Allocation to the intervention and waitlist control arms was unblinded and determined by recruitment into the program. Neurodevelopment was assessed by blinded testers when each child turned age two. Primary comparison consisted of neurodevelopmental scores between the intervention and waitlist control groups (Clinicaltrials.gov registration # NCT04697134). Secondary comparison consisted of changes in maternal mental health, home environment, and attitudes towards CP. Children in the intervention group (n = 153) had significantly higher scores than children in the control group (n = 151) on measures of cognition (p = .022), fine motor (p < .0001), gross motor (p = .015), and language development (p = .013). No difference in secondary outcomes, including CP, was detected.
Collapse
Affiliation(s)
- Randall Waechter
- George’s UniversityGrenadaWest IndiesSt. George’s University, Grenada, West Indies
- Caribbean Center for Child NeurodevelopmentWindward Islands Research and Education FoundationGrenadaWest IndiesCaribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, Grenada, West Indies;
| | - Roberta Evans
- Caribbean Center for Child NeurodevelopmentWindward Islands Research and Education FoundationGrenadaWest IndiesCaribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, Grenada, West Indies;
| | - Michelle Fernandes
- University Hospitals SouthamptonSouthamptonUKUniversity Hospitals Southampton, Southampton, UK;
- University of OxfordOxfordUKUniversity of Oxford, Oxford, UK;
| | - Becky Bailey
- Conscious DisciplineFloridaUSAConscious Discipline, Florida, USA
| | - Stephanie Holmes
- Caribbean Center for Child NeurodevelopmentWindward Islands Research and Education FoundationGrenadaWest IndiesCaribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, Grenada, West Indies;
| | - Toni Murray
- Caribbean Center for Child NeurodevelopmentWindward Islands Research and Education FoundationGrenadaWest IndiesCaribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, Grenada, West Indies;
| | - Rashida Isaac
- Caribbean Center for Child NeurodevelopmentWindward Islands Research and Education FoundationGrenadaWest IndiesCaribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, Grenada, West Indies;
| | - Bianca Punch
- Caribbean Center for Child NeurodevelopmentWindward Islands Research and Education FoundationGrenadaWest IndiesCaribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, Grenada, West Indies;
| | - Nikita Cudjoe
- Caribbean Center for Child NeurodevelopmentWindward Islands Research and Education FoundationGrenadaWest IndiesCaribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, Grenada, West Indies;
| | - Lauren Orlando
- George’s UniversityGrenadaWest IndiesSt. George’s University, Grenada, West Indies
| | - Barbara Landon
- George’s UniversityGrenadaWest IndiesSt. George’s University, Grenada, West Indies
| |
Collapse
|
9
|
Othman S, Yuen CW, Mohd Zain N, Abdul Samad A. Exploring Intimate Partner Violence Among Women Attending Malaysian Primary Care Clinics. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP7920-NP7941. [PMID: 30938233 DOI: 10.1177/0886260519839426] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Victims of intimate partner violence (IPV) are frequent attendees at health care facilities. Although most literature on this subject focuses on developed or Western countries, there is a dearth of information from Asian countries. This study aims to estimate the prevalence of IPV among women attending urban primary care services in Malaysia and to identify the risk factors associated with IPV. Six out of 15 available public primary care clinics in the federal territory of Kuala Lumpur, Malaysia, were randomly selected. The sampling size for each clinic was conducted proportionate to the clinic's average daily patient attendance. A total of 882 women participated in this study via a self-administered questionnaire. We administered the women's experience with battering scale (WEB-scale) to estimate the prevalence of psychological violence and included a screening question for physical and sexual assault. The results showed that 22.0% of the women surveyed reported experiencing IPV. Ethnicity appears to be a significant predictor, with Chinese and Indian women reporting IPV at a higher rate than Malay women. Women with IPV are more likely to come from lower income households, have witnessed parental IPV, receive less social support, and have poorer psychological well-being. Our findings indicate that the prevalence of IPV among women attending urban public primary care clinics is high. Health care providers should pay close attention during clinical encounters for any sign of IPV, particularly among those presenting with risk factors.
Collapse
|
10
|
Perceived stress may mediate the relationship between antenatal depressive symptoms and preterm birth: A pilot observational cohort study. PLoS One 2021; 16:e0250982. [PMID: 33945579 PMCID: PMC8096039 DOI: 10.1371/journal.pone.0250982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/16/2021] [Indexed: 11/19/2022] Open
Abstract
Background Screening for changes in pregnancy-related anxiety and depressive symptoms during pregnancy may further our understanding of the relationship between these two variables and preterm birth. Objectives To determine whether changes in pregnancy-related anxiety and depressive symptoms during pregnancy influence the risk of preterm birth among Pakistani women; explore whether perceived stress moderates or mediates this relationship, and examine the relationship between the various components of pregnancy-related anxiety and preterm birth. Methods A prospective cohort study design was used to recruit a diverse sample of 300 low-risk pregnant women from four centers of Aga Khan Hospital for Women and Children in Karachi, Pakistan. Changes in pregnancy-related anxiety and depressive symptoms during pregnancy were tested. Multiple logistic regression analysis was used to determine a predictive model for preterm birth. We then determined if the influence of perceived stress could moderate or mediate the effect of depressive symptoms on preterm birth. Results Changes in pregnancy-related anxiety (OR = 1.1, CI 0.97–1.17, p = 0.167) and depressive symptoms (OR = 0.9, CI 0.85–1.03, p = 0.179) were insignificant as predictors of preterm birth after adjusting for the effects of maternal education and family type. When perceived stress was added into the model, we found that changes in depressive symptoms became marginally significant after adjusting for covariates (OR = 0.9, CI 0.82–1.01, p = 0.082). After adjusting for the mediation effect of change in perceived stress, the effect of change in depressive symptoms on preterm birth were marginally significant after adjusting for covariates. Among six different dimensions of pregnancy-related anxiety, mother’s concerns about fetal health showed a trend towards being predictive of preterm birth (OR = 1.3, CI 0.97–1.72, p = 0.078). Conclusions There may be a relationship between perceived stress and antenatal depressive symptoms and preterm birth. This is the first study of its kind to be conducted in Pakistan. Further research is required to validate these results.
Collapse
|
11
|
Lyubenova A, Neupane D, Levis B, Wu Y, Sun Y, He C, Krishnan A, Bhandari PM, Negeri Z, Imran M, Rice DB, Azar M, Chiovitti MJ, Saadat N, Riehm KE, Boruff JT, Ioannidis JPA, Cuijpers P, Gilbody S, Kloda LA, Patten SB, Shrier I, Ziegelstein RC, Comeau L, Mitchell ND, Tonelli M, Vigod SN, Aceti F, Barnes J, Bavle AD, Beck CT, Bindt C, Boyce PM, Bunevicius A, Chaudron LH, Favez N, Figueiredo B, Garcia-Esteve L, Giardinelli L, Helle N, Howard LM, Kohlhoff J, Kusminskas L, Kozinszky Z, Lelli L, Leonardou AA, Meuti V, Radoš SN, García PN, Pawlby SJ, Quispel C, Robertson-Blackmore E, Rochat TJ, Sharp DJ, Siu BWM, Stein A, Stewart RC, Tadinac M, Tandon SD, Tendais I, Töreki A, Torres-Giménez A, Tran TD, Trevillion K, Turner K, Vega-Dienstmaier JM, Benedetti A, Thombs BD. Depression prevalence based on the Edinburgh Postnatal Depression Scale compared to Structured Clinical Interview for DSM DIsorders classification: Systematic review and individual participant data meta-analysis. Int J Methods Psychiatr Res 2021; 30:e1860. [PMID: 33089942 PMCID: PMC7992289 DOI: 10.1002/mpr.1860] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/28/2020] [Accepted: 10/13/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Estimates of depression prevalence in pregnancy and postpartum are based on the Edinburgh Postnatal Depression Scale (EPDS) more than on any other method. We aimed to determine if any EPDS cutoff can accurately and consistently estimate depression prevalence in individual studies. METHODS We analyzed datasets that compared EPDS scores to Structured Clinical Interview for DSM (SCID) major depression status. Random-effects meta-analysis was used to compare prevalence with EPDS cutoffs versus the SCID. RESULTS Seven thousand three hundred and fifteen participants (1017 SCID major depression) from 29 primary studies were included. For EPDS cutoffs used to estimate prevalence in recent studies (≥9 to ≥14), pooled prevalence estimates ranged from 27.8% (95% CI: 22.0%-34.5%) for EPDS ≥ 9 to 9.0% (95% CI: 6.8%-11.9%) for EPDS ≥ 14; pooled SCID major depression prevalence was 9.0% (95% CI: 6.5%-12.3%). EPDS ≥14 provided pooled prevalence closest to SCID-based prevalence but differed from SCID prevalence in individual studies by a mean absolute difference of 5.1% (95% prediction interval: -13.7%, 12.3%). CONCLUSION EPDS ≥14 approximated SCID-based prevalence overall, but considerable heterogeneity in individual studies is a barrier to using it for prevalence estimation.
Collapse
Affiliation(s)
- Anita Lyubenova
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,School of Primary, Centre for Prognosis Research, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Ying Sun
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Chen He
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Parash M Bhandari
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Zelalem Negeri
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Matthew J Chiovitti
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Nazanin Saadat
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Kira E Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jill T Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada
| | - John P A Ioannidis
- Department of Medicine, Stanford University, Stanford, California, USA.,Department of Health Research and Policy, Stanford University, Stanford, California, USA.,Department of Biomedical Data Science, Stanford University, Stanford, California, USA.,Department of Statistics, Stanford University, Stanford, California, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, EMGO Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Simon Gilbody
- Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK
| | - Lorie A Kloda
- Library, Concordia University, Montréal, Québec, Canada
| | - Scott B Patten
- Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada.,Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, Alberta, Canada
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Liane Comeau
- International Union for Health Promotion and Health Education, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada
| | - Nicholas D Mitchell
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simone N Vigod
- Women's College Hospital and Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Franca Aceti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Jacqueline Barnes
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Amar D Bavle
- Department of Psychiatry, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
| | - Cheryl T Beck
- University of Connecticut School of Nursing, Mansfield, Connecticut, USA
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philip M Boyce
- Discipline of Psychiatry, Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Psychiatry, Westmead Hospital, Sydney, New South Wales, Australia
| | - Adomas Bunevicius
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Linda H Chaudron
- Departments of Psychiatry, Pediatrics, Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Nicolas Favez
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,IUP, University of Lausanne, Lausanne, Switzerland
| | | | - Lluïsa Garcia-Esteve
- Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.,Vulnerability, Psychopathology and Gender Research Group, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Lisa Giardinelli
- Department of Health Sciences, Psychiatry Unit, University of Florence, Firenze, Italy
| | - Nadine Helle
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Louise M Howard
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Jane Kohlhoff
- School of Psychiatry, University of New South Wales, Kensington, New South Wales, Australia.,Ingham Institute, Liverpool, New South Wales, Australia.,Karitane, Carramar, New South Wales, Australia
| | | | - Zoltán Kozinszky
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Lorenzo Lelli
- Department of Health Sciences, Psychiatry Unit, University of Florence, Firenze, Italy
| | - Angeliki A Leonardou
- First Department of Psychiatry, Women's Mental Health Clinic, Athens University Medical School, Athens, Greece
| | - Valentina Meuti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Sandra N Radoš
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
| | - Purificación N García
- Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.,Psychology Service, Regidoria de Polítiques de Gènere, Ajuntament de Terrassa, Terrassa, Spain
| | - Susan J Pawlby
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Chantal Quispel
- Department of Obstetrics and Gynaecology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | | | - Tamsen J Rochat
- MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa.,Human and Social Development Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Deborah J Sharp
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bonnie W M Siu
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Robert C Stewart
- Division of Psychiatry, University of Edinburgh, Edinburgh, Scotland, UK.,Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - Meri Tadinac
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - S Darius Tandon
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Iva Tendais
- School of Psychology, University of Minho, Braga, Portugal
| | | | - Anna Torres-Giménez
- Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.,Vulnerability, Psychopathology and Gender Research Group, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Thach D Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kylee Trevillion
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katherine Turner
- Epilepsy Center-Child Neuropsychiatry Unit, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy
| | | | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada.,Department of Psychology, McGill University, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada.,Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada.,Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada
| |
Collapse
|
12
|
de Arriba-García M, Diaz-Martinez A, Monfort-Ortiz R, Roca-Prats A, Monfort-Beltrán S, Ivañez-Muñoz M, Alberola-Rubio J, Perales-Marín A. GESTACOVID project: psychological and perinatal effects in Spanish pregnant women subjected to confinement due to the COVID-19 pandemic. J Matern Fetal Neonatal Med 2021; 35:5665-5671. [PMID: 33615968 DOI: 10.1080/14767058.2021.1888922] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION COVID-19 was declared a pandemic and confinement with movement restriction measures were applied in Spain. Postnatal mental disorders are common but frequently undiagnosed, being a risk period to develop anxiety and depression symptoms. The aim of this study is to evaluate the impact of confinement as depressive and anxiety symptoms in pregnant women (PrW) and puerperal women (PuW) mental health, as well as obstetric and perinatal outcomes during this period. MATERIALS AND METHODS The self-administered survey consists of a total of 28 questions, the first 16 providing contextual information and the following ones corresponding to the GHQ-12 that has been evaluated in a binomial form. A logistic regression model has been used to assess whether the contextual variables acted as a protective or risk factor and its fitting has been represented by a receiver operating curve. RESULTS Of the 754 PrW interviewed, 58.22% were screened positive. Confinement time for these was 54.93 ± 9.75 days. The risk factors that were identified after the refinement have been to have a worse general state of health, to be sadder and to be more nervous. Among the protectors have been found to have a higher Apgar 10 score and induction of labor. The area under the adjusted regression adjustment curve was 0.8056. CONCLUSIONS Our results show a high prevalence of depression and anxiety symptoms with strict confinement measures. PrW and PuW must be considered a risk group to develop mental health disorders during disruption circumstances. Using a mental health screening tool could help to identify a group of patients with more risk and to carry out a careful monitoring to allow adequate management.
Collapse
Affiliation(s)
| | - Alba Diaz-Martinez
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Valencia, Spain
| | - Rogelio Monfort-Ortiz
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alba Roca-Prats
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Sara Monfort-Beltrán
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María Ivañez-Muñoz
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - José Alberola-Rubio
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alfredo Perales-Marín
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| |
Collapse
|
13
|
Jradi H, Alfarhan T, Alsuraimi A. Validation of the Arabic version of the Perinatal Anxiety Screening Scale (PASS) among antenatal and postnatal women. BMC Pregnancy Childbirth 2020; 20:758. [PMID: 33276746 PMCID: PMC7716415 DOI: 10.1186/s12884-020-03451-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 11/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety among women in the perinatal period is common. Assessing the severity of perinatal anxiety will help monitor the progress of the patient through the stages of anxiety and facilitated the treatment. This study assesses the validity and reliability of the "Perinatal Anxiety Screening Scale" (PASS) in the Arabic language. METHODS The PASS was translated into Arabic. Two hundred seventeen women in the antenatal and postnatal phase participated (92 antenatal and 125 postnatal) answered to PASS, GHQ12, EPDS-10, and DASS-21. Content validity, factor analysis, internal consistency, and test retest reliability were assessed. RESULTS Content Validity Index (CVI) and Content Validity Ratio (CVR) were .88 and 0.79; respectively. The scale loaded on four components: acute anxiety, social anxiety, and dissociation; specific fears and trauma; general anxiety and adjustment; and perfectionism and control. Cronbach's Alpha value for the scale was 0.78 and test retest correlation coefficient was 0.94. PASS significantly correlated with EPDS-10 (rho=0.46), GHQ-12(rho=0.58), the three components of DASS-21 (0.47, 0.50, and 0.43; respectively), and experiencing adverse life events. CONCLUSION The Arabic translated version of the PASS showed reasonably adequate validity and reliability and can be used to screen for anxiety disorder among women in the perinatal phase.
Collapse
Affiliation(s)
- Hoda Jradi
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. .,College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Mail code 2350, 11426, Riyadh, Saudi Arabia.
| | - Thikrayat Alfarhan
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Mail code 2350, 11426, Riyadh, Saudi Arabia
| | - Anas Alsuraimi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| |
Collapse
|
14
|
Anjara SG, Bonetto C, Van Bortel T, Brayne C. Using the GHQ-12 to screen for mental health problems among primary care patients: psychometrics and practical considerations. Int J Ment Health Syst 2020; 14:62. [PMID: 32793301 PMCID: PMC7418321 DOI: 10.1186/s13033-020-00397-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/04/2020] [Indexed: 10/28/2022] Open
Abstract
Background This study explores the factor structure of the Indonesian version of the GHQ-12 based on several theoretical perspectives and determines the threshold for optimum sensitivity and specificity. Through a focus group discussion, we evaluate the practicality of the GHQ-12 as a screening tool for mental health problems among adult primary care patients in Indonesia. Methods This is a prospective study exploring the construct validity, criterion validity and reliability of the GHQ-12, conducted with 676 primary care patients attending 28 primary care clinics randomised for participation in the study. Participants' GHQ-12 scores were compared with their psychiatric diagnosis based on face-to-face clinical interviews with GPs using the CIS-R. Exploratory and Confirmatory Factor Analyses determined the construct validity of the GHQ-12 in this population. The appropriate threshold score of the GHQ-12 as a screening tool in primary care was determined using the receiver operating curve. Prior to data collection, a focus group discussion was held with research assistants who piloted the screening procedure, GPs, and a psychiatrist, to evaluate the practicality of embedding screening within the routine clinic procedures. Results Of all primary care patients attending the clinics during the recruitment period, 26.7% agreed to participate (676/2532 consecutive patients approached). Their median age was 46 (range 18-82 years); 67% were women. The median GHQ-12 score for our primary care sample was 2, with an interquartile range of 4. The internal consistency of the GHQ-12 was good (Cronbach's α = 0.76). Four factor structures were fitted on the data. The GHQ-12 was found to best fit a one-dimensional model, when response bias is taken into consideration. Results from the ROC curve indicated that the GHQ-12 is 'fairly accurate' when discriminating primary care patients with indication of mental disorders from those without, with average AUC of 0.78. The optimal threshold of the GHQ-12 was either 1/2 or 2/3 point depending on the intended utility, with a Positive Predictive Value of 0.68 to 0.73 respectively. The screening procedure was successfully embedded into routine patient flow in the 28 clinics. Conclusions The Indonesian version of the GHQ-12 could be used to screen primary care patients at high risk of mental disorders although with significant false positives if reasonable sensitivity is to be achieved. While it involves additional administrative burden, screening may help identify future users of mental health services in primary care that the country is currently expanding.
Collapse
Affiliation(s)
- S G Anjara
- Cambridge Institute of Public Health, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Forvie Site, Robinson Way, Box 113, Cambridge, CB2 0SR UK
| | - C Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy
| | - T Van Bortel
- Cambridge Institute of Public Health, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Forvie Site, Robinson Way, Box 113, Cambridge, CB2 0SR UK
| | - C Brayne
- Cambridge Institute of Public Health, University of Cambridge, School of Clinical Medicine, Cambridge Biomedical Campus, Forvie Site, Robinson Way, Box 113, Cambridge, CB2 0SR UK
| |
Collapse
|
15
|
Gelabert E, Gutierrez-Zotes A, Navines R, Labad J, Puyané M, Donadon MF, Guillamat R, Mayoral F, Jover M, Canellas F, Gratacós M, Guitart M, Gornemann I, Roca M, Costas J, Ivorra JL, Subirà S, de Diego Y, Osorio FL, Garcia-Esteve L, Sanjuan J, Vilella E, Martin-Santos R. The role of personality dimensions, depressive symptoms and other psychosocial variables in predicting postpartum suicidal ideation: a cohort study. Arch Womens Ment Health 2020; 23:585-593. [PMID: 31802248 DOI: 10.1007/s00737-019-01007-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/07/2019] [Indexed: 12/14/2022]
Abstract
Suicidability has been associated with neuroticism and psychoticism, but its role during perinatal period has not been analyzed. We explore the association between personality dimensions, depressive symptoms, and other psychosocial variables in postpartum suicidal ideation. A cohort of 1795 healthy Spanish women from the general population was assessed for suicidal ideation (EPDS-Item10) in early postpartum, 8 and 32 weeks postpartum. Sociodemographic, obstetric, and reproductive variables, psychiatric history, social support, stressful life-events during pregnancy, depressive symptoms (EPDS), and the Eysenck's personality dimensions (EPQ-RS) were also assessed at baseline. A major depressive episode (DSM-IV) was confirmed in women with EPDS>10 at follow-up assessments. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted logistic regression analysis was reported as odds ratio (ORs) with 95% confidence intervals (CIs). Seven percent of mothers reported suicidal ideation during the first 8 months postpartum. Sixty-two percent of women with suicidal ideation had a major depressive episode at 8 weeks, and 70% at 32 weeks postpartum. Neuroticism and psychoticism predicted suicidal ideation throughout the first 2 weeks after delivery (OR, 1.03; 95%CI 1.01-1.06; and OR, 1.03; 95%CI 1.01-1.05 respectively). Early postpartum depressive symptoms (OR 1.2; 95%CI 1.11-1.26), personal psychiatric history (OR 2.1; 95%CI 1.33-3.27), and stressful life events during pregnancy (OR 1.88; 95%CI 1.12-3.16) also emerged as predictors of postpartum suicidal ideation. Analysis of women for postpartum suicidal ideation should include not only psychiatric symptoms but also psychosocial assessment (i.e., covering psychiatric history, stressful events, or long-standing personality vulnerabilities) in order to identify those in need of early psychosocial or psychiatric care.
Collapse
Affiliation(s)
- E Gelabert
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - A Gutierrez-Zotes
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - R Navines
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - J Labad
- Parc Taulí Hospital Universitario, Instituto de Investigación Sanitaria Parc Taulí (I3PT), UAB, CIBERSAM, Sabadell, Spain
| | - M Puyané
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - M F Donadon
- Department of Neuroscience and Behavior, Ribeirão Preto, University of São Paulo, National Institute for Science and Technology (INCT-TM, CNPq, Brazil), São Paulo, Brazil
| | - R Guillamat
- Departamento de Psiquiatria, Departamento de Salud Mental, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - F Mayoral
- Instituto de Investigación Biomédica de Málaga (IBIMA) and Hospital Universitario Regional de Málaga, UGC Salud Mental, España, Málaga, Spain
| | - M Jover
- Hospital Clinic, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - F Canellas
- Institut Universitari d'Investigació en Ciències de la Salut, Red en Asistencia Primaria (RediAPP), Hospital de Son Dureta, Palma de Mallorca, Spain
| | - M Gratacós
- Centro de Regulación Genómica (CRG) y UPF, Barcelona, Spain
| | - M Guitart
- Parc Taulí Hospital Universitario, Instituto de Investigación Sanitaria Parc Taulí (I3PT), UAB, CIBERSAM, Sabadell, Spain
| | - I Gornemann
- Instituto de Investigación Biomédica de Málaga (IBIMA) and Hospital Universitario Regional de Málaga, UGC Salud Mental, España, Málaga, Spain
| | - M Roca
- Institut Universitari d'Investigació en Ciències de la Salut, Red en Asistencia Primaria (RediAPP), Hospital de Son Dureta, Palma de Mallorca, Spain
| | - J Costas
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Servizo Galego de Saúde (SERGAS), Complexo Hospitalario Universitario de Santiago (CHUS), Galicia, Spain
| | - J L Ivorra
- Hospital Clinic, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - S Subirà
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Y de Diego
- Instituto de Investigación Biomédica de Málaga (IBIMA) and Hospital Universitario Regional de Málaga, UGC Salud Mental, España, Málaga, Spain
| | - F L Osorio
- Department of Neuroscience and Behavior, Ribeirão Preto, University of São Paulo, National Institute for Science and Technology (INCT-TM, CNPq, Brazil), São Paulo, Brazil
| | - L Garcia-Esteve
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - J Sanjuan
- Hospital Clinic, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - E Vilella
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - R Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain.
- Department of Neuroscience and Behavior, Ribeirão Preto, University of São Paulo, National Institute for Science and Technology (INCT-TM, CNPq, Brazil), São Paulo, Brazil.
| |
Collapse
|
16
|
Grussu P, Andreetto I, Pastore M, Calcagnì A, Quatraro RM. Perinatal psychological well-being in women with zero postnatal anxiety-depressive symptoms scores: a retrospective descriptive study. J Reprod Infant Psychol 2020; 38:199-213. [PMID: 32064910 DOI: 10.1080/02646838.2020.1724915] [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] [Indexed: 12/16/2022]
Abstract
Background: A total absence of psychological symptoms during pregnancy or postpartum period is not common. Although there are some considerations on zero scores detected by EPDS, no thorough analysis is currently present in the literature of the eventuality and meaning of a total absence of postpartum symptoms following the compilation of two or more self-report symptom questionnaires.Methods: In a sample of 960 Italian women, three groups of 31 subjects are defined retrospectively by scores on the EPDS-GHQ12: women with 'zero', 'lower', and 'higher' postnatal symptomatology. The psychological well-being of these groups was compared as detected in pregnancy and after childbirth by PWB questionnaire.Results: Higher and excessive scores in Environmental mastery dimension connote the profile of women with a total absence of postpartum anxiety-depression symptoms. Positive relations with other dimension were less characterising, but it should be noted as a distinctive trait in the 'zero' symptoms postnatal symptomatology group. In the same 'zero' group, the scores of the six PWB questionnaire dimensions - except Personal growth - are all higher than the scores obtained by women in the general population.Conclusion: The atypical self-reported perinatal mood condition present in the 'zero' symptoms group have currently unknown clinical significance.
Collapse
Affiliation(s)
- Pietro Grussu
- Consultorio Familiare Service, Azienda ULSS 6 Euganea, National Health Service, Este, Italy
| | - Irene Andreetto
- Consultorio Familiare Service, Azienda ULSS 6 Euganea, National Health Service, Este, Italy
| | - Massimiliano Pastore
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
| | - Antonio Calcagnì
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
| | - Rosa Maria Quatraro
- Hospital Psychology Unit, Obstetrics and Gynaecology Section, Azienda ULSS 8 Berica, National Health Service, Este, Italy
| |
Collapse
|
17
|
Costs and Burden Associated With Loss of Labor Productivity in Informal Caregivers of People With Dementia: Results From Spain. J Occup Environ Med 2019; 60:449-456. [PMID: 29135840 DOI: 10.1097/jom.0000000000001229] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS We analyzed indirect costs related to loss of labor productivity (LLP) in informal caregivers (ICs) of people with dementia (PwD) and the associated caregiver burden and patients' clinical variables. METHODS Multicenter cohort study of PwD and their ICs (n = 287) focused on two groups: (1) home care and (2) institutional long-term care. The costs of LLP were assessed using the Resource Utilization Dementia instrument and a human capital approach. RESULTS The cost for LLP was 378&OV0556;/month or 4.536&OV0556;/year. Greater disease severity increased the likelihood of reducing working hours and missing a working day. There was a significant association between partial absenteeism and burden in employed informal caregiver in both the home and institutional setting. CONCLUSION Cognitive impairment contributes to the cost of LLP in IC especially in home-care. LLP has a negative impact on IC burden.
Collapse
|
18
|
van der Zee-van den Berg AI, Boere-Boonekamp MM, Groothuis-Oudshoorn CGM, Reijneveld SA. The Edinburgh Postpartum Depression Scale: Stable structure but subscale of limited value to detect anxiety. PLoS One 2019; 14:e0221894. [PMID: 31498818 PMCID: PMC6733480 DOI: 10.1371/journal.pone.0221894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/17/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The Edinburgh Postnatal Depression Scale (EPDS) aims at detecting postpartum depression. It has been hypothesized that a subscale (items 3, 4, 5) may detect anxiety. The aim of this study is to assess whether this EPDS anxiety subscale is present in a community-based dataset, and if so, to assess its validity and stability during the first six months postpartum. METHODS We obtained EPDS data of a community sample of 1612 women at 1 month, with follow-up at 3 and 6 months, postpartum (Post-Up study). We performed an exploratory factor analysis on the EPDS forcing two- and three-factor solutions. We assessed the correlations of the extracted factor subscales and the total EPDS with the short-form of the STAI (STAI-6). We examined the stability of the identified factors by means of a confirmatory factor analysis (CFA), using the EPDS data collected at 3 and 6 months postpartum. RESULTS Both the two- and three-factor solutions contained a hypothesized anxiety subscale of items 3,4,5,10, and fitted well with the 3- and 6-months EPDS data, with CFI and TLI values >.99 and RMSEA and SRMR values < .035 and < .45. The subscale's Pearson correlations with the STAI-6 were moderate: .516, compared to .643 for the total EPDS. CONCLUSIONS The factor structure of the EPDS is stable across the first six months postpartum, and includes the subscale assumed to represent anxiety. However, this subscale as well as the total EPDS correlate only moderately with anxiety criteria. Using the EPDS thus does not imply adequate screening for anxiety.
Collapse
Affiliation(s)
| | - Magda M. Boere-Boonekamp
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | | | - Sijmen A. Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
19
|
Krzeczkowski JE, Lau A, Fitzpatrick J, Tamana S, Smithson L, de Souza R, Kozyrskyj AL, Lefebvre D, Becker AB, Subbarao P, Turvey SE, Pei J, Schmidt LA, Sears MR, Van Lieshout RJ, Mandhane PJ. Maternal Metabolic Complications in Pregnancy and Offspring Behavior Problems at 2 Years of Age. Matern Child Health J 2019; 23:746-755. [PMID: 30600520 DOI: 10.1007/s10995-018-2691-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives Prenatal maternal metabolic problems such as pre-pregnancy adiposity, excess gestational weight gain, and gestational diabetes mellitus (GDM) are associated with an increased risk of psychopathology in offspring. We examined whether these exposures were linked to symptoms of emotional and behavioral problems in offspring at 2 years of age, or if associations were due to confounding variables. Methods Data from 815 mother-child pairs enrolled at the Edmonton site of the Canadian Healthy Infant Longitudinal Development cohort were used to examine associations between gestational metabolic complications and scores on the externalizing and internalizing scales of the Child Behavior Checklist (CBCL-1½ to 5) at age two. Associations between maternal metabolic complications and offspring psychopathology were assessed before and after adjustment for gestational diet, socioeconomic status (SES), postpartum depression (PPD), prenatal smoking and breastfeeding. Results Pre-pregnancy body mass index and GDM, but not gestational weight gain, predicted more offspring externalizing and internalizing problems. However, after adjustment for confounding variables, these associations were no longer statistically significant. Post-hoc analyses revealed that gestational diet accounted for unique variance in both externalizing (semi-partial rdiet = - 0.20, p < 0.001) and internalizing (semi-partial rdiet = - 0.16, p = 0.01) problems. PPD and SES also accounted for a similar amount of variance for both externalizing (semi-partial rPPD = 0.17, p < 0.001; rses = - 0.11, p = 0.03) and internalizing problems (semi-partial rPPD = 0.21, p < 0.001; rses = - 0.14, p = 0.004). Conclusions for Practice Since the confounding effect of gestational diet persisted after adjustment for, and was similar in magnitude to, SES and PPD, future research should consider the impact of unhealthy prenatal diets on offspring neurodevelopment.
Collapse
Affiliation(s)
| | - Amanda Lau
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Sukhpreet Tamana
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Lisa Smithson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Russell de Souza
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Diana Lefebvre
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Allan B Becker
- Manitoba Institute of Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, AB, Canada
| | - Louis A Schmidt
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. .,Department of Pediatrics, 4-590 Edmonton Clinic Health Academy (ECHA), University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | | |
Collapse
|
20
|
Mu TY, Li YH, Pan HF, Zhang L, Zha DH, Zhang CL, Xu RX. Postpartum depressive mood (PDM) among Chinese women: a meta-analysis. Arch Womens Ment Health 2019; 22:279-287. [PMID: 29980903 DOI: 10.1007/s00737-018-0885-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/25/2018] [Indexed: 01/29/2023]
Abstract
Postpartum depression is a common complication of childbearing and up to 12 months postpartum. This study aimed to determine the prevalence of postpartum depressive mood (PDM) in China by performing a meta-analysis of published studies. Studies that reported the prevalence of PDM in China were identified by searching the PubMed, Embase, CNKI, and CQVIP databases. Three thousand, one hundred, and two articles were obtained, and after careful evaluation, 26 studies were finally included in the meta-analysis. The combined studies included a total of 7618 cases with 1621 cases of PDM. The studies were assessed on the basis of heterogeneity testing and the potential for publication bias. Stata software 11.0 was used to perform the meta-analysis. The random-effect model showed that the prevalence of PDM was 21% with a 95% confidence interval (CI) of 17-25%. PDM was the highest 0 to 1.5 months after delivery. PDM levels decreased to 10.4% (95% CI 9.7-11.1%, P < 0.001) after publication bias were corrected. Sensitivity analyses evaluated the stability of our results and showed no significant change when any single study was excluded. Subgroup analyses showed that region, instruments used, cut-off score, and time points for depression assessment were positively associated with PDM prevalence. The prevalence of PDM differed among regions, with South Central China and East China exhibiting the lowest prevalence. The prevalence was higher in regions with poor economic development, suggesting that more attention should be devoted to Southwest and North China and that the prevalence of PDM should be evaluated 0 to 1.5 months after delivery.
Collapse
Affiliation(s)
- Ting-Yu Mu
- Nursing College of Anhui Medical University, Feicui Road, Jingkai District, Hefei, 230032, Anhui Province, People's Republic of China
| | - Yu-Hong Li
- Nursing College of Anhui Medical University, Feicui Road, Jingkai District, Hefei, 230032, Anhui Province, People's Republic of China.
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| | - Liu Zhang
- Nursing College of Anhui Medical University, Feicui Road, Jingkai District, Hefei, 230032, Anhui Province, People's Republic of China
| | - Da-Hui Zha
- Nursing College of Anhui Medical University, Feicui Road, Jingkai District, Hefei, 230032, Anhui Province, People's Republic of China
| | - Cheng-Lu Zhang
- Nursing College of Anhui Medical University, Feicui Road, Jingkai District, Hefei, 230032, Anhui Province, People's Republic of China
| | - Ri-Xiang Xu
- School of Pharmacy, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China
| |
Collapse
|
21
|
Chandrasekaran N, De Souza LR, Urquia ML, Young B, Mcleod A, Windrim R, Berger H. Is anemia an independent risk factor for postpartum depression in women who have a cesarean section? - A prospective observational study. BMC Pregnancy Childbirth 2018; 18:400. [PMID: 30314455 PMCID: PMC6186102 DOI: 10.1186/s12884-018-2032-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The symptoms of anemia and depression are very similar suggesting that there may be an association between the two entities. The aim of this study is to assess whether postpartum anemia (PPA) is an independent risk factor for de novo postpartum depression (PPD)in women undergoing elective cesarean section. METHODS Women after an uncomplicated term cesarean section were recruited and their hemoglobin and iron status were measured on day 3-5 post section and again at 6 weeks. Postpartum depression was screened using the Edinburgh Postnatal Depression Scale (EPDS) and functional capacity was assessed with the RAND 12-item Health survey. RESULTS One hundred and three women completed the study. The incidence of probable postpartum depression (PPD) as defined by EPDS score ≥ 10 was 17% at 6 weeks. There was no difference in hemoglobin or iron status in women who had PPD compared to those without (OR-0.69; 95% CI-0.15-2.49). Similarly, there was no significant association between low hemoglobin and maternal functional status (OR -1.03; 95% CI-0.34 - 2.94). CONCLUSIONS Neither anemia or low iron stores were found to be an independent risk factors for postpartum depression or decreased postpartum functional capacity in women who undergo an elective cesarean section.
Collapse
Affiliation(s)
- Nirmala Chandrasekaran
- Department of Maternal and Fetal Medicine, St Michaels Hospital, 30 Bond street, Toronto, ON, M5B 1W8, Canada.
| | - Leanne R De Souza
- Department of Maternal and Fetal Medicine, St Michaels Hospital, 30 Bond street, Toronto, ON, M5B 1W8, Canada
| | - Marcelo L Urquia
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
| | - Beverley Young
- Perinatal Mental Health Program, Mount Sinai Hospital, Toronto, Canada
| | | | | | - Howard Berger
- Department of Maternal and Fetal Medicine, St Michaels Hospital, 30 Bond street, Toronto, ON, M5B 1W8, Canada
| |
Collapse
|
22
|
The structure of the Patient Health Questionnaire-9 in pregnant women in Spain. Midwifery 2018; 62:36-41. [DOI: 10.1016/j.midw.2018.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/08/2018] [Accepted: 03/15/2018] [Indexed: 01/30/2023]
|
23
|
Wall V, Premji SS, Letourneau N, McCaffrey G, Nyanza EC. Factors associated with pregnancy-related anxiety in Tanzanian women: a cross sectional study. BMJ Open 2018; 8:e020056. [PMID: 29866722 PMCID: PMC5988139 DOI: 10.1136/bmjopen-2017-020056] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 03/13/2018] [Accepted: 04/12/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To identify factors predictive of pregnancy-related anxiety (PRA) among women in Mwanza, Tanzania. DESIGN A cross-sectional study was used to explore the relationship between psychosocial health and preterm birth. SETTING Antenatal clinics in the Ilemela and Nyamagana districts of Mwanza, Tanzania. PARTICIPANTS Pregnant women less than or equal to 32 weeks' gestational age (n=212) attending the two antenatal clinics. MEASURES PRA was measured using a revised version of the 10-item PRA Questionnaire (PRA-Q). Predictive factors included social support (Multidimensional Scale of Perceived Social Support), stress (Perceived Stress Scale), depression (Edinburg Postpartum Depression Scale) and sociodemographic data. Bivariate analysis permitted variable selection while multiple linear regression analysis enabled identification of predictive factors of PRA. RESULTS Twenty-five per cent of women in our sample scored 13 or higher (out of a possible 30) on the PRA-Q. Perceived stress, active depression and number of people living in the home were the only statistically significant predictors of PRA in our sample. CONCLUSIONS Our findings were contrary to most current literature which notes socioeconomic status and social support as significant factors in PRA. A greater understanding of the experience of PRA and its predictive factors is needed within the social cultural context of low/middle-income countries to support the development of PRA prevention strategies specific to low/middle income countries.
Collapse
Affiliation(s)
- Vanessa Wall
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Shahirose Sadrudin Premji
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, Psychiatry and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Graham McCaffrey
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Elias Charles Nyanza
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- School of Public Health, Catholic University of Health and Allied Sciences, Bugando Area, Mwanza, Tanzania
| |
Collapse
|
24
|
Farré-Sender B, Torres A, Gelabert E, Andrés S, Roca A, Lasheras G, Valdés M, Garcia-Esteve L. Mother-infant bonding in the postpartum period: assessment of the impact of pre-delivery factors in a clinical sample. Arch Womens Ment Health 2018; 21:287-297. [PMID: 29046965 DOI: 10.1007/s00737-017-0785-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 10/03/2017] [Indexed: 11/30/2022]
Abstract
This study aims to examine the extent to which a variety of pre-delivery factors (demographic, reproductive, psychological, psychiatric, and psychopathological) predict disturbances in mother-infant bonding (MIB) in the postpartum period. Two hundred fifty-one pregnant women enrolled at a public perinatal psychiatric service were assessed between the first and second trimester of pregnancy and at 6-7 weeks after delivery. During pregnancy, the psychological risk factors were assessed with the Vulnerable Personality Style Questionnaire, the Marital Adjustment Scale, the Early Trauma Inventory, and the General Health Questionnaire. To detect psychopathology, the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory were used. At the postpartum evaluation, MIB was measured by the Postpartum Bonding Questionnaire. The results of the final regression model showed that emotional abuse in childhood, family psychiatric history, previous psychiatric hospitalization, and anxiety during pregnancy were significant predictors of MIB disturbances in postpartum, explaining 10.7% of the variance. The evaluation of women's risk factors in pregnancy is important in order to prevent MIB disturbances and thus to ensure the welfare of mothers and their babies.
Collapse
Affiliation(s)
- Borja Farré-Sender
- Perinatal Psychiatry Program, Department of Psychiatry and Clinical Psychology, Hospital Clinic, C/ Sabino de Arana 1, 08028, Barcelona, Spain. .,Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain.
| | - Anna Torres
- Perinatal Psychiatry Program, Department of Psychiatry and Clinical Psychology, Hospital Clinic, C/ Sabino de Arana 1, 08028, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Vulnerability, Psychopathology and Gender research group (SGR2014/1411), Generalitat de Catalunya, Catalonia, Spain.,Department of Psychiatry and Clinical Psychology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Estel Gelabert
- Neuropsychopharmacology Programme, IMIM-Hospital del Mar, Barcelona, Spain
| | - Susana Andrés
- Perinatal Psychiatry Program, Department of Psychiatry and Clinical Psychology, Hospital Clinic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
| | - Alba Roca
- Perinatal Psychiatry Program, Department of Psychiatry and Clinical Psychology, Hospital Clinic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
| | - Gracia Lasheras
- Department of Psychiatry, Psychology and Psychosomatics, Dexeus University Hospital, Barcelona, Spain
| | - Manuel Valdés
- Vulnerability, Psychopathology and Gender research group (SGR2014/1411), Generalitat de Catalunya, Catalonia, Spain.,Department of Psychiatry and Clinical Psychology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Lluïsa Garcia-Esteve
- Perinatal Psychiatry Program, Department of Psychiatry and Clinical Psychology, Hospital Clinic, C/ Sabino de Arana 1, 08028, Barcelona, Spain.,Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Vulnerability, Psychopathology and Gender research group (SGR2014/1411), Generalitat de Catalunya, Catalonia, Spain
| |
Collapse
|
25
|
Loughnan SA, Newby JM, Haskelberg H, Mahoney A, Kladnitski N, Smith J, Black E, Holt C, Milgrom J, Austin MP, Andrews G. Internet-based cognitive behavioural therapy (iCBT) for perinatal anxiety and depression versus treatment as usual: study protocol for two randomised controlled trials. Trials 2018; 19:56. [PMID: 29357918 PMCID: PMC5778736 DOI: 10.1186/s13063-017-2422-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/18/2017] [Indexed: 11/16/2022] Open
Abstract
Background We aimed to evaluate the acceptability and efficacy of two brief, Internet-delivered cognitive behavioural therapy interventions—MUMentum Pregnancy (study 1) and MUMentum Postnatal (study 2)—in reducing maternal symptoms of anxiety, depression and overall psychological distress compared to usual care in the perinatal period. Methods/Design Women who are pregnant (study 1) or < 12 months postpartum (study 2) with current clinically elevated symptoms of anxiety and/or depression according to validated self-report measures, will be recruited via the research arm of a not-for-profit clinical and research unit in Australia and randomised to the intervention group or treatment as usual control group. The minimum sample size for each study (alpha 0.05; power 0.80 for a g of 0.80) was identified as 50 with at least 10% more to be recruited to account for expected attrition. The co-primary outcome measures are the Patient Health Questionnaire 9-item scale and Generalised Anxiety Disorder 7-item scale to measure depression and anxiety symptom severity, respectively, and will be administered at the following primary time-points: baseline; post treatment; and at one-month follow-up. Psychological distress will be measured according to the Kessler-10 psychological distress scale at each primary time-point and will also be completed before each lesson for those in the intervention group. The total trial period nine weeks for study 1 and 11 weeks for study 2. Program efficacy will be determined using intent-to-treat mixed models. Maintenance of gains will be assessed at one-month follow-up. Discussion The current randomised controlled trial seeks to extend the literature by evaluating the efficacy of a self-help intervention for women in the perinatal period. If efficacious, the MUMentum programs have the potential to be easily disseminated via https://thiswayup.org.au/ to large numbers of women across Australia as an intervention for women screening positive for anxiety, depressive or distress symptoms during pregnancy or postpartum. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616000560493; ACTRN12616000559415. Registered on 2nd May 2016. Electronic supplementary material The online version of this article 10.1186/s13063-017-2422-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Siobhan A Loughnan
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent's Hospital, Level 4, O'Brien Centre, St Vincent's Hospital, 394 Victoria Street, Sydney, NSW, 2010, Australia.
| | - Jill M Newby
- School of Psychology, Faculty of Science, UNSW Sydney, 1302 Mathews Building, Kensington, NSW, 2052, Australia
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent's Hospital, Level 4, O'Brien Centre, St Vincent's Hospital, 394 Victoria Street, Sydney, NSW, 2010, Australia
| | - Alison Mahoney
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent's Hospital, Level 4, O'Brien Centre, St Vincent's Hospital, 394 Victoria Street, Sydney, NSW, 2010, Australia
| | - Natalie Kladnitski
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent's Hospital, Level 4, O'Brien Centre, St Vincent's Hospital, 394 Victoria Street, Sydney, NSW, 2010, Australia
| | - Jessica Smith
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent's Hospital, Level 4, O'Brien Centre, St Vincent's Hospital, 394 Victoria Street, Sydney, NSW, 2010, Australia
| | - Emma Black
- Perinatal & Women's Mental Health Unit, c/o St John of God Hospital, 13 Grantham Street, Burwood, NSW, 2134, Australia
| | - Christopher Holt
- Parent-Infant Research Institute (PIRI) and Melbourne School of Psychological Science, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, VIC, 3081, Australia
| | - Jeannette Milgrom
- Parent-Infant Research Institute (PIRI) and Melbourne School of Psychological Science, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, VIC, 3081, Australia
| | - Marie-Paule Austin
- Perinatal & Women's Mental Health Unit, c/o St John of God Hospital, 13 Grantham Street, Burwood, NSW, 2134, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW School of Psychiatry at St Vincent's Hospital, Level 4, O'Brien Centre, St Vincent's Hospital, 394 Victoria Street, Sydney, NSW, 2010, Australia
| |
Collapse
|
26
|
Van Droogenbroeck F, Spruyt B, Keppens G. Gender differences in mental health problems among adolescents and the role of social support: results from the Belgian health interview surveys 2008 and 2013. BMC Psychiatry 2018; 18:6. [PMID: 29320999 PMCID: PMC5763832 DOI: 10.1186/s12888-018-1591-4] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/04/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To investigate how social support relates to mental health problems for Belgian late adolescents and young adults 15-25 years of age. Additionally, we examine changes in mental health problems between 2008 and 2013 and investigate gender differences. METHODS Multivariate analysis of variance was used to investigate (1) psychological distress, (2) anxiety and (3) depression among 713 boys and 720 girls taken from two successive waves (2008 and 2013) of a representative sample of the Belgian population (Belgian Health Interview survey). Psychological distress was measured by the General Health Questionnaire, anxiety and depression by the Symptom Check-List-90-Revised. RESULTS Gender differences were found for psychological distress, anxiety and depression with girls reporting significantly higher scores than boys. Multivariate analysis of variance (MANOVA) revealed that adolescents who are dissatisfied with their social contacts and experience poor social support reported more psychological distress, anxiety and depression. In addition, young adult boys (20-25 years of age) were more likely to experience psychological distress when compared to late adolescent boys (15-19 years of age). Finally, the prevalence of anxiety and depression increased substantially between 2008 and 2013 for girls and to a lesser extent for boys. CONCLUSIONS Especially girls and young people with poor social support experience mental health problems more frequently than boys and those with strong social support. Improving social support among young people may serve as a protective buffer to mental health problems.
Collapse
Affiliation(s)
| | - Bram Spruyt
- Sociology Department, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussel, Belgium
| | - Gil Keppens
- Sociology Department, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussel, Belgium
| |
Collapse
|
27
|
Webb R, Ayers S, Rosan C. A systematic review of measures of mental health and emotional wellbeing in parents of children aged 0-5. J Affect Disord 2018; 225:608-617. [PMID: 28889046 DOI: 10.1016/j.jad.2017.08.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/15/2017] [Accepted: 08/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A significant proportion of women with young children experience mental health problems and recent research suggests fathers may also be affected. This may have a long term negative impact on the child's development with significant costs to society. Appropriate measures are therefore needed to identify parents and children at risk. METHOD This literature review aimed to identify the most reliable, evidence based global measures of mental health for parents of infants from pregnancy to 5 years postpartum (0-5 years). Literature searches were conducted on online databases and hand searches of reference lists were also carried out. Studies were included in the review if they reported information on measures of global psychological distress or wellbeing from 0 to 5 years postpartum. RESULTS A total of 183 studies were included in the review, 19 of which directly examined the psychometric validity of an outcome measure. These studies reported information on 23 outcome measures, 4 of which had been validated in parents of children from 1 to 5. These were: the General Health Questionnaire (GHQ), the Symptom Checklist (SCL), the Self-Reporting Questionnaire (SRQ) and the Kessler scale (K10/6). Reliability and validity varied across studies. LIMITATIONS Only a small number of studies included fathers and examined psychometric validity across the entire period of early childhood. CONCLUSIONS The GHQ was the most frequently validated but results suggest poor reliability and validity. The SRQ and K10/6 were the most promising measures in terms of psychometric properties and clinical utility.
Collapse
Affiliation(s)
- Rebecca Webb
- Centre for Maternal and Child Health Research, City, University of London, EC1V 0HB, United Kingdom
| | - Susan Ayers
- Centre for Maternal and Child Health Research, City, University of London, EC1V 0HB, United Kingdom.
| | - Camilla Rosan
- Development and Delivery Department, Mental Health Foundation, Colechurch House, 1 London Bridge Walk, London SE1 2SX, United Kingdom
| |
Collapse
|
28
|
Ukatu N, Clare CA, Brulja M. Postpartum Depression Screening Tools: A Review. PSYCHOSOMATICS 2017; 59:211-219. [PMID: 29396166 DOI: 10.1016/j.psym.2017.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the accuracy of screening tools in detecting postpartum depression (PPD). METHODS A review of the literature was conducted using PubMed, Clinical Key, and Google Scholar from the years 2001-2016 with a modified PRISMA method. The keywords, "postnatal depression screening," "antenatal depression screening," and "maternal depression" were used in the search. Sixty-eight articles were reviewed, and 36 further analyzed. RESULTS The accuracy of screening tools was dependent upon a number of factors. The studies reviewed differed in the types of screening tools tested, the combination of screening tools administered, the timing in which screening tools were administered, the geographic location of patients screened, and the reference standard(s) used. CONCLUSIONS No tool could be deemed best at accurately detecting PPD on the basis of sensitivity and specificity. Additionally, there was no recommended time duration in which screening should be done. Thus, further research is needed to elucidate the accuracy of PPD screening tools, and the best criteria to determine this.
Collapse
Affiliation(s)
- Nneamaka Ukatu
- School of Medicine, New York Medical College, Valhalla, NY
| | - Camille A Clare
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY.
| | - Mary Brulja
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY
| |
Collapse
|
29
|
Bolton JL, Wiley MG, Ryan B, Truong S, Strait M, Baker DC, Yang NY, Ilkayeva O, O'Connell TM, Wroth SW, Sánchez CL, Swamy G, Newgard C, Kuhn C, Bilbo SD, Simmons LA. Perinatal western-type diet and associated gestational weight gain alter postpartum maternal mood. Brain Behav 2017; 7:e00828. [PMID: 29075574 PMCID: PMC5651398 DOI: 10.1002/brb3.828] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/07/2017] [Accepted: 08/06/2017] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The role of perinatal diet in postpartum maternal mood disorders, including depression and anxiety, remains unclear. We investigated whether perinatal consumption of a Western-type diet (high in fat and branched-chain amino acids [BCAA]) and associated gestational weight gain (GWG) cause serotonin dysregulation in the central nervous system (CNS), resulting in postpartum depression and anxiety (PPD/A). METHODS Mouse dams were fed one of four diets (high-fat/high BCAA, low-fat/high BCAA, high-fat, and low-fat) prior to mating and throughout gestation and lactation. Postpartum behavioral assessments were conducted, and plasma and brain tissues assayed. To evaluate potential clinical utility, we conducted preliminary human studies using data from an extant sample of 17 primiparous women with high GWG, comparing across self-reported postpartum mood symptoms using the Edinburgh Postnatal Depression Scale (EPDS) for percent GWG and plasma amino acid levels. RESULTS Mouse dams fed the high-fat/high BCAA diet gained more weight per kcal consumed, and BCAA-supplemented dams lost weight more slowly postpartum. Dams on BCAA-supplemented diets exhibited increased PPD/A-like behavior, decreased dopaminergic function, and decreased plasma tyrosine and histidine levels when assessed on postnatal day (P)8. Preliminary human data showed that GWG accounted for 29% of the variance in EPDS scores. Histidine was also lower in women with higher EPDS scores. CONCLUSIONS These findings highlight the role of perinatal diet and excess GWG in the development of postpartum mood disorders.
Collapse
Affiliation(s)
- Jessica L Bolton
- Department of Psychology and Neuroscience Duke University Durham NC USA
| | - Melanie G Wiley
- Department of Psychology and Neuroscience Duke University Durham NC USA
| | - Bailey Ryan
- Department of Psychology and Neuroscience Duke University Durham NC USA
| | - Samantha Truong
- Department of Psychology and Neuroscience Duke University Durham NC USA
| | | | | | | | - Olga Ilkayeva
- Duke Molecular Physiology Institute Duke University School of Medicine Durham NC USA
| | - Thomas M O'Connell
- Duke Molecular Physiology Institute Duke University School of Medicine Durham NC USA
| | | | - Cristina L Sánchez
- Department of Pharmacology and Cancer Biology Duke University School of Medicine Durham NC USA
| | - Geeta Swamy
- Department of Obstetrics and Gynecology Duke University School of Medicine Durham NC USA
| | - Christopher Newgard
- Duke Molecular Physiology Institute Duke University School of Medicine Durham NC USA.,Department of Pharmacology and Cancer Biology Duke University School of Medicine Durham NC USA
| | - Cynthia Kuhn
- Department of Pharmacology and Cancer Biology Duke University School of Medicine Durham NC USA
| | - Staci D Bilbo
- Department of Psychology and Neuroscience Duke University Durham NC USA
| | | |
Collapse
|
30
|
Ahmed A, Bowen A, Feng CX. Maternal depression in Syrian refugee women recently moved to Canada: a preliminary study. BMC Pregnancy Childbirth 2017; 17:240. [PMID: 28738869 PMCID: PMC5525250 DOI: 10.1186/s12884-017-1433-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 07/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Refugee women are almost five times more likely to develop postpartum depression than Canadian-born women. This can be attributed to various difficulties they faced before coming to Canada as well as during resettlement. Moreover, refugee women usually face many obstacles when accessing health services, including language and cultural barriers, as well as unique help-seeking behaviors that are influenced by various cultural and practical factors. There has been a recent, rapid influx of Syrian refugees to Canada, and many of them are childbearing women. However, little is known about the experiences that these women have encountered pre- and post-resettlement, and their perceptions of mental health issues. Thus, there is an urgent need to understand refugee women's experiences of having a baby in Canada from a mental health perspective. METHODS A mixed methods research design included 12 Syrian refugee women who migrated to Saskatoon in 2015-16 and who were either pregnant or 1 year postpartum. The data were collected during a single focus group discussion and a structured questionnaire. RESULTS Our results showed that more than half of participants have depressive symptoms, half of them have anxiety symptoms, and one sixth have PTSD symptoms. Three major themes emerged from the qualitative data: 1) Understanding of maternal depression; 2) Protective factors for mental health; and 3) Barriers to mental health services. CONCLUSIONS Maternal depression is an important feature in Syrian refugee women recently resettled in Canada. Reuniting these women with their families and engaging them in culturally appropriate support programs may improve their mental health outcomes.
Collapse
Affiliation(s)
- Asma Ahmed
- School of Public Health, University of Saskatchewan, Saskatoon, Canada
| | - Angela Bowen
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Health Sciences Building, Room 4246, Saskatoon, SK, S7N 2Z4, Canada.
| | - Cindy Xin Feng
- School of Public Health, University of Saskatchewan, 104 Clinic Place, Health Sciences Building, Room 3338, Saskatoon, SK, S7N 2Z4, Canada
| |
Collapse
|
31
|
|
32
|
Fisher SD, Wisner KL, Clark CT, Sit DK, Luther JF, Wisniewski S. Factors associated with onset timing, symptoms, and severity of depression identified in the postpartum period. J Affect Disord 2016; 203:111-120. [PMID: 27285724 DOI: 10.1016/j.jad.2016.05.063] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/25/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Unipolar and bipolar depression identified in the postpartum period have a heterogeneous etiology. The objectives of this study are to examine the risk factors that distinguish the timing of onset for unipolar and bipolar depression and the associations between depression onset by diagnosis, and general and atypical depressive symptoms. METHODS Symptoms of depression were assessed at 4- to 6-weeks postpartum by the Structured Interview Guide for the Hamilton Depression Rating Scale-Atypical Depression Symptoms in an obstetrical sample of 727 women. Data were analyzed using ANOVA, Chi-square, and linear regression. RESULTS Mothers with postpartum onset of depression were more likely to be older, Caucasian, educated, married/cohabitating, have one or no previous child, and have private insurance in contrast to mothers with pre-pregnancy and prenatal onset of depression. Mothers with bipolar depression were more likely to have a pre-pregnancy onset. Three general and two atypical depressive symptoms distinguished pre-pregnancy, during pregnancy, and postpartum depression onset, and the presence of agitation distinguished between unipolar and bipolar depression. LIMITATIONS The sample was urban, which may not be generalizable to other populations. The study was cross-sectional, which excludes potential late onset of depression (after 4-6 weeks) in the first postpartum year. CONCLUSIONS A collective set of factors predicted the onset of depression identified in the postpartum for mothers distinguished by episodes of unipolar versus bipolar depression, which can inform clinical interventions. Future research on the onset of major depressive episodes could inform prophylactic and early psychiatric interventions.
Collapse
Affiliation(s)
- Sheehan D Fisher
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Science, 676 North St. Clair, Suite 1000, Chicago, IL 60611, United States.
| | - Katherine L Wisner
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Science and Obstetrics and Gynecology, United States
| | - Crystal T Clark
- Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Science, 676 North St. Clair, Suite 1000, Chicago, IL 60611, United States
| | - Dorothy K Sit
- University of Pittsburgh, Department of Psychiatry, United States
| | - James F Luther
- University of Pittsburgh, Department of Epidemiology, Graduate School of Public Health, United States
| | - Stephen Wisniewski
- University of Pittsburgh, Department of Epidemiology, Graduate School of Public Health, United States
| |
Collapse
|
33
|
Woolhouse H, James J, Gartland D, McDonald E, Brown SJ. Maternal depressive symptoms at three months postpartum and breastfeeding rates at six months postpartum: Implications for primary care in a prospective cohort study of primiparous women in Australia. Women Birth 2016; 29:381-7. [DOI: 10.1016/j.wombi.2016.05.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/03/2016] [Accepted: 05/29/2016] [Indexed: 11/15/2022]
|
34
|
Kolla NJ, van der Maas M, Toplak ME, Erickson PG, Mann RE, Seeley J, Vingilis E. Adult attention deficit hyperactivity disorder symptom profiles and concurrent problems with alcohol and cannabis: sex differences in a representative, population survey. BMC Psychiatry 2016; 16:50. [PMID: 26920911 PMCID: PMC4769555 DOI: 10.1186/s12888-016-0746-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 02/12/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Adult attention deficit hyperactivity disorder (ADHD) shows a robust association with alcohol and cannabis misuse, and these relationships are expressed differently in males and females. Manifestation of specific ADHD symptom profiles, even in the absence of the full disorder, may also be related to problems with alcohol and cannabis, although these relationships have not been investigated in epidemiological studies. To address this question, we studied the sex-specific associations of ADHD symptomatology with problematic alcohol and cannabis use in a representative sample of adults aged 18 years and older residing in Ontario, Canada. METHODS Data were obtained from the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, between January 2011 and December 2013. Respondents (n = 5080) reported on current ADHD symptomatology, measured using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four additional items, and alcohol and cannabis use, which were measured using the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), respectively. Logistic regression analyses were conducted in men and women to test the association of each ADHD symptom cluster (hyperactivity, inattentiveness, impulsivity) with problematic alcohol and cannabis use. RESULTS After controlling for age, education, and comorbid internalizing and externalizing psychopathology, hyperactive symptoms were associated with problematic alcohol use in both men and women and with problematic cannabis use in men. Impulsive symptoms were independently associated with problematic cannabis use in men. By contrast, inattentive symptomatology predicted problems with alcohol and cannabis only in women. In all models, age was negatively associated with substance misuse and externalizing behavior was positively correlated and the strongest predictor of hazardous alcohol and cannabis use. CONCLUSIONS ADHD symptom expression in adulthood is related to concurrent hazardous use of alcohol and cannabis. Distinctive ADHD symptom profiles may confer increased risk for substance misuse in a sex-specific manner.
Collapse
Affiliation(s)
- Nathan J. Kolla
- Centre for Addiction and Mental Health, Toronto, ON Canada ,Department of Psychiatry, University of Toronto, Toronto, ON Canada ,CAMH, 250 College Street, Toronto, ON Canada
| | - Mark van der Maas
- Centre for Addiction and Mental Health, Toronto, ON, Canada. .,Department of Sociology, University of Toronto, Toronto, ON, Canada.
| | | | | | - Robert E. Mann
- Centre for Addiction and Mental Health, Toronto, ON Canada ,Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Jane Seeley
- Department of Family Medicine, University of Western Ontario, London, ON, Canada.
| | - Evelyn Vingilis
- Department of Family Medicine, University of Western Ontario, London, ON, Canada.
| |
Collapse
|
35
|
Using factor analytic models to examine the association between attention-deficit/hyperactivity disorder symptoms and health-related outcomes in a representative population survey. ACTA ACUST UNITED AC 2015; 7:225-35. [PMID: 25809202 DOI: 10.1007/s12402-015-0167-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
The objective of the study was to examine the factor structure of attention-deficit/hyperactivity disorder (ADHD) symptoms in a representative population survey of adults and the association of these factors with health outcomes. Hierarchical and correlated factor analysis models were compared, and regression analyses with these models were used to determine the associations with psychological distress and substance use problems. A total of 1449 adults 18-65 years of age participated in a cross-sectional survey over the phone. ADHD symptom data came from an ADHD screener (10 items), and health outcomes were assessed using a questionnaire measuring psychological distress and two measures of substance use problems. The hierarchical general factor models with specific factors best represented the structure of ADHD in this representative population survey. The general factor and residual inattention factor were significantly associated with psychological distress, and the general factor was associated with substance use problems. From the correlated factor models, the inattention factor was associated with psychological distress and the hyperactivity factor was related to substance use problems. The hierarchical and correlated factor models explained similar levels of variance in outcomes. The results replicate previous studies indicating that a model of ADHD symptoms with a unitary dimension and separable dimensions of residual inattention and hyperactivity/impulsivity demonstrates a better fit than correlated factor models. The ADHD general factor was consistently significantly related to outcomes.
Collapse
|
36
|
Coates R, Ayers S, de Visser R. Women's experiences of postnatal distress: a qualitative study. BMC Pregnancy Childbirth 2014; 14:359. [PMID: 25315742 PMCID: PMC4288655 DOI: 10.1186/1471-2393-14-359] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 10/03/2014] [Indexed: 11/13/2022] Open
Abstract
Background Women can experience a range of psychological problems after birth, including anxiety, depression and adjustment disorders. However, research has predominantly focused on depression. Qualitative work on women’s experiences of postnatal mental health problems has sampled women within particular diagnostic categories so not looked at the range of potential psychological problems. The aims of this study were to explore how women experienced and made sense of the range of emotional distress states in the first postnatal year. Methods A qualitative study of 17 women who experienced psychological problems in the first year after having a baby. Semi-structured interviews took place in person (n =15) or on the telephone (n =2). Topics included women’s experiences of becoming distressed and their recovery. Data were analysed using Interpretative Phenomenological Analysis (IPA). Themes were developed within each interview before identifying similar themes for multiple participants across interviews, in order to retain an idiographic approach. Results Psychological processes such as guilt, avoidance and adjustment difficulties were experienced across different types of distress. Women placed these in the context of defining moments of becoming a mother; giving birth and breastfeeding. Four superordinate themes were identified. Two concerned women’s unwanted negative emotions and difficulties adjusting to their new role. “Living with an unwelcome beginning” describes the way mothers’ new lives with their babies started out with unwelcome emotions, often in the context of birth and breastfeeding difficulties. All women spoke about the importance of their postnatal healthcare experiences in “Relationships in the healthcare system”. “The shock of the new” describes women’s difficulties adjusting to the demands of motherhood and women emphasised the importance of social support in “Meeting new support needs”. Conclusions These findings emphasise the need for exploration of psychological processes such as distancing, guilt and self-blame across different types of emotional difficulties, as these may be viable targets for therapeutic intervention. Breastfeeding and birth trauma were key areas with which women felt they needed support with but which was not easily available.
Collapse
Affiliation(s)
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City University London, 1 Myddelton Street, London EC1R 1UW, UK.
| | | |
Collapse
|
37
|
Tsao Y, Creedy DK, Gamble J. Prevalence and Psychological Correlates of Postnatal Depression in Rural Taiwanese Women. Health Care Women Int 2014; 36:457-74. [DOI: 10.1080/07399332.2014.946510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
38
|
Very preterm birth: maternal experiences of the neonatal intensive care environment. J Perinatol 2014; 34:555-61. [PMID: 24651730 PMCID: PMC4154363 DOI: 10.1038/jp.2014.43] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 01/17/2014] [Accepted: 02/13/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Examine sources, predictors and child outcomes associated with neonatal intensive care unit (NICU)-related stress for mothers of infants born very preterm (VPT). STUDY DESIGN Participants were 133 mothers of VPT infants admitted to a regional level-III NICU. At term equivalent, mothers completed the Parental Stressor Scale: NICU and were interviewed about their psychological well-being and family circumstances. Infant clinical data were also collected. At corrected age 4 years, 49 children were assessed for cognition, language and socio-emotional development. RESULT Mothers reported moderate to low stress, with parental role alteration considered most stressful and parent-staff communications least stressful. Predictors of overall stress included maternal educational underachievement, stressful life events, postnatal depression and infant unsettled-irregular behavior. NICU-related stress was associated with child anxiety and poorer language development. CONCLUSION Parental well-being is an important focus of care in the neonatal setting. Strategies are needed to optimize early engagement and reduce stress levels to assist improved child outcomes.
Collapse
|
39
|
Tsao Y, Creedy DK, Gamble J. Emotional well-being of Vietnamese immigrant women during the transition to motherhood: A descriptive cohort study. Nurs Health Sci 2014; 17:49-56. [PMID: 24941901 DOI: 10.1111/nhs.12143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 03/16/2014] [Indexed: 11/26/2022]
Abstract
This study investigated the health and well-being of Vietnamese foreign brides recently immigrated to southern Taiwan. Forty-four participants were recruited during pregnancy and 23 were followed-up at six weeks post-partum. Standardized measures completed during face-to-face interviews revealed high levels of life stress, poor general health, low social support, and difficulty caring for their infant amongst participants. Estimated prevalence of probable antenatal depression was 32%, and 26% for probable post-partum depression using Edinburgh Postnatal Depression Scale (EPDS) scores of ≥ 13. Probable antenatal depression predicted postnatal depression. Pregnant immigrant women experienced a high level of difficult life circumstances and were significantly more likely to develop depressive symptoms after birth. Immigrant women with low social support during pregnancy were also more likely to report higher EPDS scores than well-supported women. Given these results, prevention and intervention activities are needed to promote maternal psychological well-being in disadvantaged women, especially immigrant brides.
Collapse
Affiliation(s)
- Ying Tsao
- Department of Nursing, Tzu-Chi University, Hualien, Taiwan
| | - Debra Kay Creedy
- Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia
| | - Jenny Gamble
- Griffith Health Institute, Griffith University, Brisbane, Queensland, Australia
| |
Collapse
|
40
|
Zhong Q, Gelaye B, Rondon M, Sánchez SE, García PJ, Sánchez E, Barrios YV, Simon GE, Henderson DC, Cripe SM, Williams MA. Comparative performance of Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale for screening antepartum depression. J Affect Disord 2014; 162:1-7. [PMID: 24766996 PMCID: PMC4040145 DOI: 10.1016/j.jad.2014.03.028] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 03/14/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We sought to evaluate the psychometric properties of two widely used screening scales: the Patient Health Questionnaire (PHQ-9) and Edinburgh Postnatal Depression Scale (EPDS) among pregnant Peruvian women. METHODS This cross-sectional study included 1517 women receiving prenatal care from February 2012 to March 2013. A structured interview was used to collect data using PHQ-9 and EPDS. We examined reliability, construct and concurrent validity between two scales using internal consistency indices, factor structures, correlations, and Cohen׳s kappa. RESULTS Both scales had good internal consistency (Cronbach׳s alpha>0.8). Correlation between PHQ-9 and EPDS scores was fair (rho=0.52). Based on exploratory factor analysis (EFA), both scales yielded a two-factor structure. EFA including all items from PHQ-9 and EPDS yielded four factors, namely, "somatization", "depression and suicidal ideation", "anxiety and depression", and "anhedonia". The agreement between the two scales was generally fair at different cutoff scores with the highest Cohen׳s kappa being 0.46. CONCLUSIONS Both the PHQ-9 and EPDS are reliable and valid scales for antepartum depression assessment. The PHQ-9 captures somatic symptoms, while EPDS detects depressive symptoms comorbid with anxiety during early pregnancy. Our findings suggest simultaneous administration of both scales may improve identification of antepartum depressive disorders in clinical settings.
Collapse
Affiliation(s)
- Qiuyue Zhong
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Bizu Gelaye
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, K505F, Boston, MA 02115, United States.
| | - Marta Rondon
- Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
| | | | | | | | - Yasmin V Barrios
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | | | | | - Swee May Cripe
- School of Medicine, Perdana University, Kuala Lumpur, Malaysia
| | | |
Collapse
|
41
|
Makanjuola VA, Onyeama M, Nuhu FT, Kola L, Gureje O. Validation of short screening tools for common mental disorders in Nigerian general practices. Gen Hosp Psychiatry 2014; 36:325-9. [PMID: 24559789 DOI: 10.1016/j.genhosppsych.2013.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective was to examine the psychometric properties of two brief screening questionnaires for common mental disorders in general practices in areas speaking the three main Nigerian languages. METHOD Consecutives attendees of selected general practices in Ibadan, Enugu and Kaduna were screened with the General Health Questionnaire 12-item version (GHQ12) and K6. We selected all cases and 50% of noncases for second-stage interview with the Composite International Diagnostic Interview. The receiver operating characteristic curves were generated for both questionnaires, and optimal cutoffs were determined. Exploratory factor analysis was done for both questionnaires. RESULTS The K6 had an area under the curve (AUC) of 0.62 for depression and 0.58 for anxiety disorder. The GHQ12 had an AUC of 0.74 for depression, while that for generalized anxiety disorder was 0.6. The GHQ12 was able to correctly classify 75% of the subjects with or without depression, while the K6 was able to correctly classify 56% of the subjects with or without depression. The optimal cutoff for both questionnaires was 4, selecting the point of best balance of sensitivity and specificity. CONCLUSION The findings suggest that the GHQ12 will be a useful tool in screening for common mental disorders in general practice in Nigeria.
Collapse
Affiliation(s)
| | - Mbadiwe Onyeama
- Department of Psychological Medicine, University of Nigeria, Enugu, Nigeria
| | | | - Lola Kola
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
42
|
Genetic variants in the genes of the stress hormone signalling pathway and depressive symptoms during and after pregnancy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:469278. [PMID: 24741566 PMCID: PMC3972848 DOI: 10.1155/2014/469278] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/07/2014] [Accepted: 02/08/2014] [Indexed: 11/29/2022]
Abstract
Purpose. The aim of this study was to investigate whether single nucleotide polymorphisms (SNPs) in genes of the stress hormone signaling pathway, specifically FKBP5, NR3C1, and CRHR1, are associated with depressive symptoms during and after pregnancy. Methods. The Franconian Maternal Health Evaluation Study (FRAMES) recruited healthy pregnant women prospectively for the assessment of maternal and fetal health including the assessment of depressiveness. The German version of the 10-item Edinburgh Postnatal Depression Scale (EPDS) was completed at three time points in this prospective cohort study. Visit 1 was at study entry in the third trimester of the pregnancy, visit 2 was shortly after birth, and visit 3 was 6–8 months after birth. Germline DNA was collected from 361 pregnant women. Nine SNPs in the above mentioned genes were genotyped. After construction of haplotypes for each gene, a multifactorial linear mixed model was performed to analyse the depression values over time. Results. EPDS values were within expected ranges and comparable to previously published studies. Neither did the depression scores differ for comparisons among haplotypes at fixed time points nor did the change over time differ among haplotypes for the examined genes. No haplotype showed significant associations with depressive symptoms severity during pregnancy or the postpartum period. Conclusion. The analysed candidate haplotypes in FKBP5, NR3C1, and CRHR1 did not show an association with depression scores as assessed by EPDS in this cohort of healthy unselected pregnant women.
Collapse
|
43
|
Clarke K, Saville N, Shrestha B, Costello A, King M, Manandhar D, Osrin D, Prost A. Predictors of psychological distress among postnatal mothers in rural Nepal: a cross-sectional community-based study. J Affect Disord 2014; 156:76-86. [PMID: 24370265 PMCID: PMC3969296 DOI: 10.1016/j.jad.2013.11.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 11/23/2013] [Accepted: 11/23/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Perinatal common mental disorders are a major cause of disability among women and have consequences for children's growth and development. We aimed to identify factors associated with psychological distress, a proxy for common mental disorders, among mothers in rural Dhanusha, Nepal. METHODS We used data from 9078 mothers who were screened for distress using the 12-item General Health Questionnaire (GHQ-12) around six weeks after delivery. We assessed the association between GHQ-12 score and socioeconomic, gender-based, cultural and reproductive health factors using a hierarchical analytical framework and multilevel linear regression models. RESULTS Using a threshold GHQ-12 score of ≥6 to indicate caseness, the prevalence of distress was 9.8% (886/9078). Factors that predicted distress were severe food insecurity (β 2.21 (95% confidence interval 1.43, 3.40)), having a multiple birth (2.28 (1.27, 4.10)), caesarean section (1.70 (0.29, 2.24)), perinatal health problems (1.58 (1.23, 2.02)), no schooling (1.37 (1.08, 1.73)), fewer assets (1.33 (1.10, 1.60)), five or more children (1.33 (1.09, 1.61)), poor or no antenatal care (1.31 (1.15, 1.48) p<0.001), having never had a son (1.31 (1.14, 1.49)), not staying in the parental home in the postnatal period (1.15 (1.02, 1.30)), having a husband with no schooling (1.17 (0.96, 1.43)) and lower maternal age (0.99 (0.97, 1.00)). LIMITATIONS The study was cross-sectional and we were therefore unable to infer causality. Because data were not collected for some established predictors, including infant death, domestic violence and history of mental illness, we could not assess their associations with distress. CONCLUSIONS Socioeconomic disadvantage, gender inequality and poor reproductive health predict distress among mothers in Dhanusha. Maternal and child health programmes, as well as poverty-alleviation and educational interventions, may be beneficial for maternal mental health.
Collapse
Affiliation(s)
- Kelly Clarke
- University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, United Kingdom.
| | - Naomi Saville
- University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Bhim Shrestha
- Mother and Infant Research Activities (MIRA), P.O. Box 921, Kathmandu, Nepal
| | - Anthony Costello
- University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Michael King
- Mental Health Sciences Unit, University College London, United Kingdom
| | - Dharma Manandhar
- Mother and Infant Research Activities (MIRA), P.O. Box 921, Kathmandu, Nepal
| | - David Osrin
- University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Audrey Prost
- University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, United Kingdom
| |
Collapse
|
44
|
Clarke K, Saville N, Bhandari B, Giri K, Ghising M, Jha M, Jha S, Magar J, Roy R, Shrestha B, Thakur B, Tiwari R, Costello A, Manandhar D, King M, Osrin D, Prost A. Understanding psychological distress among mothers in rural Nepal: a qualitative grounded theory exploration. BMC Psychiatry 2014; 14:60. [PMID: 24581309 PMCID: PMC3943437 DOI: 10.1186/1471-244x-14-60] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 02/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a large burden of psychological distress in low and middle-income countries, and culturally relevant interventions must be developed to address it. This requires an understanding of how distress is experienced. We conducted a qualitative grounded theory study to understand how mothers experience and manage distress in Dhanusha, a low-resource setting in rural Nepal. We also explored how distressed mothers interact with their families and the wider community. METHODS Participants were identified during a cluster-randomised controlled trial in which mothers were screened for psychological distress using the 12-item General Health Questionnaire (GHQ-12). We conducted 22 semi-structured interviews with distressed mothers (GHQ-12 score ≥ 5) and one with a traditional healer (dhami), as well as 12 focus group discussions with community members. Data were analysed using grounded theory methods and a model was developed to explain psychological distress in this setting. RESULTS We found that distress was termed tension by participants and mainly described in terms of physical symptoms. Key perceived causes of distress were poor health, lack of sons, and fertility problems. Tension developed in a context of limited autonomy for women and perceived duty towards the family. Distressed mothers discussed several strategies to alleviate tension, including seeking treatment for perceived physical health problems and tension from doctors or dhamis, having repeated pregnancies until a son was delivered, manipulating social circumstances in the household, and deciding to accept their fate. Their ability to implement these strategies depended on whether they were able to negotiate with their in-laws or husbands for resources. CONCLUSIONS Vulnerability, as a consequence of gender and social disadvantage, manifests as psychological distress among mothers in Dhanusha. Screening tools incorporating physical symptoms of tension should be envisaged, along with interventions to address gender inequity, support marital relationships, and improve access to perinatal healthcare.
Collapse
Affiliation(s)
- Kelly Clarke
- University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Naomi Saville
- University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Bishnu Bhandari
- Mother and Infant Research Activities (MIRA), Thapathali, Kathmandu, Nepal
| | - Kalpana Giri
- Mother and Infant Research Activities (MIRA), Thapathali, Kathmandu, Nepal
| | - Mamita Ghising
- Mother and Infant Research Activities (MIRA), Thapathali, Kathmandu, Nepal
| | | | - Sonali Jha
- Mother and Infant Research Activities (MIRA), Thapathali, Kathmandu, Nepal
| | - Jananee Magar
- Transcultural Psychosocial Organisation Nepal, Baluwatar, Kathmandu, Nepal
| | - Rinku Roy
- Mother and Infant Research Activities (MIRA), Thapathali, Kathmandu, Nepal
| | - Bhim Shrestha
- Mother and Infant Research Activities (MIRA), Thapathali, Kathmandu, Nepal
| | - Bhawana Thakur
- Mother and Infant Research Activities (MIRA), Thapathali, Kathmandu, Nepal
| | - Rinku Tiwari
- Mother and Infant Research Activities (MIRA), Thapathali, Kathmandu, Nepal
| | - Anthony Costello
- University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Dharma Manandhar
- Mother and Infant Research Activities (MIRA), Thapathali, Kathmandu, Nepal
| | - Michael King
- Research Department of Mental Health Sciences, University College London, Charles Bell House, 2nd Floor, 67-73 Riding House Street, London W1W 7EJ, UK
| | - David Osrin
- University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, UK
| | - Audrey Prost
- University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, UK
| |
Collapse
|
45
|
Reimagining the General Health Questionnaire as a measure of emotional wellbeing: A study of postpartum women in Malta. Women Birth 2013; 26:e105-11. [DOI: 10.1016/j.wombi.2013.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 06/13/2013] [Accepted: 06/14/2013] [Indexed: 12/20/2022]
|
46
|
Grzeskowiak LE, Gilbert AL, Sørensen TI, Olsen J, Sørensen HT, Pedersen LH, Morrison JL. Prenatal exposure to selective serotonin reuptake inhibitors and childhood overweight at 7 years of age. Ann Epidemiol 2013; 23:681-7. [DOI: 10.1016/j.annepidem.2013.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 08/08/2013] [Accepted: 08/19/2013] [Indexed: 01/23/2023]
|
47
|
Socioeconomic status and depression during and after pregnancy in the Franconian Maternal Health Evaluation Studies (FRAMES). Arch Gynecol Obstet 2013; 289:755-63. [DOI: 10.1007/s00404-013-3046-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
|
48
|
Mortazavi F, Chaman R, Mousavi SA, Khosravi A, Ajami ME. Maternal psychological state during the transition to motherhood: a longitudinal study. Asia Pac Psychiatry 2013; 5:E49-57. [PMID: 23857812 DOI: 10.1111/appy.12075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 02/26/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the psychological state of women and its associated factors in the third trimester of pregnancy and at 8 weeks postpartum and to explore the changes in psychological state between these two time points. METHODS This survey study was carried out on 358 pregnant women visiting urban health centers in Shahroud, northeast Iran, in 2011. The women were followed at 8 weeks postpartum. In the third trimester of pregnancy, the participants completed the 28-item General Health Questionnaire (GHQ-28) and two other questionnaires on sociodemographic characteristics and frequent psychosocial stressors. They also completed the GHQ-28 and an obstetric information form at 8 weeks postpartum. The cutoff score for GHQ-28 in Iran has been calculated as 24, which denotes probable psychological health problems. RESULTS The mean total GHQ score decreased from 23.7 in the third trimester of pregnancy to 18.8 postpartum (P < 0.001). The proportion of women with a GHQ-28 score of 24 or higher in the third trimester of pregnancy and postpartum were 42% and 26%, respectively. Multiparity, caring for other family members, financial problems, and anxiety about personal and fetal health were the predictors of psychological health problems in the third trimester of pregnancy. The two predictors for postpartum psychological health problems were psychological health problems in the third trimester of pregnancy and the method of infant feeding at 8 weeks postpartum. DISCUSSION The prevalence of psychological symptoms was high among women in the third trimester of pregnancy. Psychological state of women improved after childbirth.
Collapse
Affiliation(s)
- Forough Mortazavi
- Student Research Committee, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | | | | | | |
Collapse
|
49
|
Matthey S, Fisher J, Rowe H. Using the Edinburgh postnatal depression scale to screen for anxiety disorders: conceptual and methodological considerations. J Affect Disord 2013; 146:224-30. [PMID: 23116811 DOI: 10.1016/j.jad.2012.09.009] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/11/2012] [Accepted: 09/11/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Perinatal anxiety symptoms and disorders are prevalent and disabling but have not to date been a focus for specific clinical and public health attention. The EPDS is widely used to detect probable depression, and many studies have also found that three items from this scale load on an anxiety factor, in both the antenatal and postnatal periods. In addition, studies have found clinically significant correlations between the EPDS and various anxiety-specific measures in the perinatal period. The aim of this paper is to examine studies which address the capacity of the EPDS to detect anxiety disorders, to assess whether the EPDS performs differently in women with depressive or anxiety disorders and to consider the implications for future research and clinical practice. METHODS The English-language perinatal mental health literature was searched. Six studies with data pertaining to the capacity of the EPDS to detect perinatal anxiety disorders in women were identified. These studies provide information on i) comparison of total EPDS score by diagnoses of anxiety and depression and ii) comparison of the anxiety subscale score (EPDS-3A) by diagnoses of anxiety and depression. RESULTS There is evidence from both sets of information that the EPDS is useful for screening for anxiety in women and emerging evidence that Total EPDS and EPDS-3A can distinguish depression from anxiety reliably. LIMITATIONS The findings are based on a small number of studies, conducted in a variety of clinical and community settings in different languages and countries, and with variable sample sizes, some of which lack power to ensure reliable conclusions. CONCLUSIONS The EPDS appears to detect perinatal anxiety disorders, but further research is required to establish the clinical and public health value of the EPDS for this purpose, and whether it has more robust psychometric properties or is more feasible and acceptable than existing anxiety-specific measures.
Collapse
|
50
|
Leung BMY, Kaplan BJ, Field CJ, Tough S, Eliasziw M, Gomez MF, McCargar LJ, Gagnon L. Prenatal micronutrient supplementation and postpartum depressive symptoms in a pregnancy cohort. BMC Pregnancy Childbirth 2013; 13:2. [PMID: 23324464 PMCID: PMC3585741 DOI: 10.1186/1471-2393-13-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 01/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postpartum depression is a serious problem for women and their offspring. Micronutrient supplements are recommended for pregnant women because of their documented protective effects for the offspring, but their potential beneficial effects on maternal mental health are unknown. This study investigated the association between prenatal micronutrient supplementation and the risk for symptoms of postpartum depression in a longitudinal pregnancy cohort from the Alberta Pregnancy Outcomes and Nutrition (APrON) study. METHODS Participants came from a cohort of the first 600 APrON women. Supplemental nutrient intake and symptoms of depression (measured with the Edinburgh Postnatal Depression Scale (EPDS)) were collected at each trimester and 12 weeks postpartum. RESULTS Of the 475 participants who completed the EPDS at least twice in pregnancy and at 12 weeks postpartum, 416 (88%) scored <10 and 59 (12%) scored ≥10, where an EPDS ≥10 is considered to be "at least probable minor depression". Mean nutrient intakes from supplements were higher in women with lower EPDS scores, particularly selenium (p = 0.0015) and omega-3s (p = 0.01). Bivariate analyses showed that several demographic and social/lifestyle variables were associated with EPDS ≥10: not having been born in Canada (p = 0.01), greater number of chronic conditions (p = 0.05), greater number of stressful life events during this pregnancy (p = 0.02), and lower prenatal and postnatal support (p = 0.0043 and p = 0.0001, respectively). Adjusting for covariates and nutrients known to be associated with postpartum depression, logistic regression showed that having a prenatal EPDS ≥ 10 increased the odds of postpartum depressive symptoms (second and third trimester OR = 3.29, 95% CI = 1.55 - 7.01, p = 0.004 and OR = 4.26, 95% CI = 2.05 - 8.85, p < 0.0001, respectively), while prenatal supplemental selenium (per 10 mcg, OR = 0.76, 95% CI = 0.74 - 0.78, p = 0.0019) and postnatal social support (OR = 0.87, 95% CI = 0.78 - 0.97, p = 0.0015) were protective. CONCLUSIONS Multiple factors, including supplementary selenium intake, are associated with the risk of postpartum depressive symptoms. Future research on dietary supplementation in pregnancy with special attention to selenium intake is warranted.
Collapse
Affiliation(s)
- Brenda M Y Leung
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|