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Ohene-Agyei P, Tran T, Harding JE, Crowther CA. Do glycaemic treatment targets affect the perinatal mental health status of women with gestational diabetes? - Data from the TARGET Trial. BMC Pregnancy Childbirth 2023; 23:869. [PMID: 38104076 PMCID: PMC10724999 DOI: 10.1186/s12884-023-06190-4] [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: 06/16/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus is associated with perinatal mental disorders. Effective management may reduce this risk, but there is little evidence on effects of different glycaemic treatment targets. We assessed whether tight glycaemic treatment targets compared with less-tight targets reduce the risk of poor mental health outcomes in women with gestational diabetes. METHODS This was a secondary analysis of data from women who consented to complete perinatal mental health questionnaires as participants in the TARGET Trial, a stepped-wedge cluster randomized trial in 10 hospitals in New Zealand. All hospitals initially used less tight glycaemic targets for management of gestational diabetes and were sequentially randomized, in clusters of two at 4-monthly intervals, to using tighter glycaemic targets. Data were collected from 414 participants on anxiety (6-item Spielberger State Anxiety scale), depression (Edinburgh Postnatal Depression Scale), and health-related quality of life (36-Item Short-Form General Health Survey) at the time of diagnosis (baseline), 36 weeks of gestation, and 6 months postpartum. The primary outcome was composite poor mental health (any of anxiety, vulnerability to depression, or poor mental health-related quality of life). Generalized linear mixed models were used to determine the main treatment effect with 95% confidence intervals using an intention-to-treat approach. RESULTS We found no differences between randomised glycaemic target groups in the primary outcome at 36 weeks' (relative risk (RR): 1.07; 95% confidence interval 0.58, 1.95) and 6 months postpartum (RR: 1.03; 0.58, 1.81). There were similarly no differences in the components of the primary outcome at 36 weeks' [anxiety (RR: 0.85; 0.44, 1.62), vulnerability to depression (RR: 1.10; 0.43, 2.83), or poor mental health-related quality of life (RR: 1.05; 0.50, 2.20)] or at 6 months postpartum [anxiety (RR:1.21; 0.59, 2.48), vulnerability to depression (RR:1.41; 0.53, 3.79), poor mental health-related quality of life (RR: 1.11; 0.59, 2.08)]. CONCLUSION We found no evidence that adoption of tighter glycaemic treatment targets in women with gestational diabetes alters their mental health status at 36 weeks' gestation and at 6 months postpartum. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12615000282583 (ANZCTR-Registration). Date of registration: 25 March 2015.
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Affiliation(s)
| | - Thach Tran
- School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Bird A, Reese E, Salmon K, Waldie K, Peterson E, Atatoa-Carr P, Morton S. Maternal depressive symptoms and child language development: Exploring potential pathways through observed and self-reported mother-child verbal interactions. Dev Psychopathol 2023:1-14. [PMID: 37969026 DOI: 10.1017/s0954579423001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Maternal depressive symptoms (MDS) in the postnatal period may impact children's later development through poorer quality parent-child interactions. The current study tested a specific pathway from MDS (child age 9 months) to child receptive vocabulary (4 ½ years) through both self-reported and observed parent-child verbal interactions (at both 2 and 4 ½ years). Participants (n = 4,432) were part of a large, diverse, contemporary pre-birth national cohort study: Growing Up in New Zealand. Results indicated a direct association between greater MDS at 9 months and poorer receptive vocabulary at age 4 ½ years. There was support for an indirect pathway through self-reported parent-child verbal interactions at 2 years and through observed parent-child verbal interactions at 4 ½ years. A moderated mediation effect was also found: the indirect effect of MDS on child vocabulary through observed verbal interaction was supported for families living in areas of greater socioeconomic deprivation. Overall, findings support the potential role of parent-child verbal interactions as a mechanism for the influence of MDS on later child language development. This pathway may be particularly important for families experiencing socioeconomic adversity, suggesting that effective and appropriate supportive parenting interventions be preferentially targeted to reduce inequities in child language outcomes.
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Affiliation(s)
- Amy Bird
- University of Auckland, Auckland, New Zealand
- University of Waikato, Hamilton, New Zealand
| | | | - Karen Salmon
- Victoria University of Wellington, Wellington, New Zealand
| | | | | | | | - Susan Morton
- University of Auckland, Auckland, New Zealand
- University of Technology Sydney, Sydney, NSW, Australia
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Dias CC, Pinto TM, Figueiredo B. Maternal Prenatal Depressive Symptoms and Infant Sleep Problems: The Role of Infant Temperament and Sex. Behav Sleep Med 2023; 21:695-711. [PMID: 36533573 DOI: 10.1080/15402002.2022.2155162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES We aimed to analyze whether (1) infant temperament mediates the impact of maternal prenatal depressive symptoms on infant sleep problems and (2) the mediation role of infant temperament was moderated by the infant's sex. METHODS The sample was comprised of 172 mother-infant dyads. Mothers completed self-reported measures of prenatal and postnatal depressive symptoms, infant temperament (negative affectivity, surgency/extraversion, and orienting regulation), and sleep problems. RESULTS While controlling for maternal postnatal depressive symptoms, our results revealed that (1) infant negative affectivity at two weeks partially mediated the impact of maternal prenatal depressive symptoms on sleep anxiety at six months, and (2) this mediation is independent of the infant's sex. CONCLUSIONS Our findings provided evidence that negative affectivity can be an early specific marker of sleep anxiety and can partially explain the negative impact of maternal prenatal depressive symptoms on further sleep problems in the infant.
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Affiliation(s)
| | - Tiago Miguel Pinto
- School of Psychology, University of Minho, Braga, Portugal
- Lusófona University, HEI-Lab, Porto, Portugal
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Anns F, Waldie KE, Peterson ER, Walker C, Morton SMB, D'Souza S. Behavioural outcomes of children exposed to antidepressants and unmedicated depression during pregnancy. J Affect Disord 2023; 338:144-154. [PMID: 37295656 DOI: 10.1016/j.jad.2023.05.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Antenatal exposure to both antidepressants and maternal depression has been associated with child behavioural difficulties. However, previous research has not adequately distinguished between the effects of the antidepressants and the underlying maternal depression. METHODS Child behavioural difficulties were assessed using the Strengths and Difficulties Questionnaire at 2-, 4.5-, and 8-years of age by mothers in the Growing Up in New Zealand study (N = 6233 at 2-years; N = 6066 at 4.5-years; N = 4632 at 8-years). Mothers were classified as either on antidepressants, unmedicated depression, or neither based on self-reported antidepressant intake during pregnancy and the Edinburgh Postnatal Depression Scale. Hierarchical multiple logistic regressions were used to examine whether antenatal exposure to antidepressants and unmedicated depression had a differential association with child behavioural outcomes relative to no exposure. RESULTS When later life depression in the mother and a range of birth and sociodemographic variables were accounted for, neither antenatal exposure to unmedicated depression or antidepressants remained associated with an increased risk of behavioural difficulties at the ages investigated. However, maternal later life depression was associated with behavioural difficulties in the fully adjusted analyses at all three ages investigated. LIMITATIONS The current study relied on mother-report of child behaviour which may be susceptible to bias due to maternal mental health problems. CONCLUSIONS Adjusted results did not show an adverse association between antenatal antidepressant exposure or unmedicated depression in relation to child behaviour. Findings also suggest that efforts to improve child behaviour need to include more family-based approaches that support maternal wellbeing.
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Affiliation(s)
- Francesca Anns
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Elizabeth R Peterson
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Caroline Walker
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; School of Population Health, The University of Auckland, Auckland, New Zealand; INSIGHT, University of Technology Sydney, Sydney, Australia
| | - Stephanie D'Souza
- Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand; School of Social Sciences, The University of Auckland, Auckland, New Zealand.
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Broughton LC, Hughes-Medlicott N, Zeng J, Smith A. Perinatal psychotropic dispensing: A descriptive population-based study in New Zealand. Asia Pac Psychiatry 2023; 15:e12539. [PMID: 37321961 DOI: 10.1111/appy.12539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Decisions about using psychotropics during pregnancy are complex as risks of untreated illness are balanced against risks of fetal exposure to medication. The objective was to describe perinatal psychotropic dispensing patterns in New Zealand. METHODS Nationwide data from the New Zealand National Maternity Collection between January 1, 2011 and December 31, 2017 identified 399 715 pregnancies. These were linked with dispensing records to determine the proportion of pregnancies during which at least 1 psychotropic was dispensed. Proportions were calculated separately for each class, year, pregnancy period, and across maternal characteristics. The pattern of dispensing (including discontinuations) was also determined for the 25 841 women who were dispensed at least 1 psychotropic drug prior to pregnancy. RESULTS From the 399 715 pregnancies in the study cohort, 6.6% were dispensed at least 1 psychotropic during pregnancy. Antidepressants (5.1%) were the most dispensed, followed by hypnotics (1.2%), anxiolytics (0.7%), and antipsychotics (0.7%). From the 25 841 pregnancies during which a psychotropic was dispensed pre-pregnancy, 91% and 90% discontinued hypnotics and anxiolytics respectively, prior to or during pregnancy. This was followed by lithium (71%), antipsychotics (66%), and antidepressants (66%). DISCUSSION Dispensing of psychotropics during pregnancy occurs in approximately 6.6% of pregnancies in New Zealand. Two-thirds of women (66%) on antidepressants or antipsychotics discontinue dispensing before or during pregnancy. This may have implications for maternal mental health, suggesting there is a need to investigate how healthcare providers and women are making decisions about psychotropic use during pregnancy.
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Affiliation(s)
| | | | - Jiaxu Zeng
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Alesha Smith
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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Lowe LA, Betts D. Midwifery Acupuncturists' Management of Antenatal Anxiety and Depression: Data from a Survey in Aotearoa (New Zealand). Med Acupunct 2023; 35:63-72. [PMID: 37095785 PMCID: PMC10122233 DOI: 10.1089/acu.2022.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Objective The goal of this research was to explore how New Zealand midwifery acupuncturists manage mild-to-moderate antenatal anxiety and depression (AAD). Materials and Methods A survey (Surveymonkey®) on midwives' perceptions of acupuncture for treating AAD was distributed late in 2019 to midwives who completed a Certificate in Midwifery Acupuncture. Data were collected on referrals and on acupuncture and complementary and alternative medicine use for AAD and associated symptoms of concern (SoC), such as low-back and pelvic pain (LBPP), sleep issues, stress, other pain, and pregnancy issues. Descriptive analysis was used to report data. Results Of 119 midwives, 66 responded (55.5%). For AAD and SoC, midwives mostly referred patients to general practitioners and counselors, and administered acupuncture themselves. Acupuncture was most accessed for LBPP (n = 38; 70.4%), sleep (n = 31; 57.4%), anxiety (n = 27; 50.0%); stress (n = 26; 48.1%), and other pain (n = 20, 37.0%). Massage was second most-accessed for LBPP (n = 36; 66.7%), sleep (n = 25; 46.3%), and stress (n = 24; 44.4%). For depression, treatments were herbs (n = 16; 29.6%), homeopathy (n = 14; 25.9%), and acupuncture and massage (both n = 13; 24.1%). Acupuncture was most used for other pregnancy issues: birth preparation (n = 44, 88.0%); assisted labor induction (n = 43; 86.0%): nausea and vomiting (n = 43; 86.0%); breech (n = 37; 74.0%); and headaches/migraines (n = 29; 58.0%). Conclusion Acupuncture is commonly used by midwife acupuncturists in New Zealand to treat a range of pregnancy issues, including anxiety, SoC for AAD, and other pregnancy issues. Further research would be beneficial.
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Affiliation(s)
- Lee-Ana Lowe
- Dunedin, Aotearoa (New Zealand)
- New Zealand School of acupuncture and Traditional Chinese Medicine, Auckland, Aotearoa (New Zealand)
| | - Debra Betts
- New Zealand School of acupuncture and Traditional Chinese Medicine, Auckland, Aotearoa (New Zealand)
- University Western Sydney, Sydney, Australia
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Cai S, Phua DY, Tham EKH, Goh DYT, Teoh OH, Shek LPC, Tan KH, Yap F, Chong Y, Chen H, Broekman BFP, Kramer MS, Meaney MJ. Mid‐pregnancy and postpartum maternal mental health and infant sleep in the first year of life. J Sleep Res 2022; 32:e13804. [PMID: 36511597 DOI: 10.1111/jsr.13804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Abstract
Perinatal depression and anxiety are common and associated with sleep problems in the offspring. Depression and anxiety are commonly comorbid, yet often studied independently. Our study used an integrative measure of anxiety and depressive symptoms to examine the associations of maternal mental health (mid-pregnancy and postnatal) with infant sleep during the first year of life. A total of 797 mother-child dyads from the 'Growing Up in Singapore Towards healthy Outcome' cohort study provided infant sleep data at 3, 6, 9 and 12 months of age, using the caregiver reported Brief Infant Sleep Questionnaire. Maternal mental health was assessed at 26-28 weeks gestation and 3 months postpartum using the Edinburgh Postnatal Depression Scale, Beck Depression Inventory and State-Trait Anxiety Inventory. Bifactor modelling with the individual questionnaire items produced a general affect factor score that provided an integrated measure of anxiety and depressive symptoms. Linear mixed models were used to model the sleep outcomes, with adjustment for maternal age, education, parity, ethnicity, sex of the child and maternal sleep quality concurrent with maternal mental health assessment. We found that poorer mid-pregnancy, but not postpartum, maternal mental health was associated with longer wake after sleep onset duration across the first year of life (β = 49, 95% confidence interval 13-85 min). Poor maternal mental health during mid-pregnancy is linked to longer period of night awakening in the offspring during infancy. Interventions that aim to improve maternal antenatal mental health should examine infant sleep outcomes.
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Affiliation(s)
- Shirong Cai
- Agency for Science, Technology and Research (A*STAR) Singapore Institute for Clinical Sciences Singapore Singapore
- Human Potential Translational Research Programme Yong Loo Lin School of Medicine, National University of Singapore Singapore Singapore
| | - Desiree Y. Phua
- Agency for Science, Technology and Research (A*STAR) Singapore Institute for Clinical Sciences Singapore Singapore
| | - Elaine K. H. Tham
- Agency for Science, Technology and Research (A*STAR) Singapore Institute for Clinical Sciences Singapore Singapore
| | - Daniel Y. T. Goh
- Department of Paediatrics Yong Loo Lin School of Medicine, National University of Singapore, National University Health System Singapore Singapore
- Khoo Teck Puat – National University Children's Medical Institute, National University Health System Singapore Singapore
| | - Oon H. Teoh
- Respiratory Medicine Service, Department of Paediatrics KK Women's and Children's Hospital Singapore Singapore
| | - Lynette P. C. Shek
- Agency for Science, Technology and Research (A*STAR) Singapore Institute for Clinical Sciences Singapore Singapore
- Department of Paediatrics Yong Loo Lin School of Medicine, National University of Singapore, National University Health System Singapore Singapore
- Khoo Teck Puat – National University Children's Medical Institute, National University Health System Singapore Singapore
| | - Kok H. Tan
- Duke‐NUS Graduate Medical School Singapore Singapore
- Department of Maternal Fetal Medicine KK Women's and Children's Hospital Singapore Singapore
| | - Fabian Yap
- Department of Paediatric Endocrinology KK Women's and Children's Hospital Singapore Singapore
| | - Yap‐Seng Chong
- Agency for Science, Technology and Research (A*STAR) Singapore Institute for Clinical Sciences Singapore Singapore
- Department of Obstetrics and gynaecology Yong Loo Lin School of Medicine, National University of Singapore, National University Health System Singapore Singapore
| | - Helen Chen
- Duke‐NUS Graduate Medical School Singapore Singapore
- Department of psychological medicine KK Women's and Children's Hospital Singapore Singapore
| | - Birit F. P. Broekman
- Agency for Science, Technology and Research (A*STAR) Singapore Institute for Clinical Sciences Singapore Singapore
- Department of Psychiatry Amsterdam UMC and OLVG location Vrije Universiteit Amsterdam Amsterdam The Netherlands
- Amsterdam Public Health, Mental Health program Amsterdam The Netherlands
| | - Michael S. Kramer
- Department of Epidemiology, Biostatistics and Occupational Health McGill University Faculty of Medicine Montreal Canada
- Department of Pediatrics McGill University Faculty of Medicine Montreal Canada
| | - Michael J. Meaney
- Agency for Science, Technology and Research (A*STAR) Singapore Institute for Clinical Sciences Singapore Singapore
- Department of Psychiatry, Faculty of Medicine McGill University Montreal Canada
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Barber CC, Middlemiss W, Medvedev ON. Applying Rasch methodology to examine and enhance precision of the Edinburgh Postnatal Depression Scale. J Affect Disord 2022; 308:391-397. [PMID: 35398396 DOI: 10.1016/j.jad.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 02/21/2022] [Accepted: 04/03/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND The 10-item Edinburgh Postnatal Depression Scale (EPDS) is a widely used depression measure with acceptable psychometric properties, but it uses ordinal scaling that has limited precision for assessment of outcomes in clinical and research settings. This study aimed to apply Rasch methodology to examine and enhance psychometric properties of the EPDS by developing ordinal-to-interval conversion algorithm. METHODS The Partial Credit Rasch model was implemented using a sample of 621 mothers of infants (birth to 2 years old) who completed the EPDS as a part of a larger online survey. RESULTS Initial analysis indicated misfit to the Rasch model attributed to local dependency between individual EPDS items. The best model fit was achieved after combining six locally dependent items into three super-items resulting in non-significant item-trait interaction (χ2(49) = 46.61, p < 0.57), strong reliability (PSI = 0.86), unidimensionality and item invariance across personal factors such as age and mothers' education. This permitted generation of ordinal-to-interval conversion algorithms derived from person estimates of the Rasch model. LIMITATIONS Ordinal-to-interval conversion cannot be applied for individuals with missing data. CONCLUSIONS The EPDS met expectations of the unidimensional Rasch model after internal modifications, and its precision can be enhanced by using ordinal-to-interval conversion tables published in this article without the need to alter the original scale format. Scores derived from these conversion tables should decrease error and improve conformity with statistical assumptions in both clinical and research use of the EPDS, making monitoring of clinical status and outcomes more accurate.
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Affiliation(s)
| | - Wendy Middlemiss
- University of North Texas, Department of Educational Psychology, United States of America
| | - Oleg N Medvedev
- University of Waikato, School of Psychology, Hamilton, New Zealand
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Pobee RA, Setorglo J, Kwashie Klevor M, Murray-Kolb LE. High levels of depressive symptoms and low quality of life are reported during pregnancy in Cape Coast, Ghana; a longitudinal study. BMC Public Health 2022; 22:894. [PMID: 35513825 PMCID: PMC9069749 DOI: 10.1186/s12889-022-13299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background Significant rates of anxiety, depressive symptoms, and low quality of life (QoL) have been found among pregnant women in developed countries. These psychosocial disturbances have not been adequately assessed during pregnancy in many developing countries. Methods Women were recruited in their first trimester of pregnancy (< 13 weeks; n = 116) and followed through to their 2nd (n = 71) and 3rd (n = 71) trimesters. Questionnaires were used to collect data on anxiety symptoms (Beck Anxiety Inventory; BAI), depressive symptoms (Center for Epidemiological Studies-Depression Inventory; CES-D), and quality of life (RAND SF-36; QoL). Psychometric analyses were used to determine the reliability of the questionnaires in this context. The proportion of pregnant women with psychosocial disturbances at each trimester was determined. Repeated measures ANOVA were used to examine changes in psychosocial outcomes over time; and generalized estimating equation to determine if gestational age predicted the psychosocial outcomes whilst controlling for sociodemographic variables. Results Participants were aged 27.1 ± 5.2 years, on average. Psychometric analyses revealed a 4-factor solution for BAI (18 items), 1-factor solution for CES-D (13 items) and 4-factor solution for RAND SF-36 (26 items). The prevalence estimate of psychosocial disturbances was 34%, 10%, 2% (anxiety), 49%, 31%, 34% (depressive symptoms), and 46%, 37%, 59% (low QoL) for 1st, 2nd and 3rd trimesters, respectively. Gestational age and food insecurity were significant predictors of depressive symptoms, anxiety symptoms and QoL. Conclusions In this population of Ghanaian women, the levels of depressive symptoms and low QoL observed across pregnancy should be recognized as major public health problems and efforts to address these should be put in place. Addressing food insecurity may be a major step to solve not only the physical needs of the pregnant woman but also the psychological needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13299-2.
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Affiliation(s)
- Ruth Adisetu Pobee
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Jacob Setorglo
- Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana
| | - Moses Kwashie Klevor
- Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, 16802, USA. .,Department of Nutrition Science, Purdue University, Room 214 Stone Hall, 700 West State Street, West Lafayette, IN, 47907, USA.
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Svardal CA, Waldie K, Milne B, Morton SM, D'Souza S. Prevalence of antidepressant use and unmedicated depression in pregnant New Zealand women. Aust N Z J Psychiatry 2022; 56:489-499. [PMID: 34260316 DOI: 10.1177/00048674211025699] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Throughout pregnancy, women are at an increased risk of depression, with prevalence estimates between 6.5% and 18%. Global prevalence of antenatal antidepressant use is considerably lower at 3%. OBJECTIVE The present study determined the proportion of women taking antidepressants across pregnancy in New Zealand. We investigated whether variation exists across age bands, area-level deprivation and ethnicities, and identified how many women experienced unmedicated depression. METHOD Antenatal data (n = 6822) consisted of primarily third-trimester interviews conducted with mothers participating in Growing Up in New Zealand, a longitudinal study investigating child development. Women were asked about their antidepressant intake during pregnancy and assessed on antenatal depression symptoms using the Edinburgh Postnatal Depression Scale. Antidepressant use data were also compared to population-level data from Statistics New Zealand's Integrated Data Infrastructure. RESULTS Antidepressant prevalence across pregnancy was 3.2%, with a 2.7% prevalence in trimester one and 2.6% following the first trimester. There was no significant difference in usage within age bands and area-level deprivation quintiles. Ethnicity-specific data revealed that Pasifika and Asian ethnicities had the lowest antidepressant use, and New Zealand Europeans the highest. The rate of unmedicated depression, where women met the Edinburgh Postnatal Depression Scale criteria for significant depressive symptoms but did not receive antidepressants during pregnancy, was 11.8%, indicating that antenatal depression treatment may be inadequate. Greater rates of unmedicated depression were seen for younger women (⩽24 years), those living in high deprivation areas and mothers of Pasifika, Asian and Māori ethnicities. CONCLUSIONS Antenatal antidepressant use in New Zealand follows global prevalence estimates and highlights possible undertreatment of antenatal depression in New Zealand. Future research including other treatment types (e.g. behavioural therapy) is needed to evaluate whether undertreatment occurs across all treatment options.
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Affiliation(s)
- Charlotte A Svardal
- School of Psychology, Faculty of Science, The University of Auckland, Auckland, New Zealand
| | - Karen Waldie
- School of Psychology, Faculty of Science, The University of Auckland, Auckland, New Zealand.,Centre for Longitudinal Research-He Ara ki Mua, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Barry Milne
- COMPASS Research Centre, Faculty of Arts, The University of Auckland, Auckland, New Zealand.,School of Social Sciences, Faculty of Arts, The University of Auckland, Auckland, New Zealand.,A Better Start National Science Challenge, New Zealand
| | - Susan Mb Morton
- Centre for Longitudinal Research-He Ara ki Mua, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Stephanie D'Souza
- COMPASS Research Centre, Faculty of Arts, The University of Auckland, Auckland, New Zealand.,School of Social Sciences, Faculty of Arts, The University of Auckland, Auckland, New Zealand.,A Better Start National Science Challenge, New Zealand
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11
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Theunissen G, D'Souza S, Peterson ER, Walker C, Morton SMB, Waldie KE. Prenatal determinants of depressive symptoms in childhood: Evidence from Growing Up in New Zealand. J Affect Disord 2022; 302:41-49. [PMID: 35074461 DOI: 10.1016/j.jad.2022.01.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Young people who experience depression are at an increased risk of adverse psychosocial and developmental outcomes that can persist over the lifecourse. Identifying maternal prenatal risk factors that may contribute to childhood depressive symptoms can be useful when considering mental health intervention. METHODS The current study included 3,925 children from the Growing Up in New Zealand (GUiNZ) study who had complete data for self-reported depressive symptoms and mothers' antenatal information. Depressive symptoms were measured at age 8 using the Centre for Epidemiological Studies Depression Scale for Children (CESD-10) short form questionnaire. Hierarchical linear regression was used to determine the relationship between prenatal factors and depressive symptoms at age 8. RESULTS When controlling for sociodemographic characteristics, our hierarchical linear regression revealed that the most significant maternal prenatal predictors of high depressive symptoms at age 8 were maternal perceived stress, smoking during pregnancy, body mass index (BMI) in the overweight/obese range, and paracetamol intake. LIMITATIONS One limitation with the current study was a reduction in the sample due to attrition. This may have affected our statistical power, reflected in our modest effect sizes. The sample remained both socioeconomically and ethnically diverse, however our results should be interpreted with respect to the sample and not the whole New Zealand population. CONCLUSIONS A combination of maternal mental health and lifestyle factors contribute to depressive symptoms for children, possibly through foetal programming. Our results emphasise the importance of mental and physical health support for expectant mothers.
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Affiliation(s)
- Gisela Theunissen
- School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Stephanie D'Souza
- Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; School of Social Sciences, The University of Auckland, Auckland, New Zealand; A Better Start National Science Challenge, New Zealand
| | - Elizabeth R Peterson
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Caroline Walker
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand.
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Barber CC, Masters-Awatere B. Positively Pregnant: Development and piloting of a mobile app for social and emotional well-being in pregnancy. Appl Psychol Health Well Being 2021; 14:1255-1272. [PMID: 34959260 DOI: 10.1111/aphw.12333] [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: 06/14/2021] [Accepted: 12/12/2021] [Indexed: 11/27/2022]
Abstract
This paper describes development of a mobile e-health application, Positively Pregnant, which provides tools to meet the psychological challenges of pregnancy and transition to parenthood. Positively Pregnant was developed with input from maternity carers and consumers, incorporating local cultures and contexts as well as international research on effective interventions for stress management and mental well-being. The prototype app was piloted with 88 New Zealand women. Participants in the pilot used an average of 11.96 (SD = 7.44) components, and most were satisfied (45.1%) or neutral (40.3%) regarding the app. For 23 of the 26 interactive components, the majority of those who tried the component reported that they found it helpful. Participants reported a significant reduction in subjective stress (η2 = .088, p = .023). Feedback from pilot participants was incorporated in a version of the app that was publically launched as a free tool to support developing families. Mobile e-health applications are a promising medium for providing preventative interventions and psychoeducation about the social and emotional challenges of pregnancy and early parenting; Positively Pregnant is an example of a tool, grounded in strength-based, empirically supported strategies, to provide parents with support and information at this critical time.
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13
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Farewell CV, Donohoe R, Thayer Z, Paulson J, Nicklas J, Walker C, Waldie K, Leiferman JA. Maternal depression trajectories and child BMI in a multi-ethnic sample: a latent growth modeling analysis. BMC Pregnancy Childbirth 2021; 21:827. [PMID: 34903186 PMCID: PMC8667413 DOI: 10.1186/s12884-021-04308-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perinatal (antenatal and postpartum) depression impacts approximately 12% of mothers. Perinatal depression can impact everyday functioning for mothers, and the relationship with, and development of, their children. The purpose of this study was to investigate depression trajectories from the antenatal period through 54-months postpartum and associations with child body mass index at 54-months postpartum. METHODS This study applied latent growth modeling to the Growing Up in New Zealand study, which is a longitudinal pregnancy cohort study that provides nationally representative-level data, to investigate associations between depression at three time points (antenatal, 9-months postpartum, 54-months postpartum) and child body mass index at 54-months (n=4897). RESULTS The average slope of depression for this sample is low and decreases over time. When child BMI was added to the model as an outcome variable, both antenatal depression (B=.25, p<.01), and the rate of change of depression across the perinatal and postpartum periods (B=.09, p<.01) were associated with child BMI at 54-months postpartum. After controlling for sociodemographic characteristics, antenatal depression, but not the slope of depression, remained significantly associated with child BMI (B=.05, p<.05). When controlling for maternal pre-pregnancy BMI the effect of antenatal depression on child BMI at 54-months was entirely attenuated (χ2 (9) = 39.60, p < .05, SRMR = 0.01, CFI = .99, RMSEA = 0.03, BIC=53213). CONCLUSIONS Our findings align with the Developmental Origins of Health and Disease theory and imply that both the physical and mental health of mothers during pregnancy may be important indicators of child growth and development outcomes. Early intervention directed towards women who have even mild depression scores during pregnancy may promote healthy child development outcomes. Additionally, given the heterogeneity of depressive symptoms over time seen in this study, multiple assessment periods across the postpartum period may be valuable to adequately address and support maternal mental health.
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Affiliation(s)
- Charlotte V Farewell
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado - Anschutz Medical Campus, 13001 East 17th place Mail Stop B119, Aurora, CO, 80045, USA.
| | - Ryley Donohoe
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado - Anschutz Medical Campus, 13001 East 17th place Mail Stop B119, Aurora, CO, 80045, USA
| | | | - James Paulson
- Old Dominion University, Norfolk University, Norfolk, VA, USA
| | - Jacinda Nicklas
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado - Anschutz Medical Campus, 13001 East 17th place Mail Stop B119, Aurora, CO, 80045, USA
| | | | | | - Jenn A Leiferman
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado - Anschutz Medical Campus, 13001 East 17th place Mail Stop B119, Aurora, CO, 80045, USA
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14
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Parity and Psychosocial Risk Factors Increase the Risk of Depression During Pregnancy Among Recent Immigrant Women in Canada. J Immigr Minor Health 2021; 24:570-579. [PMID: 34595614 DOI: 10.1007/s10903-021-01284-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
Prior investigations have examined risk factors associated to postpartum depression in immigrant women, but depression during pregnancy has received less attention. This study describes the prevalence and early determinants of antenatal depression among recent (≤ 5 years) and long-term immigrants (> 5 years), compared to Canadian-born women. 503 women completed standardized self-report questionnaires measuring sociodemographics and psychosocial factors. Multivariate logistic regressions identified first trimester risk factors for depression in each immigrant group. The prevalence of depressive symptoms was highest for recent immigrant (25.3-30.8%) compared to long-term immigrant (16.9-19.2%) and Canadian-born women (11.7-13.8%). Among recent immigrants, multiparity, higher stress and pregnancy-specific anxiety in early pregnancy increased the risk of antenatal depression. Among long-term immigrants, stress in the first trimester was significantly associated with antenatal depressive symptoms. Knowledge of modifiable risk factors (pregnancy-specific anxiety and stress) may help improve antenatal screening and inform the development of tailored interventions to meet the mental health needs of immigrant women during the perinatal period.
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Míguez MC, Vázquez MB. Risk factors for antenatal depression: A review. World J Psychiatry 2021; 11:325-336. [PMID: 34327125 PMCID: PMC8311510 DOI: 10.5498/wjp.v11.i7.325] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/20/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Depression is the most prevalent mental disorder in pregnancy, and yet it is less studied than postpartum depression despite the consequences it may have on both the pregnant woman and her offspring. Therefore, it would be important to know which risk factors may favour the appearance of antenatal depression in order to carry out appropriate prevention interventions. The aim of the present review was to identify the main risk factors of antenatal depression. We searched in databases PubMed and PsycINFO for articles published about the factors associated with antenatal depression from January 2010 through December 2020. The literature review identified three main groups of antenatal depression risk factors: sociodemographic, obstetric, and psychological. First, among the sociodemographic variables, the low level of studies and the economic income clearly stood out from the rest. Then, not having planned the pregnancy was the main obstetric variable, and finally, the main psychological risk factors were having a history of psychological disorders and/or depression as well as presenting anxiety, stress, and/or low social support during pregnancy. This review shows that the antenatal depression is affected by multiple factors. Most can be identified at the beginning of the pregnancy, and some are risk factors potentially modifiable through appropriate interventions, such as psychological factors. For this reason, it is important to carry out a good screening for depression during pregnancy and consequently, be able to prevent its appearance or treat it if necessary.
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Affiliation(s)
- M Carmen Míguez
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Santiago de Compostela 15782, Spain
| | - M Belén Vázquez
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Santiago de Compostela 15782, Spain
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16
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Míguez MC, Vázquez MB. Prevalence of Depression during Pregnancy in Spanish Women: Trajectory and Risk Factors in Each Trimester. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6789. [PMID: 34202666 PMCID: PMC8297098 DOI: 10.3390/ijerph18136789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 01/14/2023]
Abstract
The aims of this research were to determine the trajectories of probable depression and major depression during pregnancy and to identify the associated and predictor variables (sociodemographic, pregnancy-related, and psychological) for both conditions in each trimester of pregnancy. A longitudinal study was carried out with 569 pregnant Spanish women who were assessed in the first, second, and third trimesters of pregnancy. Depression was assessed using the Edinburgh Postnatal Depression Scale and a clinical interview. Measures of anxiety and stress were also included. The prevalence of probable depression in the first, second, and third trimesters was 23.4%, 17.0%, and 21.4%, respectively, and that of major depression was 5.1%, 4.0%, and 4.7%. Thus, the prevalence of both conditions was the highest in the first and third trimesters. The trajectories of probable depression and major depression followed the same pattern throughout pregnancy. All of the psychological variables studied were associated with both conditions in all three trimesters, with perceived stress being a predictor at all times. The association between the other variables and both conditions of depression was similar. Two exceptions stand out: having had previous miscarriages, which was only associated with probable depression and was also a predictor, in the first trimester; and complications during pregnancy, which was only associated with probable and major depression in the third trimester. These findings should be taken into account in routine pregnancy follow-ups, and necessary interventions should be started in the first trimester.
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Affiliation(s)
- M. Carmen Míguez
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain;
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17
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Chan AW, Reid C, Skeffington P, Marriott R. A systematic review of EPDS cultural suitability with Indigenous mothers: a global perspective. Arch Womens Ment Health 2021; 24:353-365. [PMID: 33245435 PMCID: PMC8116293 DOI: 10.1007/s00737-020-01084-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/12/2020] [Indexed: 12/20/2022]
Abstract
The Edinburgh Postnatal Depression Scale (EPDS) is used extensively as the "gold standard" perinatal depression and anxiety screening tool. This study contributes to an emerging discussion about the tool's shortcomings, specifically around cultural suitability for use with Indigenous women. A systematic search was conducted in ProQuest, PsycINFO, MEDLINE (Web of Science), PubMed, Scopus, Informit, and CINAHL research databases, and grey literature. The quality of the body of evidence was assessed using the NHMRC Level of Evidence framework. Three studies supported the cultural validation of the EPDS with Indigenous groups in Canada (n = 2) and the USA (n = 1). The remaining eleven Australian studies demonstrated that cultural concerns were suggested by either Indigenous mothers, healthcare professionals (Indigenous and non-Indigenous), or both, though cultural concerns were more weighted from the perspectives of healthcare professionals. The quality of the evidence was not strong, and thus, there is a critical and urgent need for targeted research in this area. This review identified and recommended Indigenous-specific methodologies that can be adopted for more trustworthy, culturally safe, and effective research in this area. Given that the EPDS is currently considered gold standard in routine perinatal mental health screening practice in countries around the world, these findings raise significant concerns. Using culturally relevant research methodologies, such as the use of mixed-methods design, could lay stronger groundwork for further investigation of the broader utility and cultural relevance of the tool.
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Affiliation(s)
- Ai Wen Chan
- School of Psychology, Exercise Science, Chiropractic & Counselling, Murdoch University, Perth, Australia.
| | - Corinne Reid
- Victoria University, Melbourne, Australia.
- Global Health Academy, The University of Edinburgh, Edinburgh, Scotland.
| | - Petra Skeffington
- Psychology, Exercise Science, Chiropractic & Counselling, Murdoch University, Perth, Australia
| | - Rhonda Marriott
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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18
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Donald S, Sharples K, Barson D, Horsburgh S, Parkin L. Antidepressant dispensing before, during, and after pregnancy in New Zealand, 2005-2014. Aust N Z J Obstet Gynaecol 2021; 61:837-845. [PMID: 33908042 DOI: 10.1111/ajo.13352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/14/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Depression during pregnancy is associated with a number of negative impacts on maternal and infant health, therefore good control of depression in pregnant women is crucial. There is a lack of population-level information about patterns of antidepressant use during pregnancy in New Zealand. AIM To describe antidepressant dispensing patterns before, during, and after pregnancy in New Zealand, 2005-2014. MATERIALS AND METHODS Antidepressant dispensing records from 270 days prior to pregnancy through to 360 days after pregnancy end were linked with 805 990 pregnancies in the New Zealand Pregnancy Cohort. Proportions (and 95% confidence intervals) with at least one dispensing were calculated for the periods before, during, and after pregnancy and compared over time and by maternal characteristics. RESULTS Dispensing during the first trimester was lower than in the pre-pregnancy and post-pregnancy periods, and dropped further in later trimesters. The proportion of pregnancies during which an antidepressant was dispensed rose from 3.1 to 4.9% over the study years. Around 80% of those with a dispensing received a selective serotonin reuptake inhibitor. Dispensing before, during, and after pregnancy varied by ethnicity, age, smoking status, and body mass index. Among women taking an antidepressant before pregnancy, younger women and those of Māori, Pacific, or Asian ethnicity were less likely to continue therapy during pregnancy. CONCLUSIONS This study has established a baseline for antidepressant use around pregnancy in New Zealand, documented increasing use over time, and demonstrated that known ethnic differences in antidepressant use are also evident in the pregnant population.
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Affiliation(s)
- Sarah Donald
- Pharmacoepidemiology Research Network, Dunedin, New Zealand.,Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Pharmacoepidemiology Research Network, Dunedin, New Zealand.,Department of Mathematics and Statistics, University of Otago, Dunedin, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Dave Barson
- Pharmacoepidemiology Research Network, Dunedin, New Zealand.,Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Simon Horsburgh
- Pharmacoepidemiology Research Network, Dunedin, New Zealand.,Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Lianne Parkin
- Pharmacoepidemiology Research Network, Dunedin, New Zealand.,Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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19
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Bird AL, Underwood L, Berry S, Grant CC, Gulliver P, Fanslow J, Atatoa Carr PE, Fa'alili-Fidow J, Morton SMB. Physical Conflict During Pregnancy: A Socioecological, Cross-Cultural Examination of Risk and Protective Factors for New Zealand Women. Violence Against Women 2020; 27:1930-1956. [PMID: 33263502 DOI: 10.1177/1077801220971356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Participants were 5,831 women in their third trimester of pregnancy, part of a large, longitudinal, pre-birth national cohort study. Women reported on their experience of pushing and shoving, throwing or breaking objects within their relationship over the past month. Univariable regression models examined the association of a large number of potential risk and protective factors. Those significant at the univariable level were carried forward into final multivariable analyses, stratified by New Zealand's four main ethnic groups: European, Māori, Pacific, and Asian peoples. Relationship commitment, reduced family cohesion, and perceived stress were associated with increased risk across ethnic groups.
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Affiliation(s)
- Amy L Bird
- University of Waikato, Hamilton, New Zealand
| | | | | | - Cameron C Grant
- University of Auckland, New Zealand.,Starship Children's Hospital, Auckland, New Zealand
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20
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Bradley HA, Campbell SA, Mulder RT, Henderson JMT, Dixon L, Boden JM, Rucklidge JJ. Can broad-spectrum multinutrients treat symptoms of antenatal depression and anxiety and improve infant development? Study protocol of a double blind, randomized, controlled trial (the 'NUTRIMUM' trial). BMC Pregnancy Childbirth 2020; 20:488. [PMID: 32842983 PMCID: PMC7448485 DOI: 10.1186/s12884-020-03143-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 07/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Untreated antenatal depression and anxiety can be associated with short and long term health impacts on the pregnant woman, her infant and the rest of the family. Alternative interventions to those currently available are needed. This clinical trial aims to investigate the efficacy and safety of a broad-spectrum multinutrient formula as a treatment for symptoms of depression and anxiety in pregnant women and to determine the impact supplementation has on the general health and development of the infant. METHODS This randomised, controlled trial will be conducted in Canterbury, New Zealand between April 2017 and June 2022. One hundred and twenty women aged over 16 years, between 12 and 24 weeks gestation and who score ≥ 13 on the Edinburgh Postnatal Depression Scale (EPDS) will be randomly assigned to take the intervention (n = 60) or an active control formula containing iodine and riboflavin (n = 60) for 12 weeks. After 12 weeks, participants can enter an open-label phase until the birth of their infant and naturalistically followed for the first 12 months postpartum. Infants will be followed until 12 months of age. Randomisation will be computer-generated, with allocation concealment by opaque sequentially numbered envelopes. Participants and the research team including data analysts will be blinded to group assignment. The EPDS and the Clinical Global Impressions Scale of Improvement (CGI-I) will be the maternal primary outcome measures of this study and will assess the incidence of depression and anxiety and the improvement of symptomatology respectively. Generalized linear mixed effects regression models will analyse statistical differences between the multinutrient and active control group on an intent-to-treat basis. A minimum of a three-point difference in EPDS scores between the groups will identify clinical significance. Pregnancy outcomes, adverse events and side effects will also be monitored and reported. DISCUSSION Should the multinutrient formula be shown to be beneficial for both the mother and the infant, then an alternative treatment option that may also improve the biopsychosocial development of their infants can be provided for pregnant women experiencing symptoms of depression and anxiety. TRIAL REGISTRATION Trial ID: ACTRN12617000354381 ; prospectively registered at Australian New Zealand Clinical Trials Registry on 08/03/2017.
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Affiliation(s)
- Hayley A. Bradley
- School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8041 New Zealand
| | - Siobhan A. Campbell
- School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8041 New Zealand
| | - Roger T. Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jaqueline M. T. Henderson
- School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8041 New Zealand
| | - Lesley Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - Joseph M. Boden
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Julia J. Rucklidge
- School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8041 New Zealand
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21
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Russell J, Grant CC, Morton SMB. Multimorbidity in Early Childhood and Socioeconomic Disadvantage: Findings From a Large New Zealand Child Cohort. Acad Pediatr 2020; 20:619-627. [PMID: 31574311 DOI: 10.1016/j.acap.2019.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE In contrast with multimorbidity during adulthood, the relationship of childhood multimorbidity with socioeconomic position (SEP) is poorly understood. We aimed to describe early childhood multimorbidity and investigate the relationship of this with SEP. METHODS Within a diverse prospective child cohort study, we determined associations of SEP with multimorbidity (defined as the presence of 2 or more chronic conditions) at age 2 years. Maternal SEP was ranked into 5 categories using an index constructed from variables collected antenatally describing maternal education, employment, financial stress, beneficiary status, housing tenure, overcrowding, and residential mobility. Missing values were handled using multiple imputation with chained equations. Independent associations of SEP with multimorbidity were described using adjusted odds ratios (OR) and 95% confidence intervals (CI). RESULTS Of the 6822 women and 6853 children who were enrolled into the cohort study, 5737 (84%) mother-child dyads had complete antenatal data and were interviewed at age 2 years. Of these 5737, for 3826 (67%) dyads, there were complete data for all variables. Multimorbidity was present in 374/3838 (9.7%) of the cohort children. After multiple imputation and adjustment for maternal ethnicity, smoking, poor health, depressive symptoms, and child gender, the odds of multimorbidity being present were increased for children of mothers in the most (OR 1.74, 95% CI 1.16-2.59) and second most (OR 1.43, 95% CI 1.00-2.04) versus the least disadvantaged group. CONCLUSION The odds of multimorbidity are increased for children whose mothers have lower SEP. Cumulative socioeconomic disadvantage increases the potential for a chronic illness trajectory to develop in early childhood.
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Affiliation(s)
- Jin Russell
- Centre for Longitudinal Research-He Ara Ki Mua, University of Auckland (J Russell and SMB Morton), Auckland, New Zealand.
| | - Cameron C Grant
- School of Medicine, University of Auckland (CC Grant), Auckland, New Zealand
| | - Susan M B Morton
- Centre for Longitudinal Research-He Ara Ki Mua, University of Auckland (J Russell and SMB Morton), Auckland, New Zealand
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Effects of Home Language Environment and Household Crowding on Early Expressive Language Development. J Dev Behav Pediatr 2020; 41:289-298. [PMID: 31851080 DOI: 10.1097/dbp.0000000000000764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study examined prospective associations of the home language environment (HLE) and household crowding with expressive language development in 2-year-old children using the data from the Growing Up in New Zealand study, a population-based prospective cohort study. METHODS A total of 5960 children were included. The HLE (playing games, talking in everyday activities, playing with toys, singing songs, and reading books) and household crowding were measured when the children were 9 months old. Language development was assessed using the MacArthur-Bates Communicative Development Inventories (CDIs)-II short form (A) at age 2 years. Maternal and child characteristics were measured antenatally and when the children were 9 months old. RESULTS Each HLE activity was associated with higher language scores. A high HLE score, defined as doing at least 3 of the 5 HLE activities at least once daily, was associated with an increase in the language score of 6.31 units (95% confidence interval [CI] 5.00 to 7.62, p < 0.0001). The effect of the HLE was less pronounced in more crowded homes (coefficient = -2.24, 95% CI -0.47 to 4.97, p = 0.106) compared with less crowded homes with at least one other child (coefficient = 6.19, 95% CI 4.28 to 8.10, p < 0.0001) or with no other children (coefficient = 8.19, 95% CI 5.69 to 10.70, p < 0.0001). CONCLUSION These findings underscore the need to consider various aspects of the home environment in future interventions aiming to facilitate language development in young children.
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Dovey S. From the Editor: The essence of primary health care research. J Prim Health Care 2020; 11:85-86. [PMID: 32171349 DOI: 10.1071/hcv11n2_ed1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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McDaid F, Underwood L, Fa Alili-Fidow J, Waldie KE, Peterson ER, Bird A, D Souza S, Morton S. Antenatal depression symptoms in Pacific women: evidence from Growing Up in New Zealand. J Prim Health Care 2020; 11:96-108. [PMID: 32171352 DOI: 10.1071/hc18102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/23/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pacific women in New Zealand (NZ) have higher rates of antenatal depression than women from other ethnic groups. AIM To identify factors that are significantly associated with depression symptoms in pregnant Pacific women living in NZ. METHODS Data were collected from 5657 pregnant women, 727 of whom identified their ethnicity as Pacific Island. Antenatal depression symptoms were measured using the Edinburgh Depression Scale with scores above 12 indicating elevated antenatal depression symptoms (ADS). RESULTS Pacific women had significantly higher rates of ADS than non-Pacific women, with 23% of pregnant Pacific women experiencing ADS. Factors associated with ADS for Pacific women included age <25 years, moderate to severe nausea during pregnancy, perceived stress, family stress and relationship conflict. Not seeing the importance of maintaining one's Pacific culture and traditions and negative feelings towards NZ culture were also significantly associated with ADS in Pacific women. One in three Pacific women aged <25 years experienced ADS. Pregnant Pacific women without a family general practitioner (GP) before their pregnancy were 4.5-fold more likely to experience ADS than non-Pacific women with a regular GP. DISCUSSION Further attention is required to providing appropriate primary health care for Pacific women of child-bearing age in NZ. Better screening processes and a greater understanding of effective antenatal support for Pacific women is recommended to respond to the multiple risk factors for antenatal depression among Pacific women.
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Affiliation(s)
- Frances McDaid
- Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Auckland, New Zealand
| | - Lisa Underwood
- School of Population Health, University of Auckland, PO Box 18288, Auckland, 1743, New Zealand; and Corresponding author.
| | - Jacinta Fa Alili-Fidow
- Centre for Longitudinal Research, University of Auckland, PO Box 18288, Auckland 1743, New Zealand
| | - Karen E Waldie
- School of Psychology, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Elizabeth R Peterson
- School of Psychology, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Amy Bird
- School of Psychology, University of Wollongong, Northfields Ave, NSW 2522, Australia
| | - Stephanie D Souza
- COMPASS Research Centre, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Susan Morton
- School of Population Health, University of Auckland, PO Box 18288, Auckland, 1743, New Zealand; and Centre for Longitudinal Research, University of Auckland, PO Box 18288, Auckland 1743, New Zealand
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Kim Y, Bird A, Peterson E, Underwood L, Morton SMB, Grant CC. Maternal Antenatal Depression and Early Childhood Sleep: Potential Pathways Through Infant Temperament. J Pediatr Psychol 2020; 45:203-217. [DOI: 10.1093/jpepsy/jsaa001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 12/10/2019] [Accepted: 01/10/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Maternal depression is associated with infant and child sleep patterns, and with infant temperament. Here, we examine whether infant temperament mediated an association between maternal antenatal depression and toddler sleep.
Method
Within the prebirth longitudinal cohort Growing Up in New Zealand, symptoms of antenatal and postnatal depression were measured in 5,568 women using the Edinburgh Postnatal Depression Scale (EPDS). Infant temperament was measured at age 9 months using the Very Short Form of Infant Behavior Questionnaire-Revised (IBQ-R VSF). Sleep duration and nighttime awakenings were reported by parents when children were 2 years old.
Results
Independent associations of maternal depression with child sleep patterns at age 2 years, adjusted for maternal demographics, physical health, family relationships, and child health and feeding, were determined using multivariate logistic regression analysis. The odds of having ≥2 nighttime awakenings were increased for children whose mothers had antenatal (1.36, 1.07–1.73) but not postnatal (1.22, 0.88–1.68) or both antenatal and postnatal depression (0.89, 0.56–1.36). There was no association of maternal depression with shorter sleep duration. Two of five dimensions of infant temperament (fear and negative affect) were associated with both antenatal depression scores and increased nighttime awakenings. Mediation analyses controlling for postnatal depression and other predictors of child sleep supported an indirect pathway of antenatal depression to child sleep through infant temperamental negative affectivity.
Conclusion
Antenatal depression is independently associated with more frequent nighttime awakenings in early childhood. Findings support an indirect pathway through infant negative affect characteristics.
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Affiliation(s)
| | - Amy Bird
- University of Waikato
- University of Auckland
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Probiotics and Maternal Mental Health: A Randomised Controlled Trial among Pregnant Women with Obesity. Sci Rep 2020; 10:1291. [PMID: 31992802 PMCID: PMC6987087 DOI: 10.1038/s41598-020-58129-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/20/2019] [Indexed: 12/20/2022] Open
Abstract
Poor maternal mental health has been associated with a myriad of pregnancy and child health complications. Obesity in pregnancy is known to increase one’s risk of experiencing poor maternal mental health and associated physical and mental health complications. Probiotics may represent a novel approach to intervene in poor mental health and obesity. We conducted this pre-specified secondary analysis of the Healthy Mums and Babies (HUMBA) randomised controlled trial to investigate whether probiotics would improve maternal mental health outcomes up to 36 weeks of pregnancy. Two-hundred-and-thirty pregnant women with obesity (BMI ≥ 30.0 kg/m2) were recruited and randomised to receive probiotic (Lactobacillus rhamnosus GG and Bifidobacterium lactis BB12, minimum 6.5 × 109 CFU) or placebo capsules. Depression, anxiety, and functional health and well-being were assessed at baseline (120−176 weeks’ gestation) and 36 weeks of pregnancy. Depression scores remained stable and did not differ between the probiotic (M = 7.18, SD = 3.80) and placebo groups (M = 6.76, SD = 4.65) at 36 weeks (p-values > 0.05). Anxiety and physical well-being scores worsened over time irrespective of group allocation, and mental well-being scores did not differ between the two groups at 36 weeks. Probiotics did not improve mental health outcomes in this multi-ethnic cohort of pregnant women with obesity.
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D'Souza S, Crawford CN, Buckley J, Underwood L, Peterson ER, Bird A, Morton SMB, Waldie KE. Antenatal determinants of early childhood talking delay and behavioural difficulties. Infant Behav Dev 2019; 57:101388. [PMID: 31634704 DOI: 10.1016/j.infbeh.2019.101388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 11/26/2022]
Abstract
The determinants of talking delay alone or its comorbidity with behavioural difficulties was examined in 5768 two-year-old members of the Growing Up in New Zealand longitudinal study. Using the MacArthur-Bates Communicative Development inventories and the total difficulties score from the preschool Strengths and Difficulties Questionnaire, a composite measure was created so that children were categorised as showing no language or behavioural concerns (72.5%), behavioural only difficulties (6.1%), language only difficulties (18.1%), and comorbid language and behavioural difficulties (3.3%). Analyses revealed that antenatal factors such as maternal perceived stress, inadequate folate intake, vitamin intake, alcohol consumption during the first trimester and maternal smoking all had a significant effect on child outcomes. In particular, low multivitamin intake and perceived stress during pregnancy were associated with coexisting language and behavioural difficulties. These findings support international research in showing that maternal factors during pregnancy are associated with developmental outcomes in the early childhood period, and demonstrate these associations within a NZ context. Interventions which address maternal stress management and health behaviours during pregnancy could be beneficial to offspring development.
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Affiliation(s)
- Stephanie D'Souza
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; Centre of Methods and Policy Application in the Social Sciences, University of Auckland, Auckland, New Zealand
| | | | - Jude Buckley
- School of Psychology, The University of Auckland, Auckland, New Zealand
| | - Lisa Underwood
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Elizabeth R Peterson
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Amy Bird
- School of Psychology, University of Wollongong, NSW, Australia
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand; School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- School of Psychology, The University of Auckland, Auckland, New Zealand; Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand.
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Naja S, Al-Kubaisi N, Chehab M, Al-Dahshan A, Abuhashem N, Bougmiza I. Psychometric properties of the Arabic version of EPDS and BDI-II as a screening tool for antenatal depression: evidence from Qatar. BMJ Open 2019; 9:e030365. [PMID: 31519679 PMCID: PMC6747648 DOI: 10.1136/bmjopen-2019-030365] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The current study aimed to validate and determine the psychometric properties of the Arabic versions of the Beck Depression Inventory-II (BDI-II) and the Edinburgh Postnatal Depression Scale (EPDS) in Qatar. DESIGN A cross-sectional study design was employed. SETTING Antenatal care (ANC) clinics at nine primary healthcare centres. PARTICIPANTS Pregnant women (n=128) aged 15-46 years in different trimesters of pregnancy, attending the ANC clinics as well as capable of reading and writing in the Arabic language. RESULTS A total of 128 participants were enrolled. On conducting the receiver operating characteristic (ROC) analysis, the EPDS showed a larger area under the curve at 0.951 than the BDI-II tool (0.912). Using Youden's index, a score >13 on the EPDS (87% sensitivity, 90% specificity) and >19 on the BDI-II (96% sensitivity, 73% specificity) allowed for the greatest division between depressed and non-depressed participants. CONCLUSION To address the under-recognition of antenatal depression, physicians at primary healthcare centres in Qatar should be encouraged to utilise the EPDS to screen pregnant women seeking ANC services.
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Affiliation(s)
- Sarah Naja
- Community Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Noora Al-Kubaisi
- Community Medicine, Primary Health Care Corporation, Doha, Qatar
| | - Mohamad Chehab
- Community Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Nada Abuhashem
- Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Iheb Bougmiza
- Community Medicine, Primary Health Care Corporation, Doha, Qatar
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29
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Maternal perinatal mental health: Associations with bonding, mindfulness, and self‐criticism at 18 months’ postpartum. Infant Ment Health J 2019; 41:69-81. [DOI: 10.1002/imhj.21827] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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30
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Vázquez MB, Míguez MC. Validation of the Edinburgh postnatal depression scale as a screening tool for depression in Spanish pregnant women. J Affect Disord 2019; 246:515-521. [PMID: 30599376 DOI: 10.1016/j.jad.2018.12.075] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/10/2018] [Accepted: 12/23/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Edinburgh Postnatal Depression Scale (EPDS) is a self-reported scale designed to detect postnatal depression, and also has been validated in multiple countries for its use during pregnancy, but not in Spain. The objective of this study was to validate the EPDS as a screening instrument to detect depression during different trimesters of pregnancy in Spanish women. METHODS Longitudinal study of a large, unselected sample of 569 pregnant women who were assessed in the first, second and third trimesters of pregnancy by using the EPDS and the Structured Clinical Interview for DSM-IV (SCID). We evaluated the area under the ROC curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy (OA). RESULTS The optimal cut-off point score of the EPDS for screening current SCID diagnosis of combined depression was 9 or more in the first trimester of pregnancy (AUC of 0.76, sensitivity of 67.5%, specificity of 70.9%, PPV of 14.9%, NPV of 96.7%; and OA of 70.7%) and 10 or more in the second and third trimesters of pregnancy (AUC of 0.89 and 0.89, respectively; sensitivity of 81.5% and 78.1%, respectively; specificity of 86.0% and 81.9, respectively; PPV of 23.4% and 21.6%, respectively; NPV of 98.9% and 98.3, respectively; and OA 85.8% and 81.7%, respectively). Likewise, the optimal cut-off point score during pregnancy was 10 or more (AUC of 0.76, sensitivity of 72.4%, specificity of 79.3%, PPV of 18.2%, NPV of 97.8%, and OA of 78.9%). LIMITATIONS This study is limited due to the low rate of depression cases. CONCLUSIONS EPDS is an adequate instrument for screening depression in Spanish pregnant women.
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Affiliation(s)
- M Belén Vázquez
- Faculty of Psychology, Universidade de Santiago de Compostela, Spain
| | - M Carmen Míguez
- Faculty of Psychology, Universidade de Santiago de Compostela, Spain.
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D'Souza S, Waldie KE, Peterson ER, Underwood L, Morton SMB. Antenatal and Postnatal Determinants of Behavioural Difficulties in Early Childhood: Evidence from Growing Up in New Zealand. Child Psychiatry Hum Dev 2019; 50:45-60. [PMID: 29860616 DOI: 10.1007/s10578-018-0816-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Behavioural difficulties during early childhood have significant implications for multiple outcomes later in life. Child behavioural difficulties at 2 years of age (N = 6246) were assessed by mothers enrolled in a longitudinal, population-based New Zealand cohort study. 10.1% of children had total difficulties scores in the abnormal range on the preschool version of the Strengths and Difficulties Questionnaire. After controlling for maternal education, poverty, and child's birth age/weight, several antenatal and postnatal maternal health and family risk factors were significant for: (i) emotional problems (antenatal maternal perceived stress, lack of periconceptional folate, and moderate to severe maternal postnatal anxiety); (ii) hyperactivity-inattention (antenatal maternal perceived stress, mothers' antenatal exposure to secondhand smoke, moderate to severe maternal postnatal anxiety, and low maternal self-evaluation); (iii) conduct problems and total difficulties (antenatal maternal perceived stress, verbal inter-parental conflict and low maternal self-evaluation). The identification of risk and protective factors associated with early childhood difficulties are vital for guiding intervention and prevention efforts.
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Affiliation(s)
- Stephanie D'Souza
- School of Psychology, Faculty of Science, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.,Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- School of Psychology, Faculty of Science, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand. .,Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand.
| | - Elizabeth R Peterson
- School of Psychology, Faculty of Science, The University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.,Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Lisa Underwood
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- Centre for Longitudinal Research - He Ara ki Mua, The University of Auckland, Auckland, New Zealand.,School of Population Health, The University of Auckland, Auckland, New Zealand
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Chan JE, Samaranayaka A, Paterson H. Seasonal and gestational variation in perinatal depression in a prospective cohort in New Zealand. Aust N Z J Obstet Gynaecol 2018; 59:514-522. [PMID: 30374966 DOI: 10.1111/ajo.12912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/22/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perinatal depression has wide-ranging impacts on the health of mothers, babies and their families. Previously published data suggest seasonal variation in the prevalence of perinatal depression, as well as possible variation with gestation. AIMS To describe the prevalence of perinatal depression in a New Zealand population; to describe the trend in depression over gestational age; and to assess the influence of season on perinatal depression. MATERIALS AND METHODS We performed a secondary analysis of data from a prospective cohort of 260 women in Dunedin, New Zealand. Edinburgh Depression Scores were collected at four antenatal time points and at six months postpartum. RESULTS Prevalence of depression decreased from 8.1% to 4.6% antenatally, and to 6.6% postnatally, but the variation was non-significant. Prevalence was significantly higher in winter and spring antenatally (odds ratio (OR) 3.15, 95% CI 1.01-9.82 and OR 3.16, CI 1.05-9.55), and in spring postnatally (OR 8.40, 95% CI 1.01-69.52) compared to autumn. Antenatal depression was associated with poor sleep quality (OR 4.27, 95% CI 1.22-14.93), while postnatal depression was associated with caesarean delivery (OR 5.03, 95% CI 1.29-19.64). CONCLUSIONS This is the first NZ cohort to assess depression over multiple antenatal and postnatal time points. A significantly higher rate of depression was identified in winter and spring antenatally and in spring postnatally, corresponding to a higher risk of postnatal depression with autumn deliveries. These findings should prompt greater awareness at these higher risk time periods.
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Affiliation(s)
- Johanna E Chan
- Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand.,Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Ari Samaranayaka
- Biostatistics Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Helen Paterson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Pampaka D, Papatheodorou SI, AlSeaidan M, Al Wotayan R, Wright RJ, Buring JE, Dockery DW, Christophi CA. Depressive symptoms and comorbid problems in pregnancy - results from a population based study. J Psychosom Res 2018; 112:53-58. [PMID: 30097136 DOI: 10.1016/j.jpsychores.2018.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To estimate the prevalence of antenatal depressive symptoms, identify relevant risk factors, and assess comorbid mental health problems, among pregnant women enrolled in a population based study. METHODS This was a secondary analysis of data collected from 1916 pregnant women who participated in the TRansgenerational Assessment of Children's Environmental Risk (TRACER) study in Kuwait, and had answered the Baseline Questionnaire and completed the Edinburgh Depression Scale (EDS). Logistic regression models were used to examine the association of depressive symptoms with baseline socio-demographic characteristics and psychosocial indicators. RESULTS The prevalence of antenatal depressive symptoms, using a cut-off of EDS score ≥ 10, was 20.1%. Depressive symptoms were reported more by women of lower family income and had self-reported history of depression prior to pregnancy, with women in the third trimester having higher odds of antenatal depressive symptoms compared to those in the second trimester. Pregnancy-related anxiety, higher perceived stress levels, and post-traumatic stress disorder symptoms were comorbid with the presence of depressive symptoms. CONCLUSION The findings showed that one in five pregnant women in Kuwait experiences antenatal depressive symptoms and that these symptoms are comorbid with other mental health problems. Screening for antenatal depression and providing support to pregnant women should be considered.
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Affiliation(s)
- Despina Pampaka
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus.
| | - Stefania I Papatheodorou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | | | | | - Rosalind J Wright
- Department of Pediatrics, Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julie E Buring
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Douglas W Dockery
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Costas A Christophi
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Moore D, Ayers S, Drey N. The City MISS: development of a scale to measure stigma of perinatal mental illness. J Reprod Infant Psychol 2018. [PMID: 29517314 DOI: 10.1080/02646838.2017.1313967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study aimed to develop and validate a scale to measure perceived stigma for perinatal mental illness in women. BACKGROUND Stigma is one of the most frequently cited barriers to seeking treatment and many women with perinatal mental illness fail to get the treatment they need. However, there is no psychometric scale that measures how women may experience the unique aspects of perinatal mental illness stigma. METHOD A draft scale of 30 items was developed from a literature review. Women with perinatal mental illness (n = 279) were recruited to complete the City Mental Illness Stigma Scale. Concurrent validity was measured using the Internalised Stigma of Mental Illness Scale. Factor analysis was used to create the final scale. RESULTS The final 15-item City Mental Illness Stigma Scale has a three-factor structure: perceived external stigma, internal stigma and disclosure stigma. The scale accounted for 54% of the variance and had good internal reliability and concurrent validity. CONCLUSION The City Mental Illness Stigma Scale appears to be a valid measure which provides a potentially useful tool for clinical practice and research in stigma and perinatal mental illness, including assessing the prevalence and characteristics of stigma. This research can be used to inform interventions to reduce or address the stigma experienced by some women with perinatal mental illness.
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Affiliation(s)
- Donna Moore
- a Centre for Maternal and Child Health, School of Health Sciences, City , University of London , London , UK
| | - Susan Ayers
- a Centre for Maternal and Child Health, School of Health Sciences, City , University of London , London , UK
| | - Nicholas Drey
- b School of Health Sciences, City , University of London , London , UK
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Nichani V, Dirks K, Burns B, Bird A, Grant C. Green Space and Depression during Pregnancy: Results from the Growing Up in New Zealand Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091083. [PMID: 28927014 PMCID: PMC5615620 DOI: 10.3390/ijerph14091083] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 11/16/2022]
Abstract
Background: Antenatal depression is an important contributor to poor maternal health experienced by some women. This study aimed to determine whether exposure to green space during pregnancy is associated with less depression, and whether this association is moderated by relevant factors, such as age, education, self-identified ethnicity, physical activity, residential rurality, and socioeconomic status. Methods: Health data were sourced from the cohort study “Growing Up in New Zealand” comprised of 6772 participants. Green space was estimated based on the proportion of green space within the Census Area Unit. Adjusted logistic mixed effect models were used to investigate the association between green space and antenatal depression after controlling for confounding variables. Results: Maternal exposure to green space were not associated with lower odds of antenatal depression. Indications of effect modifications due to relevant factors were not observed. Conclusions: This study did not determine an association between access to green space (measured based on the distance to the nearest green space) and antenatal depression. Therefore, a link between green space and antenatal depression was not established. For that reason, ensuring residential areas contain adequate green space may or may not be helpful in preventing antenatal depression and adverse health outcomes associated with this depression. More studies focusing on pregnant women in a range of social contexts, and considering both exposure and access to green space, are warranted to determine the relationships between green space and antenatal depression.
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Affiliation(s)
- Vikram Nichani
- Section of Epidemiology and Statistics, School of Population Health, University of Auckland, Auckland 1142, New Zealand.
| | - Kim Dirks
- Section of Epidemiology and Statistics, School of Population Health, University of Auckland, Auckland 1142, New Zealand.
| | - Bruce Burns
- School of Biological Sciences, University of Auckland, Auckland 1142, New Zealand.
| | - Amy Bird
- Centre for Longitudinal Research he Ara ki Mua, School of Population Health, University of Auckland, Auckland 1142, New Zealand.
| | - Cameron Grant
- Centre for Longitudinal Research he Ara ki Mua, School of Population Health, University of Auckland, Auckland 1142, New Zealand.
- Department of Pediatrics: Child and Youth Health, School of Medicine, University of Auckland, Auckland 1142, New Zealand.
- General Pediatrics, Starship Children's Hospital, Auckland District Health Board, Auckland 1023, New Zealand.
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Black E, Kisely S, Alichniewicz K, Toombs M. Mood and anxiety disorders in Australia and New Zealand's indigenous populations: A systematic review and meta-analysis. Psychiatry Res 2017; 255:128-138. [PMID: 28544944 DOI: 10.1016/j.psychres.2017.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/01/2017] [Accepted: 05/09/2017] [Indexed: 12/31/2022]
Abstract
The Indigenous populations of Australia and New Zealand are considered at higher risk of mood and anxiety disorders but many studies do not include direct comparisons with similar non-Indigenous controls. We conducted a systematic search of relevant electronic databases, as well as snowballing and targeted searches of the grey literature. Studies were included for meta-analysis if they compared rates of mood and anxiety disorders between Indigenous and non-Indigenous Australians or Maori. Seven Australian and 10 NZ studies were included. Overall, Indigenous people in both countries did not have significantly higher rates of disorder. However, in terms of specific disorders, there were differences in risk by gender, country (Australia or NZ), disorder type, and prevalence (current, 12-month or lifetime). For instance, Indigenous Australians and Maori both had significantly lower rates of simple phobias (current prevalence) and Maori participants had significantly lower rates of both lifetime simple phobia and generalised anxiety disorders. By contrast, Indigenous Australians had significantly higher rates of bipolar affective disorder and social phobia (current prevalence). Generalisations regarding the risk of psychiatric disorders in Indigenous people cannot therefore be made as this varies by several factors. These include disorder type, sociodemographic factors, Indigenous origin and study method.
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Affiliation(s)
- Emma Black
- Rural Clinical School, School of Medicine, The University of Queensland, Australia
| | - Steve Kisely
- University of Queensland, School of Medicine, Woolloongabba, Australia.
| | | | - Maree Toombs
- Rural Clinical School, School of Medicine, The University of Queensland, Australia
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Underwood L, Waldie KE, Peterson E, D’Souza S, Verbiest M, McDaid F, Morton S. Paternal Depression Symptoms During Pregnancy and After Childbirth Among Participants in the Growing Up in New Zealand Study. JAMA Psychiatry 2017; 74:360-369. [PMID: 28199455 PMCID: PMC5470399 DOI: 10.1001/jamapsychiatry.2016.4234] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Antenatal and postnatal depression are known to be common and associated with poor outcomes for women and their children. There is little evidence on depression symptoms among men during the perinatal period. OBJECTIVE To identify characteristics associated with depression symptoms among men whose partners were pregnant and subsequently gave birth. DESIGN, SETTING, AND PARTICIPANTS A longitudinal cohort study provided data from a demographically diverse sample of 3523 New Zealand men who completed interviews during their partner's pregnancy and 9 months after the birth of their child. Participants were drawn from a cohort whose partners were pregnant women with a due date between April 25, 2009, and March 25, 2010, who were enrolled in the Growing Up in New Zealand study. Data analysis was conducted from September 1, 2015, to January 8, 2016. MAIN OUTCOMES AND MEASURES Depression symptoms were measured using the Edinburgh Postnatal Depression Scale and the 9-item Patient Health Questionnaire; elevated depression symptoms were defined as scores higher than 12 and 9, respectively. RESULTS The mean (SD) age of the participants at the antenatal interview was 33.20 (6.25) years (range, 16-63 years). Elevated antenatal paternal depression symptoms affected 82 fathers (2.3%) and were associated with perceived stress (odds ratio [OR], 1.38; 95% CI, 1.30-1.47) and fair to poor health during their partner's pregnancy (OR, 2.06; 95% CI, 1.18-3.61). Elevated postnatal paternal depression symptoms affected 153 (4.3%) of fathers and were associated with perceived stress in pregnancy (OR, 1.12; 95% CI, 1.08-1.17), no longer being in a relationship with the mother 9 months after childbirth (OR, 6.36; 95% CI, 2.28-17.78), having fair to poor health at 9 months (OR, 3.29; 95% CI, 2.10-5.16), being unemployed at 9 months (OR, 1.86; 95% CI, 1.11-3.10), and a history of depression (OR, 2.84; 95% CI, 1.69-4.78). CONCLUSIONS AND RELEVANCE Expectant fathers were at risk of depression symptoms if they felt stressed or were in poor health. Rates of elevated depression symptoms were higher during the postpartum period and were associated with adverse social and relationship factors. Identifying fathers most at risk of depressive symptoms and when best to target interventions (antenatal or postnatal) may be beneficial to men and their families.
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Affiliation(s)
- Lisa Underwood
- Growing Up in New Zealand, University of Auckland, Auckland, New Zealand,Center for Longitudinal Research–He Ara ki Mua, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Karen E. Waldie
- Growing Up in New Zealand, University of Auckland, Auckland, New Zealand,School of Psychology, University of Auckland, Auckland, New Zealand
| | - Elizabeth Peterson
- Growing Up in New Zealand, University of Auckland, Auckland, New Zealand,School of Psychology, University of Auckland, Auckland, New Zealand
| | - Stephanie D’Souza
- Center for Longitudinal Research–He Ara ki Mua, School of Population Health, University of Auckland, Auckland, New Zealand,School of Psychology, University of Auckland, Auckland, New Zealand
| | - Marjolein Verbiest
- Growing Up in New Zealand, University of Auckland, Auckland, New Zealand,National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Frances McDaid
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Susan Morton
- Growing Up in New Zealand, University of Auckland, Auckland, New Zealand,Center for Longitudinal Research–He Ara ki Mua, School of Population Health, University of Auckland, Auckland, New Zealand
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Moore D, Drey N, Ayers S. Use of Online Forums for Perinatal Mental Illness, Stigma, and Disclosure: An Exploratory Model. JMIR Ment Health 2017; 4:e6. [PMID: 28219879 PMCID: PMC5339438 DOI: 10.2196/mental.5926] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/11/2016] [Accepted: 08/12/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Perinatal mental illness is a global health concern; however, many women with the illness do not get the treatment they need to recover. Interventions that reduce the stigma around perinatal mental illness have the potential to enable women to disclose their symptoms to health care providers and consequently access treatment. There are many online forums for perinatal mental illness and thousands of women use them. Preliminary research suggests that online forums may promote help-seeking behavior, potentially because they have a role in challenging stigma. This study draws from these findings and theoretical concepts to present a model of forum use, stigma, and disclosure. OBJECTIVE This study tested a model that measured the mediating role of stigma between online forum use and disclosure of affective symptoms to health care providers. METHODS A Web-based survey of 200 women who were pregnant or had a child younger than 5 years and considered themselves to be experiencing psychological distress was conducted. Women were recruited through social media and questions measured forum usage, perinatal mental illness stigma, disclosure to health care providers, depression and anxiety symptoms, barriers to disclosure, and demographic information. RESULTS There was a significant positive indirect effect of length of forum use on disclosure of symptoms through internal stigma, b=0.40, bias-corrected and accelerated (BCa) 95% CI 0.13-0.85. Long-term forum users reported higher levels of internal stigma, and higher internal stigma was associated with disclosure of symptoms to health care providers when controlling for symptoms of depression and anxiety. CONCLUSIONS Internal stigma mediates the relationship between length of forum use and disclosure to health care providers. Findings suggest that forums have the potential to enable women to recognize and reveal their internal stigma, which may in turn lead to greater disclosure of symptoms to health care providers. Clinicians could refer clients to trustworthy and moderated online forums that facilitate expression of perinatal mental illness stigma and promote disclosure to health care providers.
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Affiliation(s)
- Donna Moore
- Centre for Maternal and Child Health, School of Health Sciences, City, University of London, London, United Kingdom
| | - Nicholas Drey
- School of Health Sciences, City, University of London, London, United Kingdom
| | - Susan Ayers
- Centre for Maternal and Child Health, School of Health Sciences, City, University of London, London, United Kingdom
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Signal TL, Paine SJ, Sweeney B, Muller D, Priston M, Lee K, Gander P, Huthwaite M. The prevalence of symptoms of depression and anxiety, and the level of life stress and worry in New Zealand Māori and non-Māori women in late pregnancy. Aust N Z J Psychiatry 2017; 51:168-176. [PMID: 26792830 DOI: 10.1177/0004867415622406] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To describe the prevalence of symptoms of depression and anxiety, and the level of life stress and worry in late pregnancy for Māori and non-Māori women. METHODS In late pregnancy, women completed a questionnaire recording their prior history of mood disorders; self-reported current depressive symptoms (⩾13 on the Edinburgh Postnatal Depression Scale), current anxiety symptoms (⩾6 on the anxiety items from the Edinburgh Postnatal Depression Scale), significant life stress (⩾2 items on life stress scale) and dysfunctional worry (>12 on the Brief Measure of Worry Scale). RESULTS Data were obtained from 406 Māori women (mean age = 27.6 years, standard deviation=6.3 years) and 738 non-Māori women (mean age = 31.6 years, standard deviation=5.3 years). Depressive symptoms (22% vs 15%), anxiety symptoms (25% vs 20%), significant life stress (55% vs 30%) and a period of poor mood during the current pregnancy (18% vs 14%) were more prevalent for Māori than non-Maori women. Less than 50% of women who had experienced ⩾2 weeks of poor mood during the current pregnancy had sought help. Being young was an independent risk factor for depressive symptoms, significant life stress and dysfunctional worry. A prior history of depression was also consistently associated with a greater risk of negative affect in pregnancy. CONCLUSION Antenatal mental health requires at least as much attention and resourcing as mental health in the postpartum period. Services need to specifically target Māori women, young women and women with a prior history of depression.
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Affiliation(s)
- T Leigh Signal
- 1 Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Sarah-Jane Paine
- 1 Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Bronwyn Sweeney
- 1 Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Diane Muller
- 1 Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Monique Priston
- 2 School of Population Health, The University of Western Australia, Crawley, Australia
| | - Kathryn Lee
- 3 School of Nursing, University of California, San Francisco, CA, USA
| | - Philippa Gander
- 1 Sleep/Wake Research Centre, College of Health, Massey University, Wellington, New Zealand
| | - Mark Huthwaite
- 4 Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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Staneva AA, Morawska A, Bogossian F, Wittkowski A. Maternal psychological distress during pregnancy does not increase the risk for adverse birth outcomes. Women Health 2017; 58:92-111. [DOI: 10.1080/03630242.2017.1282395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Aleksandra A. Staneva
- The School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Alina Morawska
- The School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Fiona Bogossian
- The School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Anja Wittkowski
- Department of Psychology, University of Manchester, Manchester, UK
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Underwood L, Waldie KE, D’Souza S, Peterson ER, Morton SMB. A Longitudinal Study of Pre-pregnancy and Pregnancy Risk Factors Associated with Antenatal and Postnatal Symptoms of Depression: Evidence from Growing Up in New Zealand. Matern Child Health J 2016; 21:915-931. [DOI: 10.1007/s10995-016-2191-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Filoche SK, Lawton B, Stanley J. Access to Secondary Mental Health Services in a Cohort of New Zealand Mothers. Community Ment Health J 2016; 52:964-971. [PMID: 27401165 DOI: 10.1007/s10597-016-0042-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 07/01/2016] [Indexed: 11/26/2022]
Abstract
To explore access to secondary mental health services for New Zealand women during pregnancy and for up to 1 year post-delivery. A retrospective cohort analysis of public hospital maternity data linked to mental health collections. 27 in 1000 pregnancies were associated with access to secondary mental health services (736/27,153). Independent of ethnicity, young age (<20 years) was associated with access (RR1.84; 95 %CI 1.42-2.38; P < .0001). Smoking (1.48; 1.24-1.78; P < .0001), alcohol (1.3; 0.97-1.71; P < .0001) and substance use (3.57; 2.61-4.88; P < .0001) during pregnancy were independent risk factors associated with access. Antenatal period provides an opportunity for navigating to services to ensure timely access to secondary mental health services.
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Affiliation(s)
- Sara K Filoche
- Women's Health Research Centre, Department of Primary Health Care and General Practice, University of Otago, Wellington, 6242, Wellington, New Zealand.
| | - Bev Lawton
- Women's Health Research Centre, Department of Primary Health Care and General Practice, University of Otago, Wellington, 6242, Wellington, New Zealand
| | - James Stanley
- Biostatistical Group, Dean's Department, University of Otago, 6242, Wellington, New Zealand
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A review of longitudinal studies on antenatal and postnatal depression. Arch Womens Ment Health 2016; 19:711-20. [PMID: 27085795 DOI: 10.1007/s00737-016-0629-1] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 04/10/2016] [Indexed: 01/01/2023]
Abstract
Antenatal depression is a known risk factor for postnatal depression; both are common disorders associated with negative impacts on child development. Few studies have followed up women from pregnancy and through the postnatal period to explore how rates of depression change. This review evaluates recent evidence on depression during pregnancy and after childbirth. A search of Embase, PsychINFO, MEDLINE and Cochrane Reviews was carried out to identify longitudinal studies on antenatal and postnatal depression. Studies that measured depression during pregnancy and up to 1 year after childbirth were evaluated against a set of criteria (e.g. less than 50 % attrition). Of the initial 523 studies identified, 16 studies met the final inclusion criteria with a total of 35,419 women. The average rate of antenatal depression across these studies was 17 and 13 % postnatal depression. The longitudinal nature of the studies revealed that on average 39 % of those who experienced antenatal depression went on to have postnatal depression. Similarly, on average, 47 % of those with postnatal depression had also experienced antenatal depression. On average, almost 7 % of women reported significant depressive symptoms in pregnancy that persisted after childbirth. The review provided evidence that rates of depression tend to be higher during pregnancy than in the first year following childbirth. Furthermore, the longitudinal data show that there is much movement between the groups categorised as depressed or not depressed. There is evidence that postnatal depression is often a continuation of existing antenatal depression.
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Barthow C, Wickens K, Stanley T, Mitchell EA, Maude R, Abels P, Purdie G, Murphy R, Stone P, Kang J, Hood F, Rowden J, Barnes P, Fitzharris P, Craig J, Slykerman RF, Crane J. The Probiotics in Pregnancy Study (PiP Study): rationale and design of a double-blind randomised controlled trial to improve maternal health during pregnancy and prevent infant eczema and allergy. BMC Pregnancy Childbirth 2016; 16:133. [PMID: 27255079 PMCID: PMC4891898 DOI: 10.1186/s12884-016-0923-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 05/26/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Worldwide there is increasing interest in the manipulation of human gut microbiota by the use of probiotic supplements to modify or prevent a range of communicable and non-communicable diseases. Probiotic interventions administered during pregnancy and breastfeeding offer a unique opportunity to influence a range of important maternal and infant outcomes. The aim of the Probiotics in Pregnancy Study (PiP Study) is to assess if supplementation by the probiotic Lactobacillus rhamnosus HN001 administered to women from early pregnancy and while breastfeeding can reduce the rates of infant eczema and atopic sensitisation at 1 year, and maternal gestational diabetes mellitus, bacterial vaginosis and Group B Streptococcal vaginal colonisation before birth, and depression and anxiety postpartum. METHODS/DESIGN The PiP Study is a two-centre, randomised, double-blind placebo-controlled trial in Wellington and Auckland, New Zealand. Four hundred pregnant women expecting infants at high risk of allergic disease will be enrolled in the study at 14-16 weeks gestation and randomised to receive either Lactobacillus rhamnosus HN001 (6 × 10(9) colony-forming units per day (cfu/day)) or placebo until delivery and then continuing until 6 months post-partum, if breastfeeding. Primary infant outcomes are the development and severity of eczema and atopic sensitisation in the first year of life. Secondary outcomes are diagnosis of maternal gestational diabetes mellitus, presence of bacterial vaginosis and vaginal carriage of Group B Streptococcus (at 35-37 weeks gestation). Other outcome measures include maternal weight gain, maternal postpartum depression and anxiety, infant birth weight, preterm birth, and rate of caesarean sections. A range of samples including maternal and infant faecal samples, maternal blood samples, cord blood and infant cord tissue samples, breast milk, infant skin swabs and infant buccal swabs will be collected for the investigation of the mechanisms of probiotic action. DISCUSSION The study will investigate if mother-only supplementation with Lactobacillus rhamnosus HN001 in pregnancy and while breastfeeding can reduce rates of eczema and atopic sensitisation in infants by 1 year, and reduce maternal rates of gestational diabetes mellitus, bacterial vaginosis, vaginal carriage of Group B Streptococcus before birth and maternal depression and anxiety postpartum. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registration: ACTRN12612000196842. Date Registered: 15/02/12.
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Affiliation(s)
- Christine Barthow
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand.
| | - Kristin Wickens
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Thorsten Stanley
- Department of Paediatrics, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Edwin A Mitchell
- Department of Paediatrics: Child and Youth Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Robyn Maude
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, P O Box 7625, Newtown, Wellington, 6242, New Zealand
| | - Peter Abels
- Department of Obstetrics and Gynaecology, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Gordon Purdie
- Dean's Department, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Rinki Murphy
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Peter Stone
- Department of Obstetrics and Gynaecology, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Janice Kang
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Fiona Hood
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Judy Rowden
- Department of Paediatrics: Child and Youth Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Phillipa Barnes
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
| | - Penny Fitzharris
- Immunology Department, Auckland Hospital, Private Bag 92024, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - Jeffrey Craig
- Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria, 3052, Australia
| | - Rebecca F Slykerman
- Department of Paediatrics: Child and Youth Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Julian Crane
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington South, 6242, New Zealand
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