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Cheney K, Mignacca E, Black KI, Homer C, Bradfield Z. An exploration of the contraceptive counselling practices of midwives who provide postpartum care in Australia. Midwifery 2024; 131:103948. [PMID: 38335692 DOI: 10.1016/j.midw.2024.103948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 12/13/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE We sought to explore and describe midwives' attitudes and practices relating to their provision of postpartum contraception counselling. DESIGN We used an exploratory cross-sectional design. Recruitment used an anonymous online survey using electronic communication platforms of professional, and special-interest organisations, over six months . Descriptive and quantitative analysis was used. SETTING AND PARTICIPANTS Australian Midwives who provide postpartum care. MEANING AND FINDINGS A total of 289 complete responses were included. Findings from this national survey of midwives showed that almost 75% of Australian midwives reported providing some contraceptive advice to women. Those working in continuity of care models were significantly more likely to fulfil this responsibility. More than half (67%) indicated they had not received any formal contraception education or training. Those working in private obstetric-led settings were significantly less likely to have received education compared to midwives in community settings. Systems barriers preventing the provision of contraceptive counselling included: clinical workload; lack of management support; lack of education; and models of care. KEY CONCLUSIONS Most midwives (82%) wanted to provide postpartum contraception counselling as part of their role. They cited barriers from within the health system, ambiguity about roles and responsibilities and offered solutions to improve the provision of postnatal contraception counselling. IMPLICATIONS FOR PRACTICE Recommendations include the development of education programs for midwives. Continuity of care models provided the time, autonomy and opportunity for midwives to undertake contraceptive counselling and fulfil this part of their professional scope. Consideration should be given to expanding access and provision of continuity of midwifery care. An urgent investment in the education and skills of midwives is recommended to ensure all women across acute and community services benefit from improved outcomes associated with pregnancy spacing.
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Affiliation(s)
- Kate Cheney
- The Sydney School of Nursing and Midwifery, Faculty of Medicine and Health, Susan Wakil Health Building, The University of Sydney, NSW 2006, Australia.
| | - Emily Mignacca
- School of Nursing, Midwifery, Oral Health Therapy, Paramedicine, Faculty of Health Science, Curtin University Perth, WA 6102, Australia
| | - Kirsten I Black
- The Sydney Medical School, Faculty of Medicine and Health, Susan Wakil Health Building, The University of Sydney, NSW 2006, Australia
| | - Caroline Homer
- Maternal, Child and Adolescent Health, Burnet Institute, Melbourne 3004, Australia
| | - Zoe Bradfield
- School of Nursing, Midwifery, Oral Health Therapy, Paramedicine, Faculty of Health Science, Curtin University Perth, WA 6102, Australia
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McKetta S, Chakraborty P, Gimbrone C, Soled KRS, Hoatson T, Beccia AL, Reynolds CA, Huang AK, Charlton BM. Restrictive abortion legislation and adverse mental health during pregnancy and postpartum. Ann Epidemiol 2024; 92:47-54. [PMID: 38432536 PMCID: PMC10983835 DOI: 10.1016/j.annepidem.2024.02.009] [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: 08/07/2023] [Revised: 02/06/2024] [Accepted: 02/27/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To determine the impact of abortion legislation on mental health during pregnancy and postpartum and assess whether pregnancy intention mediates associations. METHODS We quantified associations between restrictive abortion laws and stress, depression symptoms during and after pregnancy, and depression diagnoses after pregnancy using longitudinal data from Nurses' Health Study 3 in 2010-2017 (4091 participants, 4988 pregnancies) using structural equation models with repeated measures, controlling for sociodemographics, prior depression, state economic and sociopolitical measures (unemployment rate, gender wage gap, Gini index, percentage of state legislatures who are women, Democratic governor). RESULTS Restrictive abortion legislation was associated with unintended pregnancies (β = 0.127, p = 0.02). These were, in turn, associated with increased risks of stress and depression symptoms during pregnancy (total indirect effects β = 0.035, p = 0.03; β = 0.029, p = 0.03, respectively, corresponding <1% increase in probability), but not after pregnancy. CONCLUSIONS Abortion restrictions are associated with higher proportions of unintended pregnancies, which are associated with increased risks of stress and depression during pregnancy.
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Affiliation(s)
- Sarah McKetta
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States.
| | - Payal Chakraborty
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States
| | - Catherine Gimbrone
- Department of Epidemiology, Columbia University Mailman School of Public Health, United States
| | - Kodiak R S Soled
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States
| | - Tabor Hoatson
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States
| | - Ariel L Beccia
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, United States
| | - Colleen A Reynolds
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States
| | - Aimee K Huang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, United States; Department of Pediatrics, Harvard Medical School, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, United States
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Jeon N, Kent-Marvick J, Sanders JN, Hanson H, Simonsen SE. Comparing maternal factors associated with postpartum depression between primiparous adolescents and adults: A large retrospective cohort study. Birth 2024; 51:218-228. [PMID: 37849418 DOI: 10.1111/birt.12785] [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: 01/06/2022] [Revised: 06/29/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES This study aimed to estimate the prevalence of diagnosed postpartum depression (PPD) and the likelihood of PPD among primiparous women. We also evaluated differences in the influence of various maternal factors associated with PPD in adolescent versus adult mothers. METHODS We conducted a retrospective cohort study using electronic health records linked to birth certificates to evaluate the associations between maternal factors and PPD diagnosis. The study population was stratified into adults and adolescents based on age at delivery. We evaluated socioeconomic, demographic, psychological, and clinical factors associated with PPD in each of the age-defined maternal cohorts using multivariable logistic regression analyses. RESULTS A total of 61,226 primiparous women, including 6435 (11%) mothers younger than 20 years old, were included in the study. The overall PPD rate was 4.0%, with the age-specific PPD rate measuring 1.6 times higher in adolescents than in adult women (6.1% vs. 3.8%). Compared with adults, adolescents were less likely to obtain firsttrimester prenatal care (33% vs. 16%), more likely to have recent tobacco use (11% vs. 6%), and more likely to have had an infection during pregnancy (5% vs. 1%). In adjusted models, significant factors for PPD in both groups included a history of depression or anxiety, tobacco use, and long-acting reversible contraception use. CONCLUSIONS In this cohort of first-time mothers, adolescents had higher rates of PPD diagnosis as well as PPD-associated maternal factors than adults. Increased awareness of PPD risk in adolescents and early intervention, including integrating mental healthcare into prenatal care, may help benefit adolescents and reduce the risk and severity of PPD.
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Affiliation(s)
- Nakyung Jeon
- College of Pharmacy and Research Institute for Drug Development, Pusan National University, Busan, South Korea
| | - Jacqueline Kent-Marvick
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
- Interdisciplinary Training in Cancer, Caregiving & End-of-Life Care, College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Heidi Hanson
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Sara E Simonsen
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
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Kotov DA, Corpuz R. No evidence for relationship between paternal post-partum depressive symptoms and testosterone or cortisol in first-time fathers. Front Psychol 2024; 15:1348031. [PMID: 38425562 PMCID: PMC10902172 DOI: 10.3389/fpsyg.2024.1348031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Male life history strategies are regulated by the neuroendocrine system. Testosterone (T) and cortisol regulate male behaviors including parenting and facilitate managing tradeoffs at key transitions in development such as first-time fatherhood. Both hormones demonstrate marked fluctuations in the postnatal period, and this presents an opportunity to investigate the role of T and cortisol in postpartum depressive symptoms-comparably less studied in fathers than in mothers in the evolutionary literature. Prior work on depressive symptoms has yet to integrate insights from the "dual hormone hypothesis (DHH)" which has focused on how T and cortisol interact to jointly regulate traits associated with dominance and status-seeking (i.e., mating effort) but has yet to be included in models of parenting effort. In this research, we use secondary data to investigate the relationship between DHH and traits ostensibly opposed to status seeking (i.e., depressive symptoms). First-time fathers (n = 193) provided morning saliva samples 10 months following parturition and reported on the presence of depressive symptoms (BDI-II). Responses were decomposed into three factors: cognitive, affective, and somatic. Using hybrid latent variable structural equation modeling, we did not find evidence that T predicted variability in cognitive, affective, or somatic depressive symptom factors. We found a null effect for cortisol as well. Finally, we could not find evidence that the DHH variable (T × cortisol interaction) predicted any variability in cognitive, affective, or somatic depressive symptoms. While we did not find evidence to support our hypotheses using a secondary data set, this study contributes to research on the neuroendocrinology of depression in fathers. Discussion focuses on the limitations of sample demographics, timing of saliva and self-report collection, and the lack of extant theory specific to paternal postpartum depression.
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Affiliation(s)
| | - Randy Corpuz
- Department of Psychology, University of Massachusetts Boston, Boston, MA, United States
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Withers M, Trop J, Bayalag M, Schriger SH, Ganbold S, Doripurev D, Davaasambuu E, Bat-Erdene U, Gendenjamts B. "They should ask about our feelings": Mongolian women's experiences of postpartum depression. Transcult Psychiatry 2023; 60:1005-1016. [PMID: 37731351 DOI: 10.1177/13634615231187256] [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] [Indexed: 09/22/2023]
Abstract
Between 16 and 20% of perinatal women in low- and middle-income countries experience depression. Addressing postpartum depression (PPD) requires an appreciation of how it manifests and is understood in different cultural settings. This study explores postpartum Mongolian women's perceptions and experiences of PPD. We conducted interviews with 35 postpartum women who screened positive for possible depression to examine: (1) personal experiences of pregnancy/childbirth; (2) perceived causes and symptoms of PPD; and (3) strategies for help/support for women experiencing PPD. Unless extreme, depression was not viewed as a disease but rather as a natural condition following childbirth. Differences between a biomedical model of PPD and local idioms of distress could explain why awareness about PPD was low. The most reported PPD symptom was emotional volatility expressed as anger and endorsement of fear- or anxiety-related screening questions, suggesting that these might be especially relevant in the Mongolian context. Psychosocial factors, as opposed to biological, were common perceived causes of PPD, especially interpersonal relationship problems, financial strain, and social isolation. Possible barriers to PPD recognition/treatment included lack of awareness about the range of symptoms, reluctance to initiate discussions with providers about mental health, and lack of PPD screening practices by healthcare providers. We conclude that educational campaigns should be implemented in prenatal/postnatal clinics and pediatric settings to help women and families identify PPD symptoms, and possibly destigmatize PPD. Healthcare providers can also help to identify women with PPD through communication with women and families.
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Affiliation(s)
- Mellissa Withers
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Justin Trop
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Munkhuu Bayalag
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | - Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Solongo Ganbold
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
| | | | | | - Undral Bat-Erdene
- National Center for Maternal and Child Health, Ulaanbaatar, Mongolia
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Míguez MC, Vázquez MB. Prevalence of postpartum major depression and depressive symptoms in Spanish women: A longitudinal study up to 1 year postpartum. Midwifery 2023; 126:103808. [PMID: 37672853 DOI: 10.1016/j.midw.2023.103808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/15/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE Depression is a prevalent mental disorder in the postpartum period, with consequences for both the mother and her offspring. However, longitudinal studies determining the moments of greatest vulnerability and severity of depression during the postpartum period are scarce. The aims of this research were to determine the prevalence and trajectories of probable depression and major depression during the first year postpartum. DESIGN Longitudinal study. SETTING Interviews were conducted personally at three times: 2 months, 6 months and 1 year postpartum. PARTICIPANTS 561 postpartum women. MEASUREMENTS AND FINDINGS Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders (DSM). Descriptive and comparative analyses have been carried out. The prevalence of probable depression at 2 months, 6 months and 1 year postpartum, using a cut-off point ≥ 10, was 30.3%, 26.0% and 25.3%, respectively; and that of major depression using SCID was 10.3%, 10.9% and 14.8, respectively. The prevalence of probable depression was highest at 2 months postpartum and that of major depression at 1 year postpartum. Probable depression followed a downward trajectory and major depression followed an upward trajectory. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The clinical relevance of this research is that it has made it possible to demonstrate that depression is very prevalent in the first year postpartum and that, far from subsiding, the prevalence remains very high even at 1 year postpartum. Our findings highlight the importance of taking mental health care into account throughout at least the first year postpartum.
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Ohashi Y, Takegata M, Takeda S, Hada A, Usui Y, Kitamura T. Is Your Pregnancy Unwanted or Unhappy? Psychological Correlates of a Cluster of Pregnant Women Who Need Professional Care. Healthcare (Basel) 2023; 11:2196. [PMID: 37570436 PMCID: PMC10418804 DOI: 10.3390/healthcare11152196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND A negative response towards a current pregnancy consists of two elements: unwantedness of and unhappiness about the current pregnancy. Little is clear about whether pregnant women can be categorized in terms of unwantedness and unhappiness as well as what the correlates are of these categories. METHODS An internet survey of 696 women in their first trimester of pregnancy examined the participants' intention of and emotional reaction towards pregnancy, borderline personality traits, adult attachment style, depression, fear of childbirth, obsessive-compulsive symptoms, fetal bonding disorder, avoidance of taking part in child care, and consideration about termination of pregnancy (TOP). About one third of the participants were followed up with in their second trimester. RESULTS Two-step cluster analysis using the participants' intention of and emotional reaction towards pregnancy revealed three groups of pregnant women: those who wanted and were happy about the pregnancy (Cluster 1), those who were unhappy about the pregnancy (Cluster 2), and those who did not intend to be pregnant but were happy about pregnancy (Cluster 3). Cluster 2 women, but not Cluster 3 women, were likely to be single, with borderline personality traits as well as unstable adult attachment styles, accompanied by depression, fear of childbirth, obsessive-compulsive symptoms, and fetal bonding disorder. They were more likely to avoid caring for the baby after childbirth and consider TOP. CONCLUSION Expectant women who were unhappy about their pregnancy were at risk of psychological adjustment and need specific perinatal mental health assessment and care.
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Affiliation(s)
- Yukiko Ohashi
- Faculty of Nursing, Josai International University, Togane 283-8555, Japan;
- Kitamura Institute of Mental Health Tokyo, Tokyo 151-0063, Japan; (M.T.); (A.H.)
| | - Mizuki Takegata
- Kitamura Institute of Mental Health Tokyo, Tokyo 151-0063, Japan; (M.T.); (A.H.)
| | - Satoru Takeda
- Department of Obstetrics & Gynecology, Faculty of Medicine, Juntendo University, Tokyo 113-8421, Japan;
- Aiiku Research Institute for Maternal, Child Health and Welfare, Imperial Gift Foundation Boshi-Aiiku-Kai, Tokyo 106-8580, Japan
| | - Ayako Hada
- Kitamura Institute of Mental Health Tokyo, Tokyo 151-0063, Japan; (M.T.); (A.H.)
- Kitamura KOKORO Clinic Mental Health, Tokyo 151-0063, Japan
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
| | - Yuriko Usui
- Department of Midwifery and Women’s Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Toshinori Kitamura
- Kitamura Institute of Mental Health Tokyo, Tokyo 151-0063, Japan; (M.T.); (A.H.)
- Kitamura KOKORO Clinic Mental Health, Tokyo 151-0063, Japan
- T. and F. Kitamura Foundation for Studies and Skill Advancement in Mental Health, Tokyo 151-0063, Japan
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya 464-8601, Japan
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Londoño Tobón A, McNicholas E, Clare CA, Ireland LD, Payne JL, Moore Simas TA, Scott RK, Becker M, Byatt N. The end of Roe v. Wade: implications for Women's mental health and care. Front Psychiatry 2023; 14:1087045. [PMID: 37215676 PMCID: PMC10196497 DOI: 10.3389/fpsyt.2023.1087045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/07/2023] [Indexed: 05/24/2023] Open
Abstract
The Supreme Court decision in Dobbs v. Jackson in June 2022 reversed precedent which had previously protected abortion prior to fetal viability as a universal right within the United States. This decision almost immediately led to abortion restrictions across 25 states. The resulting lack of access to abortion care for millions of pregnant people will have profound physical and mental health consequences, the full effects of which will not be realized for years to come. Approximately 1 in 5 women access abortions in the U.S. each year. These women are diverse and represent all American groups. The Supreme court decision, however, will affect populations that have and continue to be marginalized the most. Forcing pregnant individuals to carry unwanted pregnancies worsens health outcomes and mortality risk for both the perinatal individual and the offspring. The US has one of the highest maternal mortality rates and this rate is projected to increase with abortion bans. Abortion policies also interfere with appropriate medical care of pregnant people leading to less safe pregnancies for all. Beyond the physical morbidity, the psychological sequelae of carrying a forced pregnancy to term will lead to an even greater burden of maternal mental illness, exacerbating the already existing maternal mental health crisis. This perspective piece reviews the current evidence of abortion denial on women's mental health and care. Based on the current evidence, we discuss the clinical, educational, societal, research, and policy implications of the Dobbs v. Jackson Supreme Court decision.
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Affiliation(s)
- Amalia Londoño Tobón
- Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, United States
| | | | - Camille A. Clare
- Department of Obstetrics and Gynecology, Downstate Health Sciences University, Brooklyn, NY, United States
| | - Luu D. Ireland
- UMass Chan Medical School, Worcester, MA, United States
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Jennifer L. Payne
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, United States
| | - Tiffany A. Moore Simas
- UMass Chan Medical School, Worcester, MA, United States
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Rachel K. Scott
- MedStar Health Research Institute, Georgetown University School of Medicine, Washington, DC, United States
| | - Madeleine Becker
- Departments of Psychiatry and Human Behavior, Sydney Kimmel Medical College, Integrative Medicine and Nutritional Sciences, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nancy Byatt
- UMass Chan Medical School, Worcester, MA, United States
- Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States
- Department of Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
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Canfield SM, Canada KE. Systematic Review of Online Interventions to Reduce Perinatal Mood and Anxiety Disorders in Underserved Populations. J Perinat Neonatal Nurs 2023; 37:14-26. [PMID: 36707743 DOI: 10.1097/jpn.0000000000000658] [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: 01/29/2023]
Abstract
BACKGROUND Online health interventions increase access to care, are acceptable to end users and effective for treating mental and physical health disorders. However, less is known about interventions to prevent and treat perinatal mood and anxiety disorders (PMADs). This review synthesizes existing research on PMAD prevention and treatment by exploring the treatment modalities and efficacy of online interventions and examining the inclusion of underserved populations in PMAD research. METHODS Using PRISMA guidelines, authors conducted a systematic review of peer-reviewed literature published between 2008 and 2018 on online interventions aimed to prevent or treat PMADs. The authors also assessed quality. Eligible articles included perinatal women participating in preventive studies or those aimed to reduce symptoms of PMADs and utilized a Web-based, Internet, or smartphone technology requiring an online component. This study excluded telephone-based interventions that required one-on-one conversations or individualized, text-based responses without a Web-based aspect. RESULTS The initial search yielded 511 articles, and the final analysis included 23 articles reporting on 22 interventions. Most studies used an experimental design. However, no study achieved an excellent or good quality rating. Psychoeducation and cognitive-behavioral therapies (CBTs) were most common. Several interventions using CBT strategies significantly decreased depression or anxiety. Four studies recruited and enrolled mainly people identifying as low-income or of a racial or ethnic minority group. Attrition was generally high across studies. DISCUSSION More research using rigorous study designs to test PMAD interventions across all perinatal times is needed. Future research needs to engage diverse populations purposefully.
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Affiliation(s)
- Shannon M Canfield
- Family and Community Medicine (Dr Canfield), Center for Health Policy (Dr Canfield), and School of Social Work (Dr Canada), University of Missouri-Columbia
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Beumer WY, Roseboom TJ, Koot MH, Vrijkotte T, van Ditzhuijzen J. Carrying an unintended pregnancy to term and long-term maternal psychological distress: Findings from the Dutch prospective Amsterdam Born Children and their Development study. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231213737. [PMID: 38062674 PMCID: PMC10704944 DOI: 10.1177/17455057231213737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Given the estimated high rate of unintended pregnancies, it is important to investigate long-term effects on psychological distress in women carrying an unintended pregnancy to term. However, research into associations between unintended pregnancies carried to term and psychological distress postpartum is mixed, and especially, evidence on long-term associations is scarce. OBJECTIVE To examine whether carrying an unintended pregnancy to term is associated with maternal psychological distress later in life, up to 12 years postpartum. DESIGN This study is based on the population-based birth cohort study 'Amsterdam Born Children and their Development' study, which included pregnant people in 2003 (n = 7784) and followed them up until 12 years postpartum. METHODS Unintended pregnancy was measured as a multidimensional construct, based on self-reported data around 16 weeks gestation on pregnancy mistiming, unwantedness and unhappiness. Symptoms of maternal psychological distress were assessed around 3 months, 5 years and 12 years postpartum using multiple questionnaires measuring symptoms of depression, anxiety and stress. Multiple structural equation modelling models were analysed, examining the associations between dimensions of unintended pregnancy and maternal psychological distress per time point, while controlling for important co-occurring risks. RESULTS Pregnancy mistiming and unhappiness were significant predictors of more maternal psychological distress around 3 months postpartum. Around 5 years postpartum, only pregnancy mistiming was positively associated with maternal psychological distress. Dimensions of unintended pregnancy were no longer associated with maternal psychological distress around 12 years postpartum. Strikingly, antenatal psychological distress was a much stronger predictor of maternal psychological distress than pregnancy intention dimensions. CONCLUSION Those who carried a more unintended pregnancy to term reported more symptoms of psychological distress at 3 months and 5 years postpartum. People carrying an unintended pregnancy to term may benefit from extra support, not because of the pregnancy intentions per se, but because they may be related to antenatal psychological distress.
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Affiliation(s)
- Wieke Y Beumer
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Tessa J Roseboom
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
- Amsterdam Reproduction and Development, Amsterdam, the Netherlands
| | - Marjette H Koot
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
| | - Tanja Vrijkotte
- Amsterdam UMC location Vrije Universiteit Amsterdam, Public and Occupational Health, Amsterdam, Netherlands
| | - Jenneke van Ditzhuijzen
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynaecology, Amsterdam, Netherlands
- Social Policy and Public Health, Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
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Perez M, Chambers S, Ceballos V, Kelley A, Hettema J, Sussman A, Kosnick S, Moralez-Norris E, Jackson S, Baca M. Informed Contraceptive Decisions: A Qualitative Study of Hispanic Teens in New Mexico. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:982-989. [PMID: 36636318 PMCID: PMC9811835 DOI: 10.1089/whr.2022.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES U.S. Hispanic teens experience higher rates of unintended pregnancy than white teens. Limited research has been done to explore the sociocultural factors that impact Hispanic teens and their decisions about birth control and long-acting reversible contraception (LARC). The theory of planned behavior served as a framework for this study and teen perspectives about contraceptive decision making. This study aimed to identify the sociocultural factors that impact Hispanic teens when they make decisions about birth control and LARC. STUDY DESIGN AND METHODS We interviewed Hispanic teens from school-based health centers in New Mexico during their schedule medical appointments. Interviews were audio recorded, transcribed, and coded using content analysis coding methods and a descriptive qualitative design. RESULTS A total of 20 Hispanic teens participated in this study, all were female and between the ages of 14 and 19 years. THEMES Five themes emerged from the analysis process that impact Hispanic teen contraceptive choice, these are family, religion, culture, peer influence, and other factors. CONCLUSIONS AND IMPLICATIONS Among both LARC and non-LARC groups, peer influence was the most frequently cited reason for contraceptive decision making. Relationships with family were cited as barriers for Hispanic teens, where lack of communication and abstinence-only beliefs made it difficult to seek contraception. Findings demonstrate that teens selected LARCs because of the impacts on menstrual cycles and clinician influence. Teens who did not self-select LARC discussed ease of protection and the utilization of birth control as a transition to LARC.
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Affiliation(s)
- Mayra Perez
- Community Health Work Initiatives, University of New Mexico, Health Sciences Center, Albuquerque, New Mexico, USA
| | - Stephanie Chambers
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Venice Ceballos
- Community Health Work Initiatives, University of New Mexico, Health Sciences Center, Albuquerque, New Mexico, USA
| | - Allyson Kelley
- Allyson Kelley & Associates PLLC, Albuquerque, New Mexico, USA
| | | | - Andrew Sussman
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | | | | | - Samantha Jackson
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Melanie Baca
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
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Kitchin Á, Huerta C, Llorente-García A, Martínez D, Ortega P, Cea-Soriano L. The role of prenatal exposure to antidepressants, anxiolytic, and hypnotics and its underlying illness on the risk of miscarriage using BIFAP database. Pharmacoepidemiol Drug Saf 2022; 31:901-912. [PMID: 35689300 PMCID: PMC9543237 DOI: 10.1002/pds.5488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/21/2022] [Accepted: 06/05/2022] [Indexed: 12/04/2022]
Abstract
Purpose Despite the notable increase on the prescription of antidepressants and anxiolytics during pregnancy, recommendation on maintaining the treatment during prenatal period is still controversial. We aimed to separately assess the role of effects of the antidepressants and anxiolytic and the underlying illness, controlled by potential confounding associated with miscarriage onset. Methods We used data from a validated pregnant cohort aged 15–49 years from 2002 to 2016 using BIFAP database. All confirmed miscarriages were used to perform a nested control analysis using conditional logistic regression. Women were classified according to use of each drug of interest into four mutually exclusive groups: nonusers, users only during prepregnancy, continuers, and initiators during first trimester. Adjusted odds ratios (aORs) for major confounders during pregnancy such as number of visits to primary care practitioners visits, obesity, smoking, HTA, diabetes with 95% confidence intervals were calculated. Results Compared with nonusers, antidepressants continuers had the highest increased risk of miscarriage aOR (95%) of 1.29 (1.13–1.46), being continuers of paroxetine and fluoxetine the antidepressants with the strongest association. Likewise, continuers of anxiolytics and initiators showed an increased risk of 1.19 (1.04–1.37) and 1.30 (1.13–1.50). When separating the effect between the condition itself or the treatment, women exposed during first trimester, regardless treatment duration and/or the underlying illness, had the highest risk 1.27 (1.08–1.51) for antidepressants and 1.25 (1.13–1.39) for anxiolytics. Conclusions Our analysis showed an association between prenatal exposure to antidepressants and anxiolytics and miscarriage onset after controlling by potential confounding adjusting for confounders and the underlying illness. This association was not supported for hypnotic medications. Further studies are warranted to evaluate the risk of miscarriage among subpopulation of pregnant women requiring these medications.
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Affiliation(s)
- Álvaro Kitchin
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Complutense University of Madrid, Madrid
| | - Consuelo Huerta
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Complutense University of Madrid, Madrid
| | - Ana Llorente-García
- BIFAP, Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - David Martínez
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Complutense University of Madrid, Madrid
| | - Paloma Ortega
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Complutense University of Madrid, Madrid
| | - Lucía Cea-Soriano
- Department of Public Health and Maternal Child Health, Faculty of Medicine, Complutense University of Madrid, Madrid
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13
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Ankerstjerne LBS, Laizer SN, Andreasen K, Normann AK, Wu C, Linde DS, Rasch V. Landscaping the evidence of intimate partner violence and postpartum depression: a systematic review. BMJ Open 2022; 12:e051426. [PMID: 35584869 PMCID: PMC9119188 DOI: 10.1136/bmjopen-2021-051426] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the evidence of the association between exposure to intimate partner violence (IPV) and postpartum depression. IPV during pregnancy can have immediate and long-term physical and mental health consequences for the family. Therefore, it has been hypothesised that IPV may affect the risk of developing postpartum depression. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Global Health Library, Scopus and Google scholar were searched for published studies without restrictions on language, time or study design (up to May 2020). Studies were included if they assessed postpartum depression using the Edinburg Postnatal Depression Scale (cut-off≥10), among women who had been exposed to IPV (emotional, physical and/or sexual abuse). The quality of studies was judged according to the Newcastle-Ottawa scale. RESULTS A total of 33 studies were included in the review (participants n=131 131). The majority of studies found an association between exposure to IPV and the development of signs of postpartum depression. Overall, studies measured both exposure and outcome in various ways and controlled for a vast number of different confounders. Thirty percent of the studies were set in low-income and lower-middle-income countries while the rest were set in upper-middle-income and high-income countries and the association did not differ across settings. Among the studies reporting adjusted OR (aOR) (n=26), the significant aOR ranged between 1.18 and 6.87 (95% CI 1.12 to 11.78). The majority of the studies were judged as 'good quality' (n=20/33). CONCLUSION We found evidence of an association between exposure to IPV and the development of signs of postpartum depression. Meta-analysis or individual patient data meta-analysis is required to quantify the magnitude of the association between IPV and postpartum depression. PROSPERO REGISTRATION NUMBER CRD42020209435.
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Affiliation(s)
- Lea Bo Sønderlund Ankerstjerne
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sweetness Naftal Laizer
- Kilimanjaro Christian Medical University College, Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Karen Andreasen
- Gynaecology and Obstetrics, Odense Universitetshospital, Odense, Denmark
| | - Anne Katrine Normann
- Deparment of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Chunsen Wu
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Obstetrics and Gynaecology, Odense Universitetshospital, Odense, Denmark
| | - Ditte Søndergaard Linde
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Obstetrics and Gynaecology, Odense Universitetshospital, Odense, Denmark
| | - Vibeke Rasch
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense Universitets hospital, Odense, Denmark
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14
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Perinatal Complications, Poor Hospital Treatment, and Positive Screen for Postpartum Depressive Symptoms Among Black Women. J Racial Ethn Health Disparities 2022; 10:1371-1378. [PMID: 35513596 DOI: 10.1007/s40615-022-01322-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
Though mandatory screening for depression during pregnancy and the postpartum period is recommended, postpartum depression is still underdiagnosed and overlooked among Black women. Understanding risk factors during pregnancy and delivery that may increase the risk for postpartum depression is important for Black women. Thus, the purpose of this study is to examine the relationship between perinatal complications (i.e., preterm birth, low birth weight, gestational diabetes, unplanned cesarean section, undesired pregnancy, depression during pregnancy), poor hospital treatment, and postpartum depressive symptoms (i.e., depressed mood, anhedonia, and positive screen on PHQ-2) among Black women. Using the Listening to Mothers III survey, we conducted logistic regression analyses in a nationally representative sample of 368 Black women to examine the relationship between perinatal complications, poor hospital treatment, and positive screen for postpartum depressive symptoms, measured by the Patient Health Questionnaire-2 (PHQ-2). We also examined these factors in predicting anhedonia and depressed mood. Poor hospital treatment was associated with a positive screen for postpartum depression, anhedonia, and depressed mood. Perinatal complications, when measured continuously, were associated with a positive screen for depression and depressed mood. Gestational diabetes and preterm birth were associated with depressed mood while depression during pregnancy was associated with anhedonia. Perinatal complications during pregnancy and delivery may increase the risk for postpartum depression among Black women. When screening for postpartum depression, it may also be important to inquire about poor hospital treatment and stressors emanating from these experiences.
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Mark NDE, Cowan SK. Do Pregnancy Intentions Matter? A Research Note Revisiting Relationships Among Pregnancy, Birth, and Maternal Outcomes. Demography 2022; 59:37-49. [PMID: 35040479 DOI: 10.1215/00703370-9710311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The prevention of unplanned or unintended pregnancies continues to be a cornerstone of U.S. reproductive health policy, but the evidence that such pregnancies cause adverse maternal and child outcomes is limited. In this research note, we examine these relationships using recent large-scale data and inverse propensity weights estimated from generalized boosted models. We find that pregnancy timing is related to maternal experience during pregnancy, but not to infant outcomes at birth-both of which are consistent with prior research. In an addition to the literature, we show that pregnancy timing is relevant for a number of maternal outcomes, such as the onset of depression and intimate partner violence, changes in smoking behavior, and receipt of medical care. These findings suggest that policy intended to improve infant welfare by preventing unintended pregnancies has little empirical support, but that policy focused on increasing reproductive autonomy and maternal well-being has the potential to improve outcomes.
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Affiliation(s)
| | - Sarah K Cowan
- Department of Sociology, New York University, New York, NY, USA
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16
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Morse RB, Bretzin AC, Canelón SP, D'Alonzo BA, Schneider ALC, Boland MR. Design and Evaluation of a Postpartum Depression Ontology. Appl Clin Inform 2022; 13:287-300. [PMID: 35263799 PMCID: PMC8906993 DOI: 10.1055/s-0042-1743240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/04/2022] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE Postpartum depression (PPD) remains an understudied research area despite its high prevalence. The goal of this study is to develop an ontology to aid in the identification of patients with PPD and to enable future analyses with electronic health record (EHR) data. METHODS We used Protégé-OWL to construct a postpartum depression ontology (PDO) of relevant comorbidities, symptoms, treatments, and other items pertinent to the study and treatment of PPD. RESULTS The PDO identifies and visualizes the risk factor status of variables for PPD, including comorbidities, confounders, symptoms, and treatments. The PDO includes 734 classes, 13 object properties, and 4,844 individuals. We also linked known and potential risk factors to their respective codes in the International Classification of Diseases versions 9 and 10 that would be useful in structured EHR data analyses. The representation and usefulness of the PDO was assessed using a task-based patient case study approach, involving 10 PPD case studies. Final evaluation of the ontology yielded 86.4% coverage of PPD symptoms, treatments, and risk factors. This demonstrates strong coverage of the PDO for the PPD domain. CONCLUSION The PDO will enable future researchers to study PPD using EHR data as it contains important information with regard to structured (e.g., billing codes) and unstructured data (e.g., synonyms of symptoms not coded in EHRs). The PDO is publicly available through the National Center for Biomedical Ontology (NCBO) BioPortal ( https://bioportal.bioontology.org/ontologies/PARTUMDO ) which will enable other informaticists to utilize the PDO to study PPD in other populations.
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Affiliation(s)
- Rebecca B. Morse
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Abigail C. Bretzin
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Silvia P. Canelón
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Bernadette A. D'Alonzo
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Andrea L. C. Schneider
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Mary R. Boland
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Muskens L, Boekhorst MGBM, Kop WJ, van den Heuvel MI, Pop VJM, Beerthuizen A. The association of unplanned pregnancy with perinatal depression: a longitudinal cohort study. Arch Womens Ment Health 2022; 25:611-620. [PMID: 35347473 PMCID: PMC9072423 DOI: 10.1007/s00737-022-01225-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/18/2022] [Indexed: 12/25/2022]
Abstract
Perinatal depression is common, affecting approximately 7-13% of women. Studies have shown an association between unplanned pregnancy and perinatal depressive symptoms, but many used a cross-sectional design and limited postnatal follow-up. The current study investigated the association of unplanned pregnancy with perinatal depressive symptoms using a longitudinal cohort study that followed women from the first trimester until 12 months postpartum. Pregnant women (N = 1928) provided demographic and clinical data and information about pregnancy intention at the first trimester. Depressive symptoms were assessed during each trimester of pregnancy and five times postpartum using the Edinburgh Postnatal Depression Scale (EPDS) until 12 months postpartum. Mixed model analyses were used to investigate the association between an unplanned pregnancy and the level of depressive symptoms. Women with an unplanned pregnancy (N = 111, 5.8%) reported persistently higher levels of depressive symptoms during the entire perinatal period compared to women with a planned pregnancy, after adjustment for confounders (p < 0.001). However, the course of depressive symptom scores over time in women with an unplanned pregnancy was similar to that of women with a planned pregnancy. Lower age (p = 0.006), unemployment (p = 0.004), and history of depression (p < 0.001) were significantly associated with higher levels of perinatal depressive symptoms. An unplanned pregnancy may have a long-lasting negative impact on a woman's perinatal mental health. Therefore, women with an unplanned pregnancy may benefit from systematic follow-up during the perinatal period with contingent mental health support.
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Affiliation(s)
- Lotte Muskens
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, Netherlands.
| | - Myrthe G. B. M. Boekhorst
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, Netherlands
| | - Willem J. Kop
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, Netherlands
| | | | - Victor J. M. Pop
- Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, Netherlands
| | - Annemerle Beerthuizen
- Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, Netherlands
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Esti Handayani T, Joko Santosa B, Suparji S, Anastasia Setyasih P. Determinants of Postpartum Blues for Postpartum Mothers Survey Study at the Madiun City General Hospital. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Postpartum blues in mothers fail in adapting to changes in life patterns due to pregnancy and the process of pregnancy, childbirth, and postpartum. Many factors influence the incidence of postpartum blues.
AIM: The purpose of this study was to determine the determinants that affect the symptoms of postpartum blues in patients treated at the Madiun City General Hospital.
METHODS: A cross-sectional study design, the population is all postpartum mothers at the Madiun City Hospital in March–April 2020, the population is 52 respondents. The sample size is 47 people, sampling using simple random sampling technique. The independent variables were age, type of delivery, parity, education, and family support. The dependent variable is postpartum blues symptoms. The research instrument used a questionnaire and a checklist. Data analysis used Chi-square and Fisher’s exact test with significance level = 0.05.
RESULTS: The results showed that age for postpartum blues symptoms had p = 0.006, and the type of delivery had p = 0.032. Meanwhile, data analysis using Chi-square test of childbirth experience (parity) on postpartum blues symptoms showed p = 0.033, education showed p = 0.006, and family support showed p = 0.000.
CONCLUSION: The conclusion of the research is the determinants of age at risk, type of delivery, parity, education, and family support which have a significant impact on the occurrence of postpartum blues symptoms. This research recommends the need for early detection efforts and increased counseling for postpartum mothers to prevent postpartum blues symptoms.
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19
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Teenage Mothers in Yaoundé, Cameroon-Risk Factors and Prevalence of Perinatal Depression Symptoms. J Clin Med 2021; 10:jcm10184164. [PMID: 34575274 PMCID: PMC8470336 DOI: 10.3390/jcm10184164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Perinatal depression is defined as a non-psychotic depressive episode occurring during pregnancy or during the first year following childbirth. This depressive disorder is highly prevalent among teenage women but there is a lack of data in low- and middle-income countries. The objective of this study was to provide baseline data on the sociodemographic characteristics of pregnant teenagers or teenage mothers in an urban zone in Yaoundé, Cameroon. Risk factors were assessed, and prevalence of depressive disorders was determined. METHODS Women aged 20 years old or less in the perinatal period were invited to participate in the study. A total of 1344 women participated in the four-stage data collection process involving a questionnaire including questions on sociodemographic background, an assessment of their risk of perinatal depression using the EPDS questionnaire (Edinburgh Postnatal Depression Scale), a clinical interview based on the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders), and a final section focusing on risk factors of perinatal depression. RESULTS The EPDS score was obtained for 1307 women. The prevalence of depressive disorder symptoms among teenage or young pregnant women is estimated to be 70.0%. This risk is significantly increased by different factors including unintended or unplanned pregnancy (aOR: 1.33, 1.14-1.56 CI95%), being separated or single (aOR: 1.34, 1.12-1.60 CI95%), experiencing depression and anxiety before childbirth (aOR: 1.50, 1.02-2.27 CI95%), abortion experience (aOR: 2.60, 1.03-7.14 CI95%) and domestic violence (aOR: 1.76, 1.12-2.83 CI95%). CONCLUSION The results of this study reveal a high prevalence of depressive disorder symptoms within the study population. These findings highlight the need to develop maternal care programs to support both mothers and their infants.
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20
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Ahmed GK, Elbeh K, Shams RM, Malek MAA, Ibrahim AK. Prevalence and predictors of postpartum depression in Upper Egypt: A multicenter primary health care study. J Affect Disord 2021; 290:211-218. [PMID: 34004403 DOI: 10.1016/j.jad.2021.04.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/23/2021] [Accepted: 04/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postpartum depression (PPD) is highly prevalent with a major impact on the mother and child health. We aimed to determine the prevalence of PPD in primary health care centres which provide vaccinations services to infants in Assiut city and to evaluate the possible risk factors associated with PPD. METHODS In this multicentre study, 257 mothers attended three primary health care centres for immunization of their babies were recruited from January 2019 to January 2020. All participants were evaluated for socio-demographic features, Family affluence scale (FAS), Edinburgh Postnatal Depression Scale (EPDS) and associated risk factors. RESULTS The mean age of the participants was 27.98 ± 4.7. About half of the mothers and their husbands had low education level. Most of the families (89%) have low socioeconomic scale (SES). About (33.5%) women were found to have possible PPD. In the logistic regression analysis, SES, history of depression, history of PPD, history of stressful conditions, familial support, unwanted pregnancy, and male preference were significant statistical in PPD (p < 0.05). LIMITATIONS We did not investigate the medical and psychological problems during antenatal care. Also, we did not assess relation of the type of delivery and medical problems during delivery on the postnatal care. CONCLUSIONS PPD was prevalent in 33.5% The possible risk factors of PPD were low SES, history of depression, history of PPD, history of stressful conditions, familial support, unwanted pregnancy, and male preference.
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Affiliation(s)
- Gellan K Ahmed
- Department of Neurology and Psychiatry, Assiut University, 71516 Assiut, Egypt; Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
| | - Khaled Elbeh
- Department of Neurology and Psychiatry, Assiut University, 71516 Assiut, Egypt
| | - Randa M Shams
- Department of Public Health, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Ahmed K Ibrahim
- Department of Public Health, Faculty of Medicine, Assiut University, Assiut, Egypt
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21
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Tasnim F, Rahman M, Islam MM, Rahman MM. Association of pregnancy intention with postpartum depression within six months postpartum among women in Bangladesh. Asian J Psychiatr 2021; 61:102686. [PMID: 34020319 DOI: 10.1016/j.ajp.2021.102686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Fowzia Tasnim
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | - Mymuna Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | - Md Monimul Islam
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | - Md Mosfequr Rahman
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, 6205, Bangladesh.
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22
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Skinner-Taylor CM, Perez-Barbosa L, Barriga-Maldonado ES, Diaz-Angulo JE, Cardenas-de la Garza JA, Corral-Trujillo ME, Galarza-Delgado DA. Postpartum depression in Mexican women with autoimmune rheumatic diseases. Clin Rheumatol 2021; 40:2509-2512. [PMID: 33507421 DOI: 10.1007/s10067-021-05593-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Cassandra Michele Skinner-Taylor
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 64460, Monterrey, Mexico
| | - Lorena Perez-Barbosa
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 64460, Monterrey, Mexico.
| | - Eugenio Salvador Barriga-Maldonado
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 64460, Monterrey, Mexico
| | - Jazzia Emily Diaz-Angulo
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 64460, Monterrey, Mexico
| | - Jesus Alberto Cardenas-de la Garza
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 64460, Monterrey, Mexico
| | - María Eugenia Corral-Trujillo
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 64460, Monterrey, Mexico
| | - Dionicio Angel Galarza-Delgado
- Department of Rheumatology, University Hospital "Dr. Eleuterio Gonzalez", Universidad Autónoma de Nuevo León, Av. Gonzalitos 235 nte, Col. Mitras Centro, 64460, Monterrey, Mexico
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Factors associated with postpartum depression among women in Vientiane Capital, Lao People's Democratic Republic: A cross-sectional study. PLoS One 2020; 15:e0243463. [PMID: 33275620 PMCID: PMC7717544 DOI: 10.1371/journal.pone.0243463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/21/2020] [Indexed: 12/01/2022] Open
Abstract
Postpartum depression is a worldwide public health concern. The prevalence of postpartum depression is reported to be greater in developing countries than in developed countries. However, to the best of our knowledge, no papers on postpartum depression in the Lao People’s Democratic Republic have been published. In order to strengthen maternal and child health, the current situation of postpartum depression should be understood. This study aims to determine the prevalence of postpartum depression and identify factors associated with postpartum depression in Vientiane Capital, Lao People’s Democratic Republic. Study participants were 428 women 6–8 weeks postpartum who visited four central hospitals in Vientiane Capital for postnatal care from July to August 2019. Structured questionnaires were used to collect socio-demographic, obstetrical and infant, and psychiatric data about the women and their partners. The Edinburgh Postnatal Depression Scale (EPDS) was used to identify suspected cases of postpartum depression with the cut-off score of 9/10. Multivariable logistic regression was used to examine independent factors that were associated with suspected postpartum depression (EPDS ≥10). The mean age of the 428 women was 28.1 years, and the prevalence of suspected postpartum depression was 31.8%. Multivariable logistic regression using variables that were statistically significant on bivariate analyses indicated that three variables were associated with suspected postpartum depression: unintended pregnancy (AOR = 1.66, 95% CI 1.00–2.73, P = 0.049), low birth satisfaction (AOR = 1.85, 95% CI 1.00–3.43, P = 0.049), and depression during pregnancy (AOR = 3.99, 95% CI 2.35–6.77, P <0.001). In this study, unintended pregnancy, low birth satisfaction, and depression during pregnancy were independent risk factors for postpartum depression. These results suggest that the mental health of pregnant women should be monitored, and that health care services, especially family planning and supportive birth care, should be strengthened to prevent postpartum depression.
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Unintended pregnancy and postpartum depression: A meta-analysis of cohort and case-control studies. J Psychosom Res 2020; 138:110259. [PMID: 33002811 DOI: 10.1016/j.jpsychores.2020.110259] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The majority of original studies showed that unintended pregnancy is related to adverse obstetric outcomes, however, up to now, the influence of unintended pregnancy on the risk of developing postpartum depression (PPD) remains unclear. This study aimed to assess the association between unintended pregnancy and the risk of developing PPD by conducting a meta-analysis of cohort and case-control studies. METHODS PubMed, Web of Science, Embase, and Cochrane Library were searched up to December 31, 2019 to identify relevant studies evaluating the association between unintended pregnancy and PPD. Meta-analysis was performed using RevMan software and Stata software. Potential heterogeneity source was explored by subgroup and sensitivity analyses, and potential publication bias was tested using Begg's funnel plots and Begg's linear regression test. RESULTS A total of thirty studies involving 65,454 participants were included in our meta-analysis. Overall, women who get pregnant unintendedly compared with those who are intending to be pregnant were at a significantly higher risk of developing PPD (odds ratio [OR] = 1.53; 95% confidence interval [CI]: 1.35-1.74; P < 0.00001). CONCLUSIONS Unintended pregnancy is significantly associated with the risk of developing PPD. These findings highlight the necessity of screening for pregnancy intention and integrating family planning and personalized mental health services into primary healthcare to promote maternal mental health.
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Williams S, Bruxner G, Ballard E, Kothari A. Prescribing antidepressants and anxiolytic medications to pregnant women: comparing perception of risk of foetal teratogenicity between Australian Obstetricians and Gynaecologists, Speciality Trainees and upskilled General Practitioners. BMC Pregnancy Childbirth 2020; 20:618. [PMID: 33054795 PMCID: PMC7556911 DOI: 10.1186/s12884-020-03293-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 09/28/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Summer Williams
- Gold Coast University Hospital, Southport, 4215, Queensland, Australia
| | - George Bruxner
- Metro North Mental Health Service, Brisbane, 4006, Queensland, Australia.,University of Queensland, St Lucia, 4067, Queensland, Australia
| | - Emma Ballard
- University of Queensland, St Lucia, 4067, Queensland, Australia.,Queensland Institute of Medical Research, Berghofer Medical Research Institute, Brisbane, 4072, Queensland, Australia
| | - Alka Kothari
- University of Queensland, St Lucia, 4067, Queensland, Australia. .,Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland, 4020, Australia.
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Lichtenstein Liljeblad K, Kopp Kallner H, Brynhildsen J. Risk of abortion within 1-2 years after childbirth in relation to contraceptive choice: a retrospective cohort study. EUR J CONTRACEP REPR 2020; 25:141-146. [PMID: 32083501 DOI: 10.1080/13625187.2020.1718091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: The primary objective of the study was to investigate whether the choice of long-acting reversible contraception (LARC) was associated with the risk of abortion over a period of 24 months postpartum. The secondary objective was to analyse whether other significant factors were affecting the risk of abortion during this period.Methods: In this retrospective cohort study, we analysed 11,066 women who had delivered in three Swedish cities during 2013 and 2014. Demographic and medical variables were obtained from medical records. Attendance at the postpartum visit, choice of postpartum contraception and history of abortion was noted. Logistic regression analysis was performed to assess factors associated with the risk of abortion. The main outcome measure was the proportion of women with abortion up to 24 months postpartum.Results: Data from 11,066 women were included in the final analysis. Within 12-24 months after delivery 2.5% of women had an abortion. The choice of LARC after childbirth reduced the risk of subsequent abortion (odds ratio 0.74; 95% confidence interval [CI] 0.60, 0.91; p = .005). Smoking, age <25 years and have had a previous abortion significantly increased the risk of abortion during follow-up, whereas exclusive breastfeeding decreased the risk.Conclusions: Increasing the proportion of women who choose LARC postpartum could decrease the risk of abortion for up to 2 years after childbirth.
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Affiliation(s)
- Karin Lichtenstein Liljeblad
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Danderyd Hospital, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Obstetrics and Gynaecology, Danderyd Hospital, Stockholm, Sweden
| | - Jan Brynhildsen
- Department of Obstetrics & Gynaecology, Department of Clinical & Experimental Medicine, Linköping University, Linköping, Sweden
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Impact of intention and feeling toward being pregnant on postpartum depression: the Japan Environment and Children's Study (JECS). Arch Womens Ment Health 2020; 23:131-137. [PMID: 30591966 PMCID: PMC6987065 DOI: 10.1007/s00737-018-0938-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/12/2018] [Indexed: 11/12/2022]
Abstract
Pregnancy intention is reported to be associated with the risk of postpartum depression (PPD), but the impact of feelings toward being pregnant on PPD is unknown. We aimed to examine whether feelings toward being pregnant are associated with PPD at 1 month after childbirth. In our nationwide study between 2011 and 2014 in Japan, we used multivariate logistic regression analyses to examine the associations between pregnancy intention and feelings toward being pregnant with PPD [Edinburgh Postnatal Depression Scale (EPDS score > 9 or > 12)] among Japanese women. Among 92,431 women, 14.0 and 5.4% had PPD with EPDS scores > 9 and > 12, respectively. Compared with women who felt very happy to be pregnant, those whose pregnancy was unintended but happy, unintended and confused, those who felt troubled, and those who felt no emotion toward being pregnant had increased risks of PPD [multivariable odds ratios (95% confidence intervals (CIs)) = 1.17 (1.11-1.22), 1.39 (1.29-1.49), 1.74 (1.42-2.14), and 1.58 (1.22-2.02), respectively, for EPDS score > 9]. Those associations were more evident without antenatal possible mental illness (K6 score < 13). Women whose pregnancy was unintended should be regarded as targets for the early detection and prevention of PPD irrespective of whether they felt happy or confused.
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Drevin J, Hallqvist J, Sonnander K, Rosenblad A, Pingel R, Bjelland EK. Childhood abuse and unplanned pregnancies: a cross-sectional study of women in the Norwegian Mother and Child Cohort Study. BJOG 2019; 127:438-446. [PMID: 31802594 DOI: 10.1111/1471-0528.16037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study if childhood emotional, physical and sexual abuse are determinants for having an unplanned pregnancy, if the categories of abuse interact, and if a potential bias due to the selection of the participants (collider stratification bias) could explain the effect of childhood abuse. DESIGN A cross-sectional study. SETTING The study is based on the Norwegian Mother and Child Cohort Study (MoBa) and uses data from the Medical Birth Registry of Norway. SAMPLE Women participating in the MoBa for the first time, ≥18 years of age who responded to questions regarding childhood abuse and pregnancy planning (n = 76 197). METHODS Data were collected using questionnaires. We conducted analyses using modified Poisson regressions and the relative excess risks due to interaction (RERI). Sensitivity analyses were performed. MAIN OUTCOME MEASURE An unplanned pregnancy (yes/no). RESULTS Exposure to childhood emotional (adjusted relative risk [RR] 1.14, 95% CI 1.10-1.19), physical (adjusted RR 1.11, 95% CI 1.04-1.18) and sexual (adjusted RR 1.20, 95% CI 1.14-1.27) abuse increased the risk of having an unplanned pregnancy. The effects could not be explained by the collider stratification bias. The different combinations of categories of abuse did not show any interaction effects. CONCLUSIONS Childhood emotional, physical and sexual abuses separately increase the risk of having an unplanned pregnancy. The results indicate that victims of childhood abuse are in greater need of support to achieve their reproductive goals. TWEETABLE ABSTRACT Childhood abuse increases the risk of having an unplanned pregnancy. #reproductivehealth #epitwitter.
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Affiliation(s)
- J Drevin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - J Hallqvist
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - K Sonnander
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - A Rosenblad
- Department of Statistics, Stockholm University, Stockholm, Sweden.,Department of Medical Sciences, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - R Pingel
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - E K Bjelland
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Obstetrics and Gynecology, Akershus University Hospital, Lørenskog, Norway
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Meng L, Li J, Cheng Y, Wei T, Du Y, Peng S. Dysmenorrhea increased the risk of postpartum depression in Chinese Han parturients. Sci Rep 2019; 9:16579. [PMID: 31719600 PMCID: PMC6851359 DOI: 10.1038/s41598-019-53059-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/28/2019] [Indexed: 12/13/2022] Open
Abstract
Several studies have shown that dysmenorrhea increased the risk of depression. However, the association between dysmenorrhea and postpartum depression (PPD) is unclear. The purpose of this study is to evaluate the effects of dysmenorrhea on the development of PPD among Chinese women. A case-control study was performed on parturients who delivered from January 1, 2016, to December 31, 2016, at Bao an Maternal and Child Health Hospital in Shenzhen, China. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for maternal postpartum depression. Logistic regression models were used to examine the association between dysmenorrhea and the risk of PPD. A total of 360 women including 120 cases and 240 controls were enrolled. Our study showed that parturients with PPD had a higher percentage of dysmenorrhea than women without PPD (64.2% vs 47.9%, P = 0.004). In univariate analysis, we observed that dysmenorrhea increased the risk for PPD (OR = 1.95; 95% CI: 1.24-3.06; P = 0.004). In the fully adjusted model, dysmenorrhea was still significantly associated with an increased risk of PPD (OR = 2.45; 95% CI: 1.36-4.54; P = 0.003). Our data confirmed that dysmenorrhea may be a risk factor for PPD. Therefore, screening for postpartum depression should be considered in parturients with a history of dysmenorrhea.
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Affiliation(s)
- Liping Meng
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Jianmei Li
- Department of Public Health, Bao an Maternal and Child Health Hospital, Jinan University, Shenzhen, Guodong, China
| | - Yuli Cheng
- Department of Public Health, Bao an Maternal and Child Health Hospital, Jinan University, Shenzhen, Guodong, China
| | - Tingting Wei
- Department of Public Health, Bao an Maternal and Child Health Hospital, Jinan University, Shenzhen, Guodong, China
| | - Yukai Du
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China.
| | - Songxu Peng
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China. .,Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, Hunan, China.
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Association between unintended pregnancy and internalizing disorders among Latina and Asian American mothers. J Affect Disord 2019; 258:117-124. [PMID: 31401539 DOI: 10.1016/j.jad.2019.07.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pregnancy, whether intended or unintended, is associated with internalizing symptoms among women; for some, these symptoms cause impairment and develop into an internalizing disorder (ID). With the growing diversity of the US population, there is a need to understand how pregnancy relates to IDs among minorities. This study examines the association between unintended pregnancy and lifetime and 12-month history of IDs among Latina and Asian mothers. METHODS Data come from the National Latino and Asian American Study (NLAAS), a nationally representative sample of Latino and Asian adults. Pregnancy intention was self-reported. ID history was assessed with the CIDI (DSM-IV). Logistic regression was used to examine the association between pregnancy intention and likelihood of lifetime and 12-month IDs. RESULTS Among 1915 mothers, 24.1% and 14.7% met criteria for a lifetime and 12-month ID, respectively. Relative to those who only reported intended pregnancies, Asian mothers reporting an unintended pregnancy had the highest odds of lifetime (Odds ratio (OR): 2.51, 95% Confidence Interval (CI): 1.55-4.08) and 12-month IDs (OR: 5.73, 95% CI: 2.67-12.29). Latina mothers reporting unintended pregnancies also had higher odds of lifetime (OR: 1.96, 95% CI: 1.41-2.72) and 12-month IDs (OR: 1.70, 95% CI: 1.12-2.59). Socioeconomic status had no significant modifying effect. LIMITATIONS Cross-sectional data and retrospective recall and social desirability could misclassify pregnancy intention. CONCLUSIONS Unintended pregnancy is associated with higher odds of IDs among mothers. Findings underscore the complex relationship between unintended pregnancy and maternal mental health.
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Upadhyay AK, Singh A, Singh A. Association between unintended births and risk of postpartum depression: Evidence from Ethiopia, India, Peru and Vietnam. SSM Popul Health 2019; 9:100495. [PMID: 31650000 PMCID: PMC6804781 DOI: 10.1016/j.ssmph.2019.100495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/05/2019] [Accepted: 10/03/2019] [Indexed: 12/29/2022] Open
Abstract
Previous studies have shown that unintended births adversely affect birth outcomes, child health and cognitive development in developing countries. However, only a few studies have examined the association between unintended births and risk of postpartum depression (PPD) in these countries. The study uses data from the first wave of Young Lives Study (YLS) conducted in 2002 in Ethiopia, India, Peru and Vietnam to examine the association between birth intention and the risk of PPD. Bivariate and multivariable logistic regressions are used to examine the association. Bivariate result indicates that the risk of PPD was substantially higher among mothers who reported an unintended birth as compared to mothers who reported an intended birth in each country. Results from multivariable logistic regression models indicate that unintended births were associated with higher risk of PPD in pooled data (odds ratio: 1.46, 95%CI. 1.29, 1.66), Ethiopia (odds ratio: 1.99, 95% CI. 1.58,2.50), and Peru (odds ratio: 1.29, 95% CI. 1.04, 1.59) compared with mothers having an intended birth. Results suggest that reducing unintended births might help in reducing the incidence of PPD among mothers in these countries. One of the most cost-effective interventions for reducing the incidence of unintended births is the availability of effective family planning programme.
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Affiliation(s)
| | - Abhishek Singh
- International Institute for Population Sciences, Mumbai, India
| | - Ashish Singh
- SJM School of Management, Indian Institute of Technology Bombay, India
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Contextual-relationship and stress-related factors of postpartum depression symptoms in nulliparas: a prospective study from Ljubljana, Slovenia. Reprod Health 2019; 16:145. [PMID: 31533847 PMCID: PMC6751738 DOI: 10.1186/s12978-019-0810-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 09/09/2019] [Indexed: 01/26/2023] Open
Abstract
Background For a significant proportion of women, postpartum depression (PPD) is the first mood episode in their lives, yet its aetiology still remains unclear. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aimed to gain further insight into the risk factors for postpartum depression symptoms (PPDS) of nulliparas in Slovenia and to examine vulnerability to developing depressive symptoms, with an emphasis on contextual and stress-related characteristics. Methods The sample consisted of 156 nulliparas in the third trimester of pregnancy enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Postpartum Depression Scale (EPDS), the Zung Anxiety Scale and a question battery designed by the research team including questions about emotional support and work-related stress. Logistic regression was used to test the association between demographic, social, environmental, personality and attachment variables and PPD of nulliparas (EPDS ≥10), controlling for baseline (prepartum) depression score. A multivariable linear regression model was built with the postpartum EPDS continuous score as a dependent variable. Results 28/156 (17,9%) were evaluated as being at risk for depression (EPDS≥10) in the last trimester and 25/156 (16%) at six weeks postpartum. The results of the logistic regression model controlled for prepartum depression score showed that increased risk for developing PPDS was associated with anxiety level postpartum, intimate-partner-attachment anxiety postpartum, and elevated stress due to loss of employment or an unsuccessful search for employment in the previous year. The results of the multivariable regression model, however, showed the association with education and postpartum anxiety with PPDS continuous score; EPDS after giving birth was higher for more educated and more anxious primiparas. Conclusions Our findings demonstrate the importance of anxiety symptoms and higher education level in assessments of nulliparas’ mental health. The results of our study show and confirm the results of previous research that anxiety symptoms in the immediate postpartum period are likely to be associated with depressive symptoms in nulliparas. The results also suggest that higher level of education of first-time mothers might not be a protective factor, especially for nulliparas with the university level of education. Further studies on larger samples should be considered.
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Carter EA, Bond MJ, Wickham RE, Barrera AZ. Perinatal depression among a global sample of Spanish-speaking women: A sequential-process latent growth-curve analysis. J Affect Disord 2019; 243:145-152. [PMID: 30243194 PMCID: PMC6207183 DOI: 10.1016/j.jad.2018.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/27/2018] [Accepted: 09/09/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite high rates of perinatal depression among women from diverse backgrounds, the understanding of the trajectory of depressive symptoms is limited. The aim of this study was to investigate the trajectories of depressive symptoms from pregnancy to postpartum among an international sample of pregnant women. METHODS Hispanic/Latina (79.2%), Spanish-speaking (81%) pregnant women (N = 1796; Mean age = 28.32, SD = 5.51) representing 78 unique countries/territories participated in this study. A sequential-process latent growth-curve model was estimated to examine general trajectories of depression as well as risk and protective factors that may impact depression levels throughout both the prenatal and postpartum periods. RESULTS Overall, depression levels decreased significantly across the entire perinatal period, but this decrease slowed over time within both the prenatal and postpartum periods. Spanish-speaking women, those who were partnered, and those with no history of depression reported lower levels of depression during early pregnancy, but this buffer effect reduced over time. Depression levels at delivery best predicted postpartum depression trajectories (i.e., women with higher levels of depression at delivery were at greater risk for depression postpartum). LIMITATIONS Given the emphasis on language and not country or culture of origin this study was limited in its ability to examine the impact of specific cultural norms and expectations on perinatal depression. CONCLUSIONS Given these findings, it is imperative that providers pay attention to, and assess for, depressive symptoms and identified buffers for depression, especially when working with women from diverse communities.
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Hollins Martin CJ, Anderson L, Martin CR. A scoping review to determine themes that represent perceptions of self as mother ('ideal mother' vs 'real mother'). J Reprod Infant Psychol 2018; 37:224-241. [PMID: 30554526 DOI: 10.1080/02646838.2018.1556786] [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: 10/27/2022]
Abstract
Background: Postnatal depression (PND) is a key cause of maternal morbidity, with current systems of initial recognition in the UK detecting only 50% of cases. In attempts to predict those potentially at risk, this review suggests a novel approach. Aim: Implementing the concept of 'ideal mother' versus 'real mother', and asking the woman to compare their 'ideal self' against 'existent self', the aim of this instrument development review was to determine themes from the literature that relate to women's perceptions of self as a mother, and from this identification develop questions for inclusion within a proposed new measure entitled the Self-Image as Mother Scale (SIMS). Method: A scoping review of the literature was carried out to identify themes considered to affect perception of self as mother, and from this identification, evidence-based questions for inclusion in the SIMS were developed. Findings: Themes identified included (1) marital dissatisfaction, (2) inadequate partner support, (3) lack of family support, (4) socioeconomic status and associated poverty, (5) concern about infant, (6) antenatal/postnatal complications, (7) acceptance of infant gender, (8) history of mental health problems, (9) unplanned pregnancy. Conclusions: From this scoping review 18 questions were developed for inclusion in the SIMS, which will then be evaluated for psychometric properties, scale refinement and validation.
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Affiliation(s)
- Caroline J Hollins Martin
- a Maternal Health, School of Nursing, Midwifery and Social Care , Edinburgh Napier University (ENU), Sighthill Campus , Edinburgh , UK
| | - Lara Anderson
- b School of Nursing, Midwifery and Social Care , Edinburgh Napier University (ENU), Sighthill Campus , Edinburgh , UK
| | - Colin R Martin
- c Perinatal Mental Health , Institute for Clinical and Applied Health Research (ICAHR), University of Hull , Hull , UK
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Hall JA, Barrett G, Copas A, Phiri T, Malata A, Stephenson J. Reassessing pregnancy intention and its relation to maternal, perinatal and neonatal outcomes in a low-income setting: A cohort study. PLoS One 2018; 13:e0205487. [PMID: 30335769 PMCID: PMC6193645 DOI: 10.1371/journal.pone.0205487] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/26/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is unclear whether unintended pregnancies are associated with adverse outcomes. Data are predominantly from high-income countries and have methodological limitations, calling the findings into question. This research was designed to overcome these limitations and assess the relationships between pregnancy intention and miscarriage, stillbirth, low birthweight, neonatal death and postnatal depression in a low-income country. METHODS The pregnancy intention of 4,244 pregnant women in Mchinji District, Malawi, was measured using the validated Chichewa version of the London Measure of Unplanned Pregnancy (LMUP). Women were re-interviewed postnatally to assess pregnancy outcome. Postnatal depression was assessed using the WHO's Self-Reporting Questionnaire. Multivariable regressions were conducted, with the choice of confounders informed by a pre-existing conceptual epidemiological hierarchy. RESULTS Planned pregnancies are associated with a reduced risk of any (adjusted RR 0.90 [95%CI 0.86, 0.95]) or high symptoms of depression (adjusted RR 0.76 [95%CI 0.63, 0.91]) compared to unplanned pregnancies in rural Malawi. There was no relationship between pregnancy intention and the composite measure of miscarriage, stillbirth, low birthweight and neonatal death. There was some evidence that greater pregnancy intention was associated with reduced adjusted risk of stillbirth (0·93 [95%CI 0·87, 1·00]). CONCLUSION Our study is the first to use a psychometrically valid measure of pregnancy intention, and to do so antenatally. As pregnancy intention increases, the risk of postnatal depression and, possibly, stillbirth decreases. This suggests a new, clinical use for the LMUP; identifying women antenatally who are at risk of these adverse pregnancy outcomes.
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Affiliation(s)
- Jennifer Anne Hall
- Research Department of Reproductive Health, UCL Institute for Women’s Health, London, United Kingdom
- * E-mail:
| | - Geraldine Barrett
- Research Department of Reproductive Health, UCL Institute for Women’s Health, London, United Kingdom
| | - Andrew Copas
- Department of Infection & Population Health, UCL Institute of Epidemiology and Health Care, London, United Kingdom
| | | | - Address Malata
- Malawi University of Science and Technology, Zomba, Malawi
| | - Judith Stephenson
- Research Department of Reproductive Health, UCL Institute for Women’s Health, London, United Kingdom
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Tweya H, Feldacker C, Haddad LB, Munthali C, Bwanali M, Speight C, Kachere LG, Tembo P, Phiri S. Integrating family planning services into HIV care: use of a point-of-care electronic medical record system in Lilongwe, Malawi. Glob Health Action 2018; 10:1383724. [PMID: 29039263 PMCID: PMC5678434 DOI: 10.1080/16549716.2017.1383724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Integrating family planning (FP) services into human immunodeficiency virus (HIV) clinical care helps improve access to contraceptives for women living with HIV. However, high patient volumes may limit providers' ability to counsel women about pregnancy risks and contraceptive options. OBJECTIVES To assess trends in the use of contraceptive methods after implementing an electronic medical record (EMR) system with FP questions and determine the reasons for non-use of contraceptives among women of reproductive age (15-49 years) receiving antiretroviral therapy (ART) at the Martin Preuss Center clinic in Malawi. METHODS In February 2012, two FP questions were incorporated into the ART EMR system (initial FP EMR module) to prompt providers to offer contraceptives to women. In July 2013, additional questions were added to the FP EMR module (enhanced FP EMR) to prompt providers to assess risks of unintended pregnancies, solicit reasons for non-use of contraceptives and offer contraceptives to non-pregnant women . We conducted a retrospective, longitudinal cohort study using the EMR routinely collected data. The primary outcome was the use of any modern contraceptive method. Descriptive statistics were used to describe the study population and report trends in contraceptive use during the initial and enhanced study periods. RESULTS Between February 2012 and December 2016, in HIV clinics, 20,253 women of reproductive age received ART, resulting in 163,325 clinic visits observations. The proportion of women using contraceptives increased significantly from 18% to 39% between February 2012 and June 2013, and from 39% to 67% between July 2013 and December 2016 (chi-square for trend p < 0.001). Common reasons reported for the non-use of contraceptives among those at risk of unintended pregnancy were: pregnancy ambivalence (n = 234, 51%) and never thought about it (n = 133, 29%). CONCLUSION Incorporating the FP EMR module into HIV clinical care prompted healthcare workers to encourage the use of contraceptives.
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Affiliation(s)
- Hannock Tweya
- a Center for Operational Research, The International Union Against Tuberculosis and Lung Disease , Paris , France.,b Monitoring and Evaluation Department, Lighthouse Trust , Lilongwe , Malawi
| | - Caryl Feldacker
- c International Training and Education Center for Health , University of Washington , Seattle , WA , USA
| | - Lisa B Haddad
- d Department of and Obstetrics , Emory University School of Medicine , Atlanta , GA , USA
| | - Chimango Munthali
- e Department of Informatics, Baobab Health Trust , Lilongwe , Malawi
| | - Mwatha Bwanali
- e Department of Informatics, Baobab Health Trust , Lilongwe , Malawi
| | - Colin Speight
- b Monitoring and Evaluation Department, Lighthouse Trust , Lilongwe , Malawi
| | - Layout G Kachere
- b Monitoring and Evaluation Department, Lighthouse Trust , Lilongwe , Malawi
| | - Petros Tembo
- b Monitoring and Evaluation Department, Lighthouse Trust , Lilongwe , Malawi
| | - Sam Phiri
- b Monitoring and Evaluation Department, Lighthouse Trust , Lilongwe , Malawi.,f Department of Medicine , University of North Carolina School of Medicine , Chapel Hill , NC , USA.,g Lilongwe, Department of Public Health, College of Medicine, School of Public Health and Family Medicine , University of Malawi , Malawi
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Skogsdal YRE, Karlsson JÅ, Cao Y, Fadl HE, Tydén TA. Contraceptive use and reproductive intentions among women requesting contraceptive counseling. Acta Obstet Gynecol Scand 2018; 97:1349-1357. [PMID: 30007091 PMCID: PMC6175138 DOI: 10.1111/aogs.13426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/12/2018] [Indexed: 11/26/2022]
Abstract
Introduction Limited attention has been paid to the use of contraception in relation to women's family planning intentions. The aim of this study was to investigate the use of contraception during the most recent intercourse as well as the reproductive intentions of Swedish‐speaking women requesting contraceptive counseling. MATERIAL AND METHODS A cross‐sectional baseline survey in a randomized controlled trial regarding reproductive life planning (before randomization). Women requesting contraceptive counseling answered questions about contraception and whether they wanted to have children/more children in the future. Results In total, 1946 women participated: 33.7% (n = 656) parous and 65.7% (n = 1279) nulliparous. The majority, 87.1% (n = 1682), had used contraception during their latest intercourse; 64.6% (n = 1239) used short‐acting reversible contraception, 22.8% (n = 443) used long‐acting reversible contraception (LARC), and 12.9% (n = 251) had not used any contraception. A combined oral contraceptive was more common among nulliparous and LARC among parous. Among all women, 64.8% (n = 1253) intended to have children/more children in the future, among parous women 35.7% (n = 220) and among nulliparous 80.0% (n = 1033). Among women who did not intend to have children/more children, 22.6% (n = 60) of parous and 10% (n = 8) of nulliparous had not used contraceptives during their most recent intercourse. Conclusions Women did not always use contraceptives that were suitable for their reproductive intentions. Questioning women who request contraceptive counseling about their pregnancy intention can give healthcare providers better opportunities for individualized counseling.
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Affiliation(s)
| | - Jan Åke Karlsson
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Yang Cao
- School of Medical Sciences, Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden.,Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helena Elisabeth Fadl
- Faculty of Medicine and Health, Department of Obstetrics and Gynecology, Örebro University, Örebro, Sweden
| | - Tanja Adele Tydén
- Department of Women's and Children's Health, Academic Hospital, Uppsala, Sweden
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Mukherjee S, Fennie K, Coxe S, Madhivanan P, Trepka MJ. Racial and ethnic differences in the relationship between antenatal stressful life events and postpartum depression among women in the United States: does provider communication on perinatal depression minimize the risk? ETHNICITY & HEALTH 2018; 23:542-565. [PMID: 28095722 DOI: 10.1080/13557858.2017.1280137] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Multi-state population-based studies exploring the racial/ethnic differences in the prevalence and correlates of postpartum depression (PPD), which affects 10-20% of women in the US, are rare. The aim of this study was to examine the racial/ethnic disparities in the relationship between antenatal stressful life events and PPD among US women and to explore whether antenatal health care provider communication on perinatal depression was associated with a lower risk. METHODS Data from the 2009-2011 Pregnancy Risk Assessment Monitoring System (PRAMS) were used. For each racial/ethnic group, the distribution of PPD was compared according to different levels of the stressors and socio-demographic, pre-pregnancy, antenatal, delivery, and neonatal characteristics. Multivariable logistic regression analyses were performed with PPD as the outcome and all variables that were significant in bivariate analyses as predictors. RESULTS Eleven percent of 87,565 women met the criteria for PPD with the prevalence ranging from 7.9% among Asian/Pacific Islanders to 14% among American Indian/Alaska Natives. Irrespective of race/ethnicity, having many bills to pay and having more than usual arguments with husband/partner were risk factors for PPD. Among non-Hispanic black (NHB) women, having a husband/partner who did not want the pregnancy was associated with PPD (adjusted odds ratio [aOR]: 1.47; 95% confidence interval [CI]: 1.14, 1.90), and among non-Hispanic whites (NHWs), drug/drinking problems of someone close was associated with PPD (aOR: 1.37; 95% CI: 1.21, 1.55). Provider communication was inversely associated with PPD among NHWs (aOR: 0.77; 95% CI: 0.69, 0.85) and NHBs (aOR: 0.74; 95% CI: 0.60, 0.93). CONCLUSION The protective effect of provider communication on PPD suggests the benefit of a simple conversation about perinatal depression during antenatal care. Furthermore, risk factors for PPD varied by race/ethnicity suggesting that these vulnerabilities should be taken into consideration in identifying women at-risk for PPD.
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Affiliation(s)
- Soumyadeep Mukherjee
- a Department of Epidemiology , Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA
| | - Kristopher Fennie
- a Department of Epidemiology , Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA
| | - Stefany Coxe
- b Department of Psychology , College of Arts and Sciences, Florida International University , Miami , FL , USA
| | - Purnima Madhivanan
- a Department of Epidemiology , Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA
| | - Mary Jo Trepka
- a Department of Epidemiology , Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA
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Pregnancy, perinatal and postpartum complications as determinants of postpartum depression: the Rhea mother-child cohort in Crete, Greece. Epidemiol Psychiatr Sci 2018; 27:244-255. [PMID: 28004625 PMCID: PMC6998861 DOI: 10.1017/s2045796016001062] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIMS Few epidemiological studies evaluated associations between perinatal complications and maternal mood at the early postpartum period and the findings are inconsistent. We aimed at investigating a wide range of complications during pregnancy, at delivery, and at the early postpartum period as determinants of postpartum depression (PPD) at 8 weeks postpartum. METHODS A total of 1037 women who enrolled in the Rhea mother-child cohort in Crete, Greece participated in the present study. Information on pregnancy, perinatal and postpartum complications was obtained from clinical records or by questionnaires. Postpartum depressive symptoms were assessed at 8 weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable linear and logistic regression models were fit to estimate the association between pregnancy, perinatal and postpartum complications and maternal depressive symptoms, adjusting also for potential confounders. RESULTS The prevalence of women with probable depression (EPDS score ≥ 13) was 13.6% at 8 weeks postpartum. Gestational hypertension and/or preeclampsia (β coefficient 1.86, 95% CI: 0.32, 3.41) and breastfeeding difficulties (β coefficient 0.77, 95% CI: 0.02, 1.53) were significantly associated with higher PPD symptoms. Sleep patterns during pregnancy, such as sleep deprivation (OR = 3.57, 95% CI: 1.91, 6.67) and snoring (OR = 1.81, 95% CI: 1.11, 2.93), and breastfeeding duration less than 2 months (OR = 1.77, 95% CI: 1.19, 2.64) were significantly associated with increase in the odds for PPD. Some other complications, such as unplanned pregnancy and hospitalisation during pregnancy were also associated with EPDS score, but these associations were explained by socio-demographic characteristics of the mother. CONCLUSIONS We found that several pregnancy, perinatal and postpartum complications may have an adverse effect on maternal mood at the early postpartum period. These findings have considerable implications for developing effective prevention and early psychoeducational intervention strategies for women at risk of developing PPD.
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Xiong R, Deng A, Wan B, Liu Y. Prevalence and factors associated with postpartum depression in women from single-child families. Int J Gynaecol Obstet 2018; 141:194-199. [PMID: 29412451 DOI: 10.1002/ijgo.12461] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/29/2017] [Accepted: 02/05/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate the prevalence of postpartum depression (PPD) and its associated factors among women without siblings from south China. METHODS A cross-sectional study was conducted involving 468 mothers from single-child families who were assessed at 6 weeks after childbirth at a tertiary hospital in Guangzhou, China, from June 2015 to July 2016. The Chinese version of the Edinburgh Postnatal Depression Scale and a self-designed questionnaire regarding risk factors were administered to all participants. RESULTS The prevalence of PPD in women from single-child families was 56.2%. A multivariate logistic regression model identified the following pregnancy-related and psychological risk factors: unplanned pregnancy (odds ratio [OR] 2.35, 95% confidence interval [CI] 1.73-3.32), being a first-time mother (OR 3.00, 95% CI 1.73-4.93), poor mother-in-law relationship (OR 3.15, 95% CI 2.93-3.36), and poor family support (OR 2.13, 95% CI 1.84-2.45). Sociodemographic characteristics were not associated with the development of PPD. CONCLUSION The development of PPD in women from single-child families is an important public health concern. Health practitioners should offer psychoeducation and culturally sensitive counseling during the postpartum period, and the screening of mood disorders from the prenatal to the postpartum period should be covered by maternity insurance.
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Affiliation(s)
- Ribo Xiong
- Department of Rehabilitation, The Third Affiliated Hospital of Southern Medical, University, Guangzhou, China.,Department of Rehabilitation, Nanhai Hospital of Southern Medical University, Foshan, China
| | - Aiwen Deng
- Department of Rehabilitation, The Third Affiliated Hospital of Southern Medical, University, Guangzhou, China.,Department of Rehabilitation, Nanhai Hospital of Southern Medical University, Foshan, China
| | - Bo Wan
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yan Liu
- Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
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Tweya H, Feldacker C, Gugsa S, Phiri S. Contraceptive use and pregnancy rates among women receiving antiretroviral therapy in Malawi: a retrospective cohort study. Reprod Health 2018; 15:25. [PMID: 29426333 PMCID: PMC5807743 DOI: 10.1186/s12978-017-0440-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 12/05/2017] [Indexed: 12/01/2022] Open
Abstract
Background In 2011, family planning (FP) services were integrated at Martin Preuss Centre (MPC), in urban Lilongwe, Malawi. To date, no previous study evaluated pregnancy rates among HIV-positive women after the integration of FP services into HIV care at the facility. In this study, we investigated whether integration of FP services into HIV clinical care led to increased use of contraceptives and decreased pregnancy rates. Methods This was a retrospective cohort analysis of HIV-positive women from 15 to 49 years of age who accessed antiretroviral therapy (ART) services at MPC. Ascertainment of FP needs, contraceptive methods and pregnancy status were done at ART initiation, and at each ART follow-up visit. Women were offered a wide range of contraceptive methods. Outcomes of interest were contraceptive use and rate of pregnancy. Incident pregnancy was ascertained through patient self-reports during clinic consultation. Trends of contraceptive use and pregnancy rates were analyzed using chi-square (χ2). Results A total of 10,472 women were included in the analysis and contributed 15,700 person-years of observation. Contraceptive use among all women receiving ART increased from 28% in 2012 to 62% in 2016 (p < 0.001). A total of 501 pregnancies occurred, including 13 multiple pregnancies, resulting in an overall pregnancy rates of 3.2 per 100 person-years. Rates of pregnancy decreased from 6.8 per 100 person-years in 2012 to 1.3 per 100 person-years in 2016 (p < 0.001). Conclusion Integration of FP services into HIV care resulted in increased contraceptive use and, subsequently, decreased pregnancy rates in women receiving ART. HIV programs should consider offering FP services to women who are receiving ART.
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Affiliation(s)
- Hannock Tweya
- The International Union Against Tuberculosis and Lung Disease, Paris, France. .,Lighthouse Trust, P.O. Box 106, Lilongwe, Malawi.
| | - Caryl Feldacker
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | - Salem Gugsa
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | - Sam Phiri
- Lighthouse Trust, P.O. Box 106, Lilongwe, Malawi.,Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Department of Public Health, College of Medicine, School of Public Health and Family Medicine, University of Malawi, Blantyre, Malawi
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Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries. Front Psychiatry 2018; 8:248. [PMID: 29449816 PMCID: PMC5799244 DOI: 10.3389/fpsyt.2017.00248] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/07/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD and a meta-regression to identify economic, health, social, or policy factors associated with national PPD prevalence. METHODS We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence. FINDINGS 291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7% (95% confidence interval: 16.6-18.8%), with significant heterogeneity across nations (Q = 16,823, p = 0.000, I2 = 98%), ranging from 3% (2-5%) in Singapore to 38% (35-41%) in Chile. Nations with significantly higher rates of income inequality (R2 = 41%), maternal mortality (R2 = 19%), infant mortality (R2 = 16%), or women of childbearing age working ≥40 h a week (R2 = 31%) have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence. INTERPRETATION The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.
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Affiliation(s)
- Jennifer Hahn-Holbrook
- Department of Psychology, University of California, Merced, Merced, CA, United States
- Center for Excellence in Biopsychosocial Approaches to Health, Chapman University, Orange, CA, United States
| | | | - Itzel Anaya
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
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Vela VX, Patton EW, Sanghavi D, Wood SF, Shin P, Rosenbaum S. Rethinking Medicaid Coverage and Payment Policy to Promote High Value Care: The Case of Long-Acting Reversible Contraception. Womens Health Issues 2018; 28:137-143. [PMID: 29329988 DOI: 10.1016/j.whi.2017.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 11/16/2022]
Abstract
CONTEXT Long-acting reversible contraception (LARC) is the most effective reversible method to prevent unplanned pregnancies. Variability in state-level policies and the high cost of LARC could create substantial inconsistencies in Medicaid coverage, despite federal guidance aimed at enhancing broad access. This study surveyed state Medicaid payment policies and outreach activities related to LARC to explore the scope of services covered. METHODS Using publicly available information, we performed a content analysis of state Medicaid family planning and LARC payment policies. Purposeful sampling led to a selection of nine states with diverse geographic locations, political climates, Medicaid expansion status, and the number of women covered by Medicaid. RESULTS All nine states' Medicaid programs covered some aspects of LARC. However, only a single state's payment structure incorporated all core aspects of high-quality LARC service delivery, including counseling, device, insertion, removal, and follow-up care. Most states did not explicitly address counseling, device removal, or follow-up care. Some states had strategies to enhance access, including policies to increase device reimbursement, stocking and delivery programs to remove cost barriers, and covering devices and insertion after an abortion. CONCLUSIONS Although Medicaid policy encourages LARC methods, state payment policies frequently fail to address key aspects of care, including counseling, follow-up care, and removal, resulting in highly variable state-level practices. Although some states include payment policy innovations to support LARC access, significant opportunities remain.
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Affiliation(s)
- Veronica X Vela
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Center for Health Policy Research, Washington, DC.
| | - Elizabeth W Patton
- Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
| | | | - Susan F Wood
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Center for Health Policy Research, Washington, DC; Jacobs Institute of Women's Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Peter Shin
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Center for Health Policy Research, Washington, DC; Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Sara Rosenbaum
- Center for Health Policy Research, Milken Institute School of Public Health, George Washington University, Washington, DC
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Cutler A, McNamara B, Qasba N, Kennedy HP, Lundsberg L, Gariepy A. "I Just Don't Know": An Exploration of Women's Ambivalence about a New Pregnancy. Womens Health Issues 2017; 28:75-81. [PMID: 29108986 DOI: 10.1016/j.whi.2017.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 09/12/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE We sought to examine how ambivalence manifests in women's lives after confirmation of a new pregnancy by exploring women's feelings, attitudes, and experiences regarding pregnancy intentions, the news itself, and related pregnancy decision making. STUDY DESIGN We recruited women aged 15 to 44 and at less than 24 completed weeks of gestational age from urban, walk-in pregnancy testing clinics in New Haven, Connecticut, from June 2014 to June 2015. We obtained quantitative and qualitative data via an enrollment survey and face-to-face, semistructured interviews, respectively. Transcripts were analyzed using framework analysis. RESULTS The sample included 84 women. Participants had a mean age of 26 years and were on average 7 weeks estimated gestational age at enrollment. Most identified as Black (54%) or Hispanic (20%), were unmarried (92%), and had at least one other child (67%). More than one-half (55%) described feelings of ambivalence regarding their current pregnancy. We identified ambivalence as a frequent and complex thread that represented distinct but overlapping perspectives about pregnancy: ambivalent pregnancy intentions, ambivalent response to new diagnosis of pregnancy, and ambivalence as uncertainty or conflict over pregnancy decision-making. Sources of ambivalence included relationship status, pregnancy timing, and maternal or fetal health problems. CONCLUSIONS This study improves on previous findings that focus only on ambivalence related to pregnancy intention or to decision making, and explores women's mixed, fluctuating, or unresolved feelings and attitudes about pregnancy before many participants had completed pregnancy decision making. Acknowledging and exploring sources of ambivalence regarding pregnancy may help health providers and policymakers to comprehensively support women with respect to both their experiences and reproductive goals.
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Affiliation(s)
- Abigail Cutler
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.
| | | | - Neena Qasba
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | | | - Lisbet Lundsberg
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Aileen Gariepy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychol Bull 2017; 143:783-822. [PMID: 28447828 PMCID: PMC5532074 DOI: 10.1037/bul0000102] [Citation(s) in RCA: 1085] [Impact Index Per Article: 155.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In 2 meta-analyses on gender differences in depression in nationally representative samples, we advance previous work by including studies of depression diagnoses and symptoms to (a) estimate the magnitude of the gender difference in depression across a wide array of nations and ages; (b) use a developmental perspective to elucidate patterns of gender differences across the life span; and (c) incorporate additional theory-driven moderators (e.g., gender equity). For major depression diagnoses and depression symptoms, respectively, we meta-analyzed data from 65 and 95 articles and their corresponding national data sets, representing data from 1,716,195 and 1,922,064 people in over 90 different nations. Overall, odds ratio (OR) = 1.95, 95% confidence interval (CI) [1.88, 2.03], and d = 0.27 [0.26, 0.29]. Age was the strongest predictor of effect size. The gender difference for diagnoses emerged earlier than previously thought, with OR = 2.37 at age 12. For both meta-analyses, the gender difference peaked in adolescence (OR = 3.02 for ages 13-15, and d = 0.47 for age 16) but then declined and remained stable in adulthood. Cross-national analyses indicated that larger gender differences were found in nations with greater gender equity, for major depression, but not depression symptoms. The gender difference in depression represents a health disparity, especially in adolescence, yet the magnitude of the difference indicates that depression in men should not be overlooked. (PsycINFO Database Record
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Affiliation(s)
- Rachel H. Salk
- Department of Psychology, University of Wisconsin –
Madison
- Department of Psychiatry, University of Pittsburgh School of
Medicine
| | - Janet S. Hyde
- Department of Psychology, University of Wisconsin –
Madison
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Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychol Bull 2017. [PMID: 28447828 DOI: 10.1037/bu10000102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
In 2 meta-analyses on gender differences in depression in nationally representative samples, we advance previous work by including studies of depression diagnoses and symptoms to (a) estimate the magnitude of the gender difference in depression across a wide array of nations and ages; (b) use a developmental perspective to elucidate patterns of gender differences across the life span; and (c) incorporate additional theory-driven moderators (e.g., gender equity). For major depression diagnoses and depression symptoms, respectively, we meta-analyzed data from 65 and 95 articles and their corresponding national data sets, representing data from 1,716,195 and 1,922,064 people in over 90 different nations. Overall, odds ratio (OR) = 1.95, 95% confidence interval (CI) [1.88, 2.03], and d = 0.27 [0.26, 0.29]. Age was the strongest predictor of effect size. The gender difference for diagnoses emerged earlier than previously thought, with OR = 2.37 at age 12. For both meta-analyses, the gender difference peaked in adolescence (OR = 3.02 for ages 13-15, and d = 0.47 for age 16) but then declined and remained stable in adulthood. Cross-national analyses indicated that larger gender differences were found in nations with greater gender equity, for major depression, but not depression symptoms. The gender difference in depression represents a health disparity, especially in adolescence, yet the magnitude of the difference indicates that depression in men should not be overlooked. (PsycINFO Database Record
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Affiliation(s)
- Rachel H Salk
- Department of Psychology, University of Wisconsin-Madison
| | - Janet S Hyde
- Department of Psychology, University of Wisconsin-Madison
| | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin-Madison
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Mukherjee S, Coxe S, Fennie K, Madhivanan P, Trepka MJ. Antenatal Stressful Life Events and Postpartum Depressive Symptoms in the United States: The Role of Women's Socioeconomic Status Indices at the State Level. J Womens Health (Larchmt) 2017; 26:276-285. [DOI: 10.1089/jwh.2016.5872] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Soumyadeep Mukherjee
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Stefany Coxe
- Department of Psychology, College of Arts and Sciences, Florida International University, Miami, Florida
| | - Kristopher Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Purnima Madhivanan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
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Ohashi Y, Sakanashi K, Tanaka T, Kitamura T. Mother-To-Infant Bonding Disorder, but not Depression, 5 days After Delivery is a Risk Factor For Neonate Emotional Abuse: A Study in Japanese Mothers of 1-Month Olds. ACTA ACUST UNITED AC 2016. [DOI: 10.2174/1874922401608010027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:Despite its clinical and public policy-making importance, neonatal abuse has been only minimally studied.Purpose:To identify predictors of mothers’ emotional abuse towards their infants at 1 month after childbirth.Methods:We studied a cohort of 252 women at three time points: late pregnancy and 5 days and 1 month after childbirth. At each time point, the women were administered a set of questionnaires about their depression (Edinburgh Postnatal Depression Scale), bonding towards the foetus or neonate (Maternal Antenatal Attachment Scale and Postnatal Bonding Questionnaire, respectively), and, at 1 month after childbirth, emotional abuse (Conflict Tactic Scale).Results:Structural equation modeling (SEM) analysis revealed that neonatal emotional abuse was predicted by bonding difficulties at 5 days after childbirth but not by depression at that time point.Conclusion:Assessment for maternal bonding problems in the early post-natal period should be routinely performed by perinatal health professionals.
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Royer PA, Turok DK, Sanders JN, Saltzman HM. Choice of Emergency Contraceptive and Decision Making Regarding Subsequent Unintended Pregnancy. J Womens Health (Larchmt) 2016; 25:1038-1043. [PMID: 27032057 PMCID: PMC5069714 DOI: 10.1089/jwh.2015.5625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To prospectively evaluate (1) pregnancy desirability, (2) stated intentions should pregnancy occur among emergency contraception (EC) users, and (3) explore differences between women selecting the copper T380 intrauterine device (Cu IUD) or oral levonorgestrel (LNG) regarding hypothetical pregnancy plans and actual pregnancy actions during subsequent unintended pregnancies. STUDY DESIGN In this prospective observational trial, women received the Cu IUD or oral LNG for EC without cost barriers. At baseline, participants completed a visual analogue scale measuring pregnancy desirability (anchors: 0, "trying hard not to get pregnant"; 10, "trying hard to get pregnant") and self-reported plans (abortion, adoption, parenting, and unsure) if the pregnancy test were to come back positive. Pregnancies were tracked for 12 months, and actions regarding unintended pregnancies were compared between EC method groups. RESULTS Of 548 enrolled women, 218 chose the Cu IUD and 330 the oral LNG for EC. Pregnancy desirability at baseline was low, with no difference between EC groups (IUD group: 0.51, SD ± 1.60; LNG group: 0.68, SD ± 1.74). Fifty-four (10%) women experienced unintended pregnancies. Pregnancy plans from baseline changed for 27 (50%) women when they became pregnant. EC groups did not differ in hypothetical pregnancy intention (p = 0.15) or in agreement of hypothetical pregnancy intention with actual pregnancy action (p = 0.80). CONCLUSIONS Women presenting for EC state high desire to prevent pregnancy regardless of method selected. When considering a hypothetical pregnancy, half of women had a plan for how they would respond to that situation, but when confronting an actual unintended pregnancy, half altered their plan. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov identifier NCT00966771.
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Affiliation(s)
- Pamela A Royer
- Department of Obstetrics and Gynecology, University of Utah , Salt Lake City, Utah
| | - David K Turok
- Department of Obstetrics and Gynecology, University of Utah , Salt Lake City, Utah
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah , Salt Lake City, Utah
| | - Hanna M Saltzman
- Department of Obstetrics and Gynecology, University of Utah , Salt Lake City, Utah
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