Diagnostic Validity of the Generalized Anxiety Disorder - 7 (GAD-7) among Pregnant Women

Human placental lactogen (human chorionic somatomammotropin) and oxytocin during pregnancy: Individual patterns and associations with maternal-fetal attachment, anxiety, and depression

Previous studies support links among maternal-fetal attachment, psychological symptoms, and hormones during pregnancy and the post-partum period. Other studies connect maternal feelings and behaviors to oxytocin and suggest that an increase in oxytocin during pregnancy may prime maternal-fetal attachment. To date, researchers have not examined a possible association between maternal-fetal attachment with human placental lactogen although animal models are suggestive. In the current study, we sought to describe oxytocin and human placental lactogen levels as related to psychological constructs across pregnancy. Seventy women participated in the study. At each of three time-points (early, mid, and late pregnancy), the women had their blood drawn to assess oxytocin and human placental lactogen levels, and they completed psychological assessments measuring maternal-fetal attachment, anxiety, and depression. Our results indicate that oxytocin levels were statistically similar across pregnancy, but that human placental lactogen significantly increased across pregnancy. Results did not indicate significant associations of within-person (comparing individuals to themselves) oxytocin or human placental lactogen levels with maternal-fetal attachment. Additionally, results did not show between-person (comparing individuals to other individuals) oxytocin or human placental lactogen levels with maternal-fetal attachment. Oxytocin levels were not associated with anxiety; rather the stage of pregnancy moderated the effect of the within-person OT level on depression. Notably, increasing levels of human placental lactogen were significantly associated with increasing levels of both anxiety and depression in between subject analyses. The current study is important because it describes typical hormonal and maternal fetal attachment levels during each stage of pregnancy, and because it suggests an association between human placental lactogen and psychological symptoms during pregnancy. Future research should further elucidate these relationships.

Prevalence and predictors of postpartum depression and generalized anxiety symptoms among women who delivered at a tertiary hospital in Mwanza Tanzania: a cross-sectional study

BACKGROUND

Postpartum depression and anxiety are major public health concerns that affect 3-39% of women after childbearing and can adversely affect maternal and child health. Most studies have investigated postpartum depression and anxiety and their associated factors among women 4-12 weeks after delivery. There is a scarcity of research among women immediately after delivery from low- and middle-income countries, the gap this study aimed to fill.

METHODS

A descriptive cross-sectional study was conducted among 386 postpartum women within one week after delivery. The Edinburg Postnatal Depression Scale was used to assess depressive symptoms and the Generalized Anxiety Disorder - 7 scale was used to screen for symptoms of generalized anxiety disorder. Participants were systematically selected from the postnatal wards and interviewed by trained research assistants from November 2019 to March 2020.

RESULTS

Using standard cut points, the prevalence of depressive and anxiety symptoms was 25.39%, and 37.31% respectively. Having a baby with a weight of 2.5 kgs or more and having partner support were associated with decreased odds of both depression and anxiety symptoms. In contrast, complications during delivery, caesarian section, marital status, and partner violence, were associated with increased odds of depressive and anxiety symptoms post-delivery.

CONCLUSION

There was a high prevalence of postpartum depression and anxiety symptoms among the study participants in the first week post-delivery, with delivery complications and outcome and psychosocial supports identified as associated factors for depression and anxiety symptoms. These findings highlight the need for early screening to identify those at risk for appropriate intervention.

Validation of the Chinese version of the Fear of Birth Scale among pregnant women

AIM

Adapt Fear of Birth Scale (FOBS) for the Chinese context, evaluate psychometric properties and determine optimal cutoff point for pregnant women in 3rd trimester.

DESIGN

This is a descriptive cross-sectional study. Cultural guidelines informed the development of the Chinese version of FOBS (FOBS-C) incorporating validation on translation, equivalence index, content validity index, and cognitive debriefing. Thirty pregnant women took a test-retest survey and another 1019 took three cross-sectional surveys. Convergent validation of the FOBS-C involved comparison with Childbirth Attitudes Questionnaire (CAQ), Wijma Delivery Expectancy Questionnaire (WDEQ-A), Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder Scale (GAD-7), and physiological indicators. Cutoff points for FOBS-C were identified using receiver operating characteristic analysis against medical indicators.

FINDINGS

FOBS-C demonstrated high translation equivalence (0.833-1), content validity (0.800-0.933), internal consistency (0.897), and test-retest reliability (0.860). Convergent validity was supported by statistically significant correlations between FOBS scores, heart rate, skin conductance changes, as well as scores from WDEQ-A, CAQ, EPDS, and GAD-7. Known-group validity was observed with different medical indicators. FOBS-C cutoff points indicating severe fear of childbirth were identified as 65, 68, 71, and 56, respectively, against WDEQ-A ≥ 85, CAQ ≥ 52, preference for C-section birth, and preference for analgesia, demonstrating known-group validity. A cutoff point of 65 showed the FOBS-C's strongest known-group validity.

CONCLUSION

The FOBS-C exhibits robust psychometric properties, making it a valid screening tool for identifying severe fear of birth. Establishing a cutoff point at 65 facilitates effective screening.

Prevalence of postnatal anxiety disorders in mothers of preterm infants: a systematic review protocol

OBJECTIVE

The objective of this systematic review is to evaluate and synthesize the available evidence on the prevalence of postnatal anxiety disorders in mothers of preterm infants within 12 months of delivery.

INTRODUCTION

Mothers of preterm infants report more postpartum psychological problems than other mothers. Anxiety disorders are among the most frequently reported manifestations, and affect the quality of maternal care and the baby's development. However, data on the prevalence of postnatal anxiety disorders in mothers of preterm infants are inconsistent and imprecise. It is, therefore, necessary to estimate the prevalence of anxiety disorders among mothers of premature infants in order to develop appropriate interventions for screening, support, and treatment.

INCLUSION CRITERIA

This review will consider studies conducted in any setting and any geographical location that report on the prevalence of any anxiety disorders in mothers of preterm infants within 12 months of delivery. Any analytical or descriptive observational studies and experimental or quasi-experimental studies will be included.

METHODS

MEDLINE (Ovid), PsycINFO (Ovid), Embase (Elsevier), CINAHL (EBSCOhost), Google Scholar, MedNar, and the World Health Organization website will be searched for studies written in English or French. Screening, critical appraisal, and data extraction will be performed by 2 independent reviewers using the relevant JBI systematic review tools. The findings will be presented in narrative format, including tables and figures to aid in data presentation.

REVIEW REGISTRATION

PROSPERO CRD42023428202.

A Prospective Study of Social Needs Associated with Mental Health among Postpartum Patients Living in Underserved Communities

OBJECTIVE

 Given the rising rates of maternal morbidity and mortality in the United States and the contribution of mental illness, especially among individuals living in underresourced communities, the objective was to evaluate the prevalence of unmet health-related social needs and their impact on perinatal mental health outcomes.

STUDY DESIGN

 This was a prospective observational study of postpartum patients residing within regions with increased rates of poor perinatal outcomes and sociodemographic disparities. Patients were enrolled in a multidisciplinary public health initiative "extending Maternal Care After Pregnancy (eMCAP)" between October 1, 2020 and October 31, 2021. Unmet health-related social needs were assessed at delivery. Symptoms of postpartum depression and anxiety were evaluated at 1 month postpartum utilizing the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD7) screening tools, respectively. Mean EPDS and GAD7 scores and odds of screening positive (scoring ≥ 10) were compared among individuals with and without unmet health-related social needs with p < 0.05 considered significant.

RESULTS

 Of participants enrolled in eMCAP, 603 completed at least one EPDS or GAD7 at 1 month. Most had at least one social need, most commonly dependence on social programs for food (n = 413/603; 68%). Individuals lacking transportation to medical (odds ratio [OR]: 4.0, 95% confidence interval [CI]: 1.2-13.32) and nonmedical appointments (OR: 4.17, 95% CI: 1.08-16.03) had significantly higher odds of screening positive on EPDS while participants lacking transportation to medical appointments (OR: 2.73, 95% CI: 0.97-7.70) had significantly higher odds of screening positive on GAD7.

CONCLUSION

 Among postpartum individuals in underserved communities, social needs correlate with higher depression and anxiety screening scores. This highlights the need to address social needs to improve maternal mental health.

KEY POINTS

· Social needs are prevalent among underserved patients.. · Needs can be assessed in a structured or freeform manner.. · Unmet needs correlate with poor mental health outcomes.. · Similar needs correlate with depression and anxiety..

A longitudinal study examining the associations between prenatal and postnatal maternal distress and toddler socioemotional developmental during the COVID-19 pandemic

Elevated psychological distress, experienced by pregnant women and parents, has been well-documented during the COVID-19 pandemic. Most research focuses on the first 6-months postpartum, with single or limited repeated measures of perinatal distress. The present longitudinal study examined how perinatal distress, experienced over nearly 2 years of the COVID-19 pandemic, impacted toddler socioemotional development. A sample of 304 participants participated during pregnancy, 6-weeks, 6-months, and 15-months postpartum. Mothers reported their depressive, anxiety, and stress symptoms, at each timepoint. Mother-reported toddler socioemotional functioning (using the Brief Infant-Toddler Social and Emotional Assessment) was measured at 15-months. Results of structural equation mediation models indicated that (1) higher prenatal distress was associated with elevated postpartum distress, from 6-weeks to 15-months postpartum; (2) associations between prenatal distress and toddler socioemotional problems became nonsignificant after accounting for postpartum distress; and (3) higher prenatal distress was indirectly associated with greater socioemotional problems, and specifically elevated externalizing problems, through higher maternal distress at 6 weeks and 15 months postpartum. Findings suggest that the continued experience of distress during the postpartum period plays an important role in child socioemotional development during the COVID-19 pandemic.

When is the best time to screen for perinatal anxiety? A longitudinal cohort study

BACKGROUND

For screening for anxiety during pregnancy and after birth to be efficient and effective it is important to know the optimal time to screen in order to identify women who might benefit from treatment.

AIMS

To determine the optimal time to screen for perinatal anxiety to identify women with anxiety disorders and those who want treatment. A secondary aim was to examine the stability and course of perinatal anxiety over time.

METHODS

Prospective longitudinal cohort study of 2243 women who completed five screening questionnaires of anxiety and mental health symptoms in early pregnancy (11 weeks), mid-pregnancy (23 weeks), late pregnancy (32 weeks) and postnatally (8 weeks). Anxiety and mental health questionnaires were the GAD7, GAD2, SAAS, CORE-10 and Whooley questions. To establish presence of anxiety disorders diagnostic interviews were conducted with a subsample of 403 participants.

RESULTS

Early pregnancy was the optimal time to screen for anxiety to identify women with anxiety disorders and women wanting treatment at any time during pregnancy or postnatally. These findings were consistent across all five questionnaires of anxiety and mental health. Receiving treatment for perinatal mental health problems was most strongly associated with late pregnancy and/or postnatal assessments. Anxiety symptoms were highest in early pregnancy and decreased over time.

CONCLUSION

Findings show that screening in early pregnancy is optimal for identifying women who have, or develop, anxiety disorders and who want treatment. This has clear implications for practice and policy for anxiety screening during the perinatal period.

Current Situation and Mental Health of Pregnant Women During the Prevention and Control of Novel Coronavirus Infection: A Cross-Sectional Study on the Investigation of Influencing Factors

Background

COVID-19 is a highly contagious respiratory infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which became a global public health crisis. In the past 3 years, the COVID-19 pandemic has resulted in a dramatic increase in the occurrence of psychological symptoms such as depression, anxiety, and stress in global populations. Therefore, it is important to help pregnant women cope with major public emergencies and improve their physical and mental health.

Objective

To investigate the status and influencing factors of anxiety, insomnia, and psychological stress disorder in pregnant women with COVID-19 to provide a theoretical basis for psychological intervention in pregnant women in the case of public health emergency events.

Patients and methods

A cross-sectional survey was conducted with 435 pregnant women from multiple tertiary hospitals in Zhengzhou from November 6 to December 6, 2022. The questionnaire contents included the general information of pregnant women, insomnia scale, generalized anxiety scale, and the revised version of the Accident Impact Scale.

Results

There are 251 pregnant women with anxiety (57.7%, 95% CI: (53.0%-62.4%).There are 166 pregnant women with insomnia.(38.2%, 95% CI: 33.6%-42.7%), There are 314 pregnant women with stress disorder.(72.2%, 95% CI: 68.0%-76.4%). During the epidemic prevention and control period, whether pregnant women had a history of adverse pregnancy had a statistically significant difference in anxiety, insomnia and stress disorders.

Conclusion and Recommendation

During the COVID-19 pandemic, pregnant women appeared to generally have anxiety, insomnia, and stress disorders. Poor pregnancy history is a protective factor for pregnant women with anxiety, insomnia, and post-traumatic stress disorder. In the case of similar public health emergencies, attention bias modification (ABM) may be a potential intervention measure to provide potentially new ideas for alleviating the psychological disorders of pregnant women during this special period.

Association between love breakup and suicidal ideation in Peruvian medical students: a cross-sectional study during the COVID-19 pandemic

Objective

We aimed to determine the association between a major romantic breakup and suicidal ideation in medical students from three universities in Peru.

Methods

A cross-sectional study was conducted during the first pandemic wave in 2021 on medical students from three universities in northern Peru. The outcome was suicidal ideation, measured with question nine of the Patient Health Questionnaire-9 (PHQ-9). Generalized Anxiety Disorder Scale-7 (GAD-7) and Insomnia Severity Index (ISI) were also used to assess mental health symptoms. The exposure was the experience of a major love breakup during the pandemic. In addition, its association with other covariates (age, sex, family members infected with COVID-19, deceased family members with COVID-19, insomnia, and anxiety, among others) was examined.

Results and discussions

Out of 370 students, 19.5% reported a major love breakup during the pandemic (95%CI: 15.5-23.8), and 34.3% had suicidal ideation (95%CI: 29.4-39.4). Having a major love breakup was associated with a higher prevalence of suicidal ideation (PR: 1.49, 95%CI: 1.32-1.67, p < 0.001). Moderate insomnia (PR: 2.56, 95%CI: 1.70-3.87, p < 0.001) and anxiety symptoms (PR: 1.94, 1.10-3.44, p = 0.023) were also associated with suicidal ideation.

Conclusion

Our study provides evidence of a significant association between a major love breakup and suicidal ideation. This finding emphasizes the need for further research to better understand this association and inform the development of effective suicide prevention policies in medical education.

Anxiety and associated factors in Northwest Ethiopian pregnant women: a broad public health concern

Introduction

Pregnancy-related anxiety is a prevalent mental health issue that mostly affects women in low-income countries such as Ethiopia. It has been linked to unfavorable pregnancy outcomes, such as miscarriage, prematurity, and low birth weight. However, it has often received less attention, and community-based evidence lacks its prevalence and associated factors. Thus, the purpose of this study was to assess the prevalence and associated factors of anxiety in Northwest Ethiopian pregnant women in Gondar city.

Methods

A community-based cross-sectional study was conducted from 1 July to 30 August 2021 in Gondar city. A cluster sampling technique was used to select a sample of 872 pregnant women, and in-person interviews were conducted to gather data. Descriptive and analytical statistical procedures were carried out.

Results

Of the participants, pregnancy-related anxiety was reported in 29.4% (95% CI: 26.3, 32.4) of women. The likelihood of having anxiety was higher among women who had known medical illness (AOR = 3.16; 95% CI: 1.8, 5.35), loneliness (AOR = 2.52; 95% CI: 1.34, 4.73), depression (AOR = 2.38; 95% CI: 1.48, 3.85), poor social support (AOR = 1.93; 95% CI: 1.21, 3.07), and intimate partner violence (AOR = 2.87; 95% CI: 2.04, 4.04).

Conclusion

In this study, three out of ten women have suffered from anxiety. It is strongly advised to identify and treat known medical illnesses early in pregnancy, enhance social support, diagnose and treat depression, and limit intimate partner violence through multimodal and integrative activities with concerned bodies.

Mapping the association between mental health and people's perceived and actual ability to practice hygiene-related behaviours in humanitarian and pandemic crises: A scoping review

Humanitarian crises such as disease outbreaks, conflict and displacement and natural disasters affect millions of people primarily in low- and middle-income countries. Here, they often reside in areas with poor environmental health conditions leading to an increased burden of infectious diseases such as gastrointestinal and respiratory infections. Water, sanitation, and hygiene behaviours are critical to prevent such infections and deaths. A scoping review was conducted to map out what is known about the association between three mental health disorders and people's perceived and actual ability to practice hygiene-related behaviours, particularly handwashing, in humanitarian and pandemic crises. Published and grey literature was identified through database searches, humanitarian-relevant portals, and consultations with key stakeholders in the humanitarian sector. 25 publications were included, 21 were peer-reviewed published articles and four were grey literature publications. Most of the studies were conducted in mainland China (n = 12) and most were conducted in an outbreak setting (n = 20). Six studies found a positive correlation between handwashing and anxiety where participants with higher rates of anxiety were more likely to practice handwashing with soap. Four studies found an inverse relationship where those with higher rates of anxiety were less likely to wash their hands with soap. The review found mixed results for the association between handwashing and depression, with four of the seven studies reporting those with higher rates of depression were less likely to wash their hands, while the remaining studies found that higher depression scores resulted in more handwashing. Mixed results were also found between post-traumatic stress disorder (PTSD) and handwashing. Two studies found that lower scores of PTSD were associated with better hygiene practices, including handwashing with soap. The contradictory patterns suggest that researchers and practitioners need to explore this association further, in a wider range of crises, and need to standardize tools to do so.

Risk perception in pregnancy: Patient-physician discrepancies, information consumption, and mental health outcomes

BACKGROUND

Little is known about the scope, causes, or consequences of risk overestimation. Our aim was to assess whether risk perceptions in pregnancy are heightened for a range of behaviors, related to consumption of health information, and associated with mental health indices.

METHODS

One hundred and fifty members of the American College of Obstetricians and Gynecologists were invited to participate in a patient-physician study, and 37% returned surveys. Physicians (n = 73) and prenatal patients (n = 388) rated the perceived safety of exposure to 40 behaviors during pregnancy. A subset of prenatal patients completed a postpartum follow-up survey (n = 103).

RESULTS

Statistical comparison of means indicated that patients overestimated the risk of 30 behaviors. Anchoring patient ratings against average physician ratings, 87.8% of total discrepancy scores reflected net risk overestimation. Greater risk overestimation was associated with higher consumption of pregnancy-related health information, but was not associated with anxiety or depression symptoms.

CONCLUSIONS

Risk perceptions may be heightened across a range of behaviors during pregnancy, even when empirical evidence of risk is absent. Information consumption could be associated with risk estimation, but causality and directionality have not been established. Further research on risk perceptions could have implications for prenatal care.

Impact of the COVID-19 Pandemic on Contraception Awareness and Mental Well-Being in Teenagers and Young Adult Women: A Three-Year Cross-Sectional Analysis

During the COVID-19 pandemic, significant shifts occurred in reproductive health, especially among teenagers and young adult women in Romania. This study, conducted from 2020 to 2022, aimed to longitudinally assess contraceptive awareness and its correlation with mental well-being in this demographic. A cohort of 210 participants aged 15-25, with a history of wanted or unwanted pregnancy, was studied. The research involved collaborations with Romanian educational institutions and strict adherence to ethical standards. Participants' data on contraceptive knowledge and practices were analyzed, considering factors like substance use and prior sexual education. Mental well-being was evaluated using the SF-36, WHOQOL-BREF, GAD-7, and PHQ-9 scales. The study revealed a positive correlation between increased contraceptive knowledge and improved mental health scores. In 2022, 68% of participants displayed proficient contraceptive awareness, up from 52% in 2020. Those with good contraceptive knowledge had an average SF-36 score of 72, indicating a better quality of life, compared to a score of 58 among those with limited knowledge. Furthermore, there was a notable decrease in GAD-7 and PHQ-9 scores among individuals with better contraceptive awareness, suggesting reduced anxiety and depression levels. The SF-36 survey results showed significant improvements across the years: the physical score increased from 52.1 (±6.3) in 2020 to 56.5 (±6.8) in 2022, the mental score from 51.4 (±7.2) to 55.0 (±6.9), and the total score from 53.6 (±7.9) to 57.5 (±8.0). WHOQOL-BREF results showed a substantial increase in the social domain score from 53.6 (±18.2) in 2020 to 63.0 (±20.5) in 2022. GAD-7 scores declined from 7.9 (±2.6) in 2020 to 6.5 (±3.3) in 2022, indicating a decrease in anxiety symptoms. PHQ-9 scores, measuring depression, also showed a downward trend, from 4.8 (±2.2) in 2020 to 3.9 (±2.8) in 2022. These findings highlight the intertwined nature of contraceptive awareness and mental well-being. The improvements in contraceptive awareness positively impacted mental health outcomes, emphasizing the need for targeted educational interventions in this demographic, particularly during global crises like the pandemic.

Impact of emotional divorce on the mental health of married women in Saudi Arabia

Emotional divorce occurs when physical, psychological, mental, and spiritual separation occurs between spouses despite the fact that they live in the same house and exercise their marital duties. Emotional divorce has adverse effects on the mental health of those involved, as evidenced by the higher incidence of depression, anxiety, and loneliness among such couples. Saudi women are particularly vulnerable to emotional divorce owing to social, legal, economic, and cultural factors. Therefore, it is important to examine the relationship between emotional divorce and mental health issues (depression, anxiety, and loneliness) in married women in Saudi Arabia. Using scales that assess emotional divorce, depression, anxiety, and loneliness, data were collected from 241 married Saudi women (Mage = 34.41 years; SDage = 5.23 years). Findings revealed a statistically significant correlation between emotional divorce, depression, anxiety, and loneliness. One-way ANOVA confirmed that those with high levels of emotional divorce concurrently scores higher on the depression, anxiety, and loneliness tools, followed by those with moderate and low emotional divorce scores, respectively. Linear regression analysis indicated that depression, anxiety, and loneliness were strong predictors of emotional divorce, explaining 61% of the variance in the emotional divorce scores in this sample. These findings highlight the need to focus on the mental health outcomes of individuals experiencing emotional divorce, especially in societies where legal divorce may not be acceptable or encouraged. The need for regular evaluation and timely interventions for individuals struggling with mental health problems, and for restoring a healthy marital relationship is also highlighted.

The feasibility and acceptability of a single-session Acceptance and Commitment Therapy (ACT) intervention to support women self-reporting fear of childbirth in a first pregnancy

OBJECTIVE

To assess the feasibility and acceptability of a single-session Acceptance and Commitment Therapy intervention to help women manage fear of childbirth during a first pregnancy.

DESIGN

A mixed-methods approach including qualitative feedback and pre/post-intervention self-report measures. Pregnant women (14-37 weeks gestation) were recruited via the UK National Health Service and attended a single-session (<3 hours) Acceptance and Commitment Therapy intervention alongside routine antenatal care. Data were analysed using content and statistical analyses.

MAIN OUTCOME MEASURES

Fear of childbirth, anxiety and wellbeing were the main outcome measures. Secondary to these, intolerance of uncertainty and valued life domains (e.g. relationships, recreation) as hypothesised mechanisms of change, were also assessed.

RESULTS

33 expressions of interest were received, 21 women signed up, 15 participated, and 11 completed follow-up measures (participation rate: 33%). Findings demonstrated clinical and statistical reductions in fear of childbirth and anxiety alongside positive feedback on the intervention. Intolerance of uncertainty and wellbeing were low at baseline and remained unchanged.

CONCLUSION

A single-session Acceptance and Commitment Therapy intervention to manage fear of childbirth is potentially feasible and acceptable. A pilot randomised controlled trial is warranted. Further research should explore efficacy and how Acceptance and Commitment Therapy may reduce perinatal distress.

A prospective study of antepartum anxiety screening in patients with and without a history of spontaneous preterm birth

BACKGROUND

Maternal stress has been identified as one of the most common clinical phenotypes associated with preterm birth. The American College of Obstetricians and Gynecologists recommends anxiety screening at least once in the perinatal period. The prevalence of perinatal anxiety is challenged by the absence of formalized screening protocols and underreporting in high-risk populations, such as those with a history of adverse pregnancy outcomes.

OBJECTIVE

This study administered a validated anxiety screening tool in a cohort of patients with and without a previous spontaneous preterm birth and compared differences in score and rate of a positive screen between groups. Moreover, this study evaluated perinatal outcomes associated with a positive screen and described a referral protocol involving evaluation by a perinatal mental health counselor and clinical diagnoses. A hypothesis was made that patients with a previous history of spontaneous preterm birth would have higher self-reported anxiety symptoms than controls and that those with recurrent preterm delivery at <35 weeks of gestation would have the highest anxiety screening scores.

STUDY DESIGN

This was a prospective observational cohort study administering the Generalized Anxiety Disorder 7-item screen to patients enrolled in 2 prenatal care clinics at our institution. The preterm birth cohort consisted of patients with a history of spontaneous preterm labor, premature rupture of membranes, or cervical insufficiency compared with the control cohort without this history. Screening was initiated at entry to prenatal care or referral to our high-risk obstetrical clinic. The inclusion criteria included English- or Spanish-speaking patients and singleton pregnancy, and the exclusion criteria included pregnancies complicated by a major congenital anomaly, enrollment after 34 weeks of gestation, delivery at <20 weeks of gestation, and incomplete delivery data. Referral to a mental health counselor was offered to those with a Generalized Anxiety Disorder 7-item screen score of ≥10. Perinatal outcomes as a comparison between the Generalized Anxiety Disorder 7-item screen-positive group and Generalized Anxiety Disorder 7-item screen-negative group were performed with statistical methods, including the Student t test, chi-square test, and Wilcoxon rank-sum test, with a P value of <.05 to determine significance.

RESULTS

Between September 2020 and December 2021, 1349 participants were analyzed, with 143 patients (11%) in the previous preterm birth cohort and 1206 (89%) patients in the control cohort. Patients with a history of preterm birth and subsequent delivery at ≤35 weeks of gestation in the study pregnancy had significantly higher Generalized Anxiety Disorder 7-item screen scores than controls with delivery after 35 weeks of gestation (median score: 4 [interquartile range, 1-9] vs 2 [interquartile range, 0-6], respectively; P=.006). Overall, 187 participants (14%) screened positive with significantly higher rates in the previous preterm birth group than in the control group (20% vs 13%; P=.036). Of note, 117 patients (63%) accepted a referral, and 32 patients (17%) with a positive screen were diagnosed with a perinatal mood disorder.

CONCLUSION

Patients with recurrent preterm birth have higher self-reported anxiety using the Generalized Anxiety Disorder 7-item screen than controls. Of those with a positive screen, 17% were diagnosed with a perinatal mood disorder.

Psychometric Adaptation of a Brief Scale of Child-to-Parent Violence and Intrafamily Violence in Peruvian Adolescents

Family violence is a critical public health problem in Latin America. In Peru, family violence continues to be difficult to detect and prevent, with child-to-parent violence (CPV) arising as a key issue. This study aimed to do a psychometric adaptation of a brief scale of evaluation of CPV and intrafamily violence in a sample of Peruvian adolescents. Our study analyzed internal structure, internal consistency (with depression, family satisfaction, and anxiety), convergent validity, and measurement invariance. The study population included 570 adolescents living with both parents (50.2% women). Adequate goodness-of-fit indices were found for the full version of CPV and intrafamily violence of nine items (CFI = 0.991; RMSEA = 0.053) and the version with only CPV of six items (CFI = 0.995; RMSEA = 0.074). The latent correlations between CPV with depressive symptoms and anxiety symptoms were greater than 0.40. Our study found that the full version of CPV and intrafamily violence (nine items) and the CPV-only version (six items) were invariant by sex. Reliability was adequate in all cases (ω > 0.70). The scale presents evidence of validity and reliability in Peruvian adolescents. It is suitable for epidemiological research on family violence.

The impact of prepartum pandemic-related perceived stress on anxiety symptoms in the postpartum: The role of perceived childbirth experiences

Postpartum anxiety is a significant component of postpartum maternal distress and is related to adverse outcomes for both the mother and the child. Although previous research reported higher anxiety symptoms in pregnant women during the Covid-19 pandemic, no studies evaluated the negative impact of pandemic-related perceived stress on postpartum anxiety symptomatology over time. This study aimed to examine the impact of prepartum pandemic-related stress on postpartum anxiety and to evaluate the role of subjective labor and delivery experiences on this relationship. A sample of 172 pregnant women completed an online questionnaire evaluating pandemic-related perceived stress and anxiety symptoms in the second or third trimester of pregnancy. In the postpartum, they completed a second questionnaire retrospectively evaluating their childbirth experience and assessing anxiety symptoms in the last two weeks. A mediation analysis was conducted. Prepartum pandemic-related perceived stress was significantly associated with postpartum anxiety symptoms. Moreover, childbirth experiences significantly and partially mediated this relationship. Findings highlighted the importance of evaluating perceived stress levels during pregnancy to prevent negative consequences on postpartum mental health. Clinicians need to foster better management of factors included in the childbirth experience that may potentially trigger or counteract anxiety risk.

Sensitivity and specificity of the Patient Health Questionnaire (PHQ-9, PHQ-8, PHQ-2) and General Anxiety Disorder scale (GAD-7, GAD-2) for depression and anxiety diagnosis: a cross-sectional study in a Peruvian hospital population

OBJECTIVES

The Patient Health Questionnaire (PHQ) and Generalised Anxiety Disorder Scale (GAD) are widely used screening tools, but their sensitivity and specificity in low-income and middle-income countries are lower than in high-income countries. We conducted a study to determine the sensitivity and specificity of different versions of these scales in a Peruvian hospital population.

DESIGN

Our study has a cross-sectional design.

SETTING

Our participants are hospitalised patients in a Peruvian hospital. The gold standard was a clinical psychiatric interview following ICD-10 criteria for depression (F32.0, F32.1, F32.2 and F32.3) and anxiety (F41.0 and F41.1).

PARTICIPANTS

The sample included 1347 participants. A total of 334 participants (24.8%) were diagnosed with depression, and 28 participants (2.1%) were diagnosed with anxiety.

RESULTS

The PHQ-9's≥7 cut-off point showed the highest simultaneous sensitivity and specificity when contrasted against a psychiatric diagnosis of depression. For a similar contrast against the gold standard, the other optimal cut-off points were: ≥7 for the PHQ-8 and ≥2 for the PHQ-2. In particular, the cut-off point ≥8 had good performance for GAD-7 with sensitivity and specificity, and cut-off point ≥10 had lower levels of sensitivity, but higher levels of specificity, compared with the cut-off point of ≥8. Also, we present the sensitivity and specificity values of each cut-off point in PHQ-9, PHQ-8, PHQ-2, GAD-7 and GAD-2. We confirmed the adequacy of a one-dimensional model for the PHQ-9, PHQ-8 and GAD-7, while all PHQ and GAD scales showed good reliability.

CONCLUSIONS

The PHQ and GAD have adequate measurement properties in their different versions. We present specific cut-offs for each version.

Changes in Intrapersonal Factors of Participants in the Pregnancy Remote Monitoring Study Who Are at Risk for Pregnancy-Induced Hypertension: Descriptive Quantitative Study

BACKGROUND

The peripartum period, defined as the period from the beginning of the gestation until 1 year after the delivery, has long been shown to be potentially associated with increased levels of stress and anxiety with regard to one's transition to the status of parent and the accompanying parental tasks. Yet, no research to date has investigated changes in intrapersonal factors during the peripartum period in women at risk for pregnancy-induced hypertension (PIH).

OBJECTIVE

The aim of this study is to explore and describe changes in intrapersonal factors in participants at risk for PIH.

METHODS

We used an explorative design in which 3 questionnaires were sent by email to 110 participants the day following enrollment in the Pregnancy Remote Monitoring program for pregnant women at risk for PIH. Women were invited to complete the questionnaires at the beginning of their participation in the Pregnancy Remote Monitoring project (mostly at 14 weeks of gestation) and after approaching 32 weeks of gestational age (GA). The Generalized Anxiety Disorder-7 Scale (GAD-7) and the Patient Health Questionnaire-9 were used to assess anxiety and depression, and adaptation of the Pain Catastrophizing Scale was used to measure trait pain catastrophizing.

RESULTS

Scores were significantly higher at 32 weeks of GA than at the moment of enrollment (GAD-7 score=7, range 4-11 vs 5, range 3-8; P=.01; and Patient Health Questionnaire-9 score=6, range 4-10 vs 4, range 2-7; P<.001). The subscale scores of the Pain Catastrophizing Scale were all lower at 32 weeks of GA compared with 14 weeks of GA (rumination: 4, range 1-6 vs 5, range 2-9.5; P=.11; magnification: 3, range 1-5.5 vs 4, range 3-7; P=.04; and helplessness: 5, range 2-9 vs 6, range 3.5-12; P=.06). The proportion of women with a risk for depression (GAD-7 score >10) was 13.3% (10/75) at enrollment and had increased to 35.6% (26/75) at 32 weeks of GA.

CONCLUSIONS

This study shows that pregnant women at risk for PIH have higher levels of stress and anxiety at 32 weeks of GA than at the moment of enrollment. Further research is recommended to investigate potential strategies to help pregnant women at risk for PIH manage feelings of stress and anxiety.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03246737; https://clinicaltrials.gov/study/NCT03246737.

Validation of the PCL-5, PHQ-9, and GAD-7 in a Sample of Veterans

OBJECTIVE

Veterans can present at nongovernment (Department of Defense, Department of Veterans Affairs) mental health agencies with complex symptom constellations that frequently include posttraumatic stress disorder, depression, and generalized anxiety. To date, no veteran study has validated these measures on a treatment-seeking sample of veterans outside the DoD and VA.

METHODS

We used a treatment-seeking sample of veterans ( N = 493) to validate measures that assess these constructs (PTSD Checklist 5, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7).

RESULTS

The seven-factor posttraumatic stress disorder hybrid configuration was the best fit. The best fitting model of the depression measure was a two-factor structure, cognitive-affective, and somatic depression. The measure of generalized anxiety was a unidimensional model.

LIMITATIONS

Follow-up studies should validate these measures on nontreatment-seeking discharged veterans.

CONCLUSIONS

We interpret these findings within the veteran scholarship and explore clinical implications for providers.

Evaluation of the Michigan Clinical Consultation and Care Program: An Evidence-Based Approach to Perinatal Mental Healthcare

Mood and anxiety disorders affect pregnant individuals and their families at increased rates throughout the perinatal period. Geographic, financial, and social barriers often preclude adequate diagnosis and treatment. The aim of this manuscript is to describe the consultation and care arms of the Michigan Clinical Consultation and Care (MC3) program, a statewide program designed to facilitate access to perinatal mental healthcare for OB/Gyn patients, and to describe the participants engaged in the program, examine the predictors of participant retention, and provide preliminary data regarding participants' mental health outcomes. We enrolled 209 participants to the clinical care arm, of which 48 were lost to follow-up, while 107 remained enrolled at the time of data analysis. A total of 54 participants met their treatment goals. A total of 97% of participants asserted they were satisfied with the services they received. Black race and public insurance predicted faster attrition from the care arm treatment; risks for interpersonal violence exposure and substance use were unrelated to attrition. Preliminary mental health outcomes showed significant decreases in anxiety and depression, with the most dramatic decreases in the first month of treatment. Overall, the MC3 clinical care arm shows promising rates of adherence, excellent program satisfaction, and a positive impact on perinatal mental health, supporting continued program implementation and ongoing evaluation.

Association between Love Breakup and Suicidal Ideation in Peruvian Medical Students: A Cross-Sectional Study during the COVID-19 Pandemic

Objective

We aimed to determine the association between a major romantic breakup and suicidal ideation in medical students from three universities in Peru.

Methods

A cross-sectional study was conducted during the first pandemic wave in 2021 on medical students from three universities in northern Peru. The outcome was suicidal ideation, measured with question nine of the PHQ-9. The exposure was the experience of a major love breakup during the pandemic. In addition, its association with other covariates (age, sex, family members infected with COVID-19, deceased family members with COVID-19, insomnia, and anxiety, among others) was examined.

Results and discussions

Out of 370 students, 19.5% reported a major love breakup during the pandemic (95%CI: 15.5-23.8), and 34.3% had suicidal ideation (95%CI: 29.4-39.4). Having a major love breakup was associated with a higher prevalence of suicidal ideation (PR: 1.49, 95%CI: 1.32-1.67). Moderate insomnia (PR: 2.56, 95%CI: 1.70-3.87) and anxiety symptoms (PR: 1.94, 1.10-3.44) were also associated with suicidal ideation.

Conclusion

Our study provides evidence of a significant association between a major love breakup and suicidal ideation. This finding emphasizes the need for further research to better understand this association and inform the development of effective suicide prevention policies in medical education.

Coping Strategies and Symptoms of Mental Health Disorders Among People with HIV Initiating HIV Care in Cameroon

Little is known about the coping strategies used among people with HIV (PWH), especially in sub-Saharan Africa, and the extent to which adaptive or maladaptive coping strategies are associated with symptoms of mental health disorders. We interviewed 426 PWH initiating HIV care in Cameroon and reported the prevalence of adaptive and maladaptive coping strategies, overall and by presence of symptoms of depression, anxiety, and PTSD. Log binominal regression was used to estimate the association between each type of coping strategy (adaptive or maladaptive) and symptoms of each mental health disorder, separately. Adaptive and maladaptive coping strategies were commonly reported among PWH enrolling in HIV care in Cameroon. Across all mental health disorders assessed, greater maladaptive coping was associated with higher prevalence of depression, anxiety, and PTSD. Adaptive coping was not associated with symptoms of any of the mental health disorders assessed in bivariate or multivariable models. Our study found that PWH endorsed a range of concurrent adaptive and maladaptive coping strategies. Future efforts should explore the extent to which coping strategies change throughout the HIV care continuum. Interventions to reduce maladaptive coping have the potential to improve the mental health of PWH in Cameroon.

GAD-7 Generalised Anxiety Disorder scale in Colombian medical professionals during the COVID-19 pandemic: Construct validity and reliability

INTRODUCTION

The detection of anxiety symptoms among health workers who care for patients infected with COVID-19 is a current priority. Fast and valid instruments are required for this population group. The objective is to establish the construct validity and reliability of the Generalised Anxiety Disorder (GAD-7) scale in Colombian doctors during the COVID-19 lockdown.

METHODS

E-health study, in which cross-sectional data were collected online (n = 1030) from 610 COVID doctors and 420 non-COVID doctors, during the Colombian lockdown, between 20 April and 10 August 2020. Each subject was contacted, and they confirmed their participation, identity and professional role.

RESULTS

A single factor factorial structure was found, made up of the 7 items of the instrument, which managed to explain 70% of the variance. The goodness of fit indices (RMSEA = 0.080; CFI = 0.995; SRMR = 0.053; p < 0.001) showed an "acceptable" unidimensionality and adequate factor loadings in each item of the GAD-7, >0.070. Finally, the internal consistency of the instrument was good, with a Cronbach's alpha of 0.920 (95%IC, 8.80-9.71).

CONCLUSIONS

The GAD-7 is an instrument that presents adequate indicators of validity and reliability. It is an excellent tool that is reliable and easy and fast to use for the detection of generalised anxiety symptoms in medical personnel caring (or not) for patients infected with COVID-19.

Evaluation of factors related to maternal anxiety during pregnancy among women referred to Tabriz primary care centers

BACKGROUND

Maternal anxiety during pregnancy is sometimes considered a normal mechanism to overcome the mother's mental preoccupation with having a child. However, stress and anxiety might become a medical condition, becoming so severe as to affect the mother's mental health. Therefore, the present study aimed to investigate factors related to maternal anxiety during pregnancy in women referring to prenatal primary care centers in Tabriz.

METHODS

The target population in the present cross-sectional study was the pregnant women referring to primary care centers affiliated with Tabriz University of Medical Sciences in 2018-2019 (n = 533). Sampling was carried out using the random cluster technique (separately for municipal centers). The data were collected using the study tools, including a questionnaire on demographic data, prenatal anxiety screening scale (PASS), and researcher-made questions on maternal anxiety during pregnancy.

RESULTS

In the present study, 37.5% of pregnant women had anxiety. Of all the demographic and background variables, income (P = 0.015), a history of preterm delivery (P = 0.018), and unintended pregnancy (P = 0.022) were significantly related to anxiety. Of the variables of income, a history of preterm delivery, and unintended pregnancy in the regression model, the odds of anxiety were 41% lower in pregnant women with somewhat adequate income than those with inadequate income after correcting for other variables (P = 0.011). In addition, the variable of unintended pregnancy increased the odds of anxiety up to 49% after correcting for other variables (P = 0.023).

CONCLUSION

The present study showed that income and unintended pregnancy significantly affect maternal anxiety during pregnancy.

TRIAL REGISTRATION

The protocol of the study was approved by the Ethics Committee of Tabriz University of Medical Sciences under the code (IR.TBZMED.REC.1398.161).

Trajectories of distress from pregnancy to 15-months post-partum during the COVID-19 pandemic

Background

The COVID-19 pandemic has particularly burdened pregnant and postpartum women. It remains unclear how distress levels of pregnant and postpartum people have changed (or persisted) as the pandemic continues on and which factors may contribute to these trajectories of distress.

Methods

This longitudinal study included 304 pregnant people, who were followed during pregnancy, 6-weeks, 6-months and 15-months postpartum. At each time point, a latent “distress” factor was estimated using self-reported depressive symptoms, anxiety symptoms, and stress. Reported negative impact of COVID-19 and social support were assessed during pregnancy as risk and protective factors related to distress. Second-order latent growth curve modeling with a piecewise growth function was used to estimate initial levels and changes in distress over time.

Results

Mean distress was relatively stable from the pregnancy to 6-weeks postpartum and then declined from 6-weeks to 15-months postpartum. Higher education, greater social support, and lower negative impact of COVID-19 were associated with a lower distress during pregnancy. Unexpectedly, negative impact of COVID-19 was associated with a faster decrease in distress and more social support was associated with a greater increase in distress from pregnancy to 6-weeks postpartum. However, these effects became non-significant after controlling for distress during pregnancy.

Conclusion

Findings indicate high but declining levels of distress from pregnancy to the postpartum period. Changes in distress are related to social support and the negative impact of the pandemic in pregnancy. Findings highlight the continued impact of COVID-19 on perinatal mental health and the need for support to limit the burden of this pandemic on pregnant people and families.

Effects of 3D-Printed Models and 3D Printed Pictures on Maternal- and Paternal-Fetal Attachment, Anxiety, and Depression

OBJECTIVE

To compare the effect of a 3D-printed model versus 3D printed pictures on maternal- and paternal-fetal attachment, pregnancy-related anxiety, and depression in parents in the third trimester.

DESIGN

Randomized controlled trial.

SETTING

University- and clinic-affiliated hospital system.

PARTICIPANTS

Between August 2020 and July 2021, we screened 419 women for eligibility. A total of 184 participants (n = 95 women and n = 89 men) were included in the intention-to-treat analysis, of whom 47 women and 44 men received the 3D-printed model, whereas 48 women and 45 men received the 3D printed picture.

METHODS

Participants completed a set of questionnaires before they received third trimester 3D ultrasonography and a second set of questionnaires approximately 14 days after the study ultrasonography. The primary outcome was the global Maternal and Paternal Antenatal Attachment scale scores. Secondary outcomes included the Maternal and Paternal Antenatal Attachment subscale scores, global Generalized Anxiety Disorder-7 scores, global Patient Health Questionnaire-9 scores, and global Pregnancy-Related Anxiety Questionnaire-Revised (second version) scores. We used multilevel models to estimate the effect of the intervention.

RESULTS

We found a statistically significant increase in mean attachment scores after the 3D printed picture and 3D-printed model intervention of 0.26, 95% confidence interval (CI) [0.22, 0.31], p < .001. Additionally, we found statistically significant improvement in depression (mean change = -1.08, 95% CI [-1.54, -0.62], p < .001), anxiety (mean change = -1.38, 95% CI [-1.87, -0.89], p < .001), and pregnancy-related anxiety (mean change = -2.92, 95% CI [-4.11, -1.72], p < .001) scores. We found no statistically significant between-group differences related to maternal or paternal attachment, anxiety, depression, or pregnancy-related anxiety.

CONCLUSIONS

Our findings support the use of 3D printed pictures and 3D-printed models to improve prenatal attachment, anxiety, depression, and pregnancy-related anxiety.

Prevalence of potentially traumatic events and symptoms of depression, anxiety, hazardous alcohol use, and post-traumatic stress disorder among people with HIV initiating HIV care in Cameroon

BACKGROUND

This study explored the relationship between specific types of potentially traumatic events (PTEs) and symptoms of mental health disorders among people with HIV (PWH) in Cameroon.

METHODS

We conducted a cross-sectional study with 426 PWH in Cameroon between 2019-2020. Multivariable log binominal regression was used to estimate the association between exposure (yes/no) to six distinct types of PTE and symptoms of depression (Patient Health Questionnaire-9 score > 9), PTSD (PTSD Checklist for DSM-5 score > 30), anxiety (Generalized Anxiety Disorder-7 scale score > 9), and hazardous alcohol use (Alcohol Use Disorders Identification Test score > 7 for men; > 6 for women).

RESULTS

A majority of study participants (96%) reported exposure to at least one PTE, with a median of 4 PTEs (interquartile range: 2-5). The most commonly reported PTEs were seeing someone seriously injured or killed (45%), family members hitting or harming one another as a child (43%), physical assault or abuse from an intimate partner (42%) and witnessing physical assault or abuse (41%). In multivariable analyses, the prevalence of PTSD symptoms was significantly higher among those who reported experiencing PTEs during childhood, violent PTEs during adulthood, and the death of a child. The prevalence of anxiety symptoms was significantly higher among those who reported experiencing both PTEs during childhood and violent PTEs during adulthood. No significant positive associations were observed between specific PTEs explored and symptoms of depression or hazardous alcohol use after adjustment.

CONCLUSIONS

PTEs were common among this sample of PWH in Cameroon and associated with PTSD and anxiety symptoms. Research is needed to foster primary prevention of PTEs and to address the mental health sequelae of PTEs among PWH.

Impact of the COVID-19 pandemic on women's perinatal mental health and its association with personality traits: An observational study

INTRODUCTION

The burden of perinatal mental health problems was expected to increase during the COVID-19 pandemic. We prospectively investigated the impact of the COVID-19 pandemic on the mental health of pregnant and postpartum women in Norway and explored associations with their sociodemographic characteristics and personality traits.

MATERIAL AND METHODS

Sociodemographic information and the self-reported impact of pandemic on wellbeing of pregnant women was collected using an online survey. To assess women's mental health, two validated questionnaires, the Edinburgh Postpartum Depression Scale (EPDS) and the Generalized Anxiety Disorder-7 item Scale (GAD-7), were used prenatally and postnatally. Personality traits were evaluated using HumanGuide, a web-based ipsative psychological evaluation instrument.

RESULTS

772 women were included prenatally, of which 526 also responded to the survey 4-6 weeks postnatally. The median age was 29 years, 53.6% of the women were nulliparous when enrolled, and 35.1% worked in the healthcare sector. The median EPDS (6.0; interquartile range [IQR] 3.0-10.0 vs 6.0; IQR: 3.0-10.0) and the median GAD-7 (5.0; IQR 2.0-9.0 vs 5.0; IQR 2.0-9.0) were similar pre-and postnatally. Prenatally, the proportion of women scoring ≥13 on EPDS and ≥10 on GAD-7 was 14.5% (112/772) and 21.5% (166/772), whereas the postnatal figures were 15.6% (82/526) and 21.5% (113/526), respectively. The differences were not significant (P = 0.59 and P = 0.99). Being <25 years of age, being on pre-pregnancy psychotherapy or psychotropic medication, frequent voluntary isolation, perception of maternity care not proceeding normally, avoiding seeking medical assistance due to fear of infection and having negative economic consequences during the COVID19 pandemic significantly increased the risk of both anxiety (GAD-7 ≥10) and depression (EPDS ≥13). Nullipara had a higher risk of anxiety, whereas being a healthcare worker had a lower risk. The personality trait factors Power (P = 0.008), Quality (P = 0.008), Stability (P < 0.001) and Contacts (P < 0.001) were significant predictors of depression among pregnant women, whereas the Quality (P = 0.005) and Contacts (P = 0.003) were significant predictors of anxiety.

CONCLUSIONS

During the initial phase of the COVID-19 pandemic, the prevalence of depression (EPDS ≥ 13) and anxiety (GAD-7 ≥ 10) was 14.5% and 21.5%, respectively, among Norwegian pregnant women. Certain sociodemographic characteristics and personality traits were significant predictors of depression and anxiety.

The COVID-19 Pandemic Significantly Impacts Pregnancy Planning and Mental Health of Women With Inflammatory Bowel Disease

BACKGROUND AND GOALS

The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted daily life, particularly in those with inflammatory bowel disease (IBD). We aimed to determine the impact of the pandemic on the pregnancy planning and mental health of women with IBD.

METHODS

Women with IBD (age 18 to 45 y) were asked to complete anonymous surveys on the impact of the COVID-19 pandemic on pregnancy planning and mental health symptoms such as stress (Perceived Stress Scale), depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder-7). Univariate and multivariable analyses were conducted to identify risk factors associated with stress, depression, and anxiety during the pandemic.

RESULTS

Seventy-three women with IBD were included (mean age: 32.1). Of 39 patients who were preconception, 20 (51.3%) reported a significant impact of the pandemic on pregnancy planning, with common reasons for not planning conception being fear of transmission of the virus to the fetus, lack of social supports, and no desire to be in hospital during pregnancy. Over half of all women reported an increase in stress and depression symptoms during the pandemic, with over half also reporting symptoms of anxiety. On multivariable linear regression analyses, increased anxiety levels were a significant predictor of increased stress and depression symptoms during the pandemic. Urban residence and younger age were significant predictors of increased anxiety symptoms during the pandemic.

CONCLUSION

A significant proportion of women with IBD experienced an impact of the COVID-19 pandemic on pregnancy planning and mental health illnesses such as stress, depression, and anxiety.

Cognitive processes associated with emotional disorders: implications for efficient psychological treatments

BACKGROUND

Emotional disorders (EDs) are the most prevalent worldwide. Despite psychotherapies are their treatment of choice, there are difficulties to apply them properly in mental health services. Since literature shows that cognitive processes are associated with anxiety and depressive symptoms, more information is needed in order to improve psychological treatments.

AIMS

To determine the relation between cognitive factors with specific and non-specific ED symptoms in order to promote the development of accurate psychological treatments.

METHODS

We analyzed the relation between rumination, worry, and metacognition with generalized anxiety, panic, and depression disorder symptoms from a clinical sample of 116 individuals through correlation and linear regression analyses.

RESULTS

Although each specific disorder had a closer link with a particular cognitive process, all general ED symptoms were associated with the three cognitive factors studied.

CONCLUSIONS

For "pure" disorders, targeting a concrete cognitive process might be an optimal therapeutic option. However, due to the high comorbidity among EDs, we support the dissemination of the transdiagnostic treatment approach in which all cognitive factors are taken into account.

The psychological impact of COVID-19 in a socio-politically unstable environment: protective effects of sleep and gratitude in Lebanese adults

BACKGROUND

The COVID-19 global pandemic initiated an unprecedented medico-psychological turmoil. Our study investigates the psychological impact of the viral spread and austere lockdown, and focuses mostly on potential protective factors in a politically and economically unstable society.

METHODS

A cross-sectional design was used to evaluate rates of mental distress in a sample of 348 Lebanese adults. Participants filled questionnaires of perceived stress (PSS), depression (PHQ-9), anxiety (GAD-7), PTSD (IES-22), as well as sleep (PSQi) and gratitude (GQ-6) immediately after 3 months of strict quarantine. Demographics included gender, age, employment and infection statuses. Correlations and regression models were used.

RESULTS

Results indicated a very high prevalence of mental distress, in addition to major alterations in sleep quality and quantity. Younger age and unemployment correlated with more severe symptoms. Sleep was found to be a protective factor against all studied psychological distress, and gratitude further mitigated effects of depression.

CONCLUSIONS

Mental health significantly degrades post-COVID lockdown, even in the absence of direct viral threat. Yet simple behavioral and cognitive changes like sleep and attitude of gratitude could provide protective factors against these psychological distresses. Such changes should be further explored and advocated as cost-efficient self-care practices to buffer this devastating public health burden, especially in unstable socio-political environments.

Fatigue and associated factors among adult cancer patients receiving cancer treatment at oncology unit in Amhara region, Ethiopia

INTRODUCTION

Fatigue is one of the most commonly and frequently reported symptoms by cancer patients. The cause of fatigue is multifactorial in origin, and its impact varies in range from affecting patients' daily social life, and physical, mental, economic, and social well-being to becoming a threat to their quality of life. Therefore every cancer patient needs to be screened for fatigue and considered as one of the vital signs.

OBJECTIVE

To assess the prevalence of fatigue and associated factors among adult cancer patients, receiving cancer treatment at the oncology unit in Amhara region, Ethiopia, 2022.

METHOD

Institutional-based, cross-sectional study was conducted among adult cancer patients receiving cancer treatment from May 9th-June 8th, 2022. A stratified random sampling technique was used to select study participants. Data were entered into Epi data version 4.6 and then exported to the SPSS statistical package version 23 for further analysis. Both bivariable and multivariable logistic regression analyses were carried out. P-values <0.05 in multivariable logistic regression were considered statistically significant.

RESULTS

The prevalence of cancer-related fatigue was 77.3% at 95% CI (73.1-81.1) with nonresponse rate of 1.97% (9). Poor social support (AOR = 3.62; 95% CI: 1.53-8.60), anxiety (AOR = 3.13; 95% CI: 1.54-6.36), physical inactivity (AOR = 3.67; 95% CI: 1.74-7.54), underweight (AOR = 2.03; 95% CI: 1.05-3.90), anemia (AOR = 2.01; 95% CI: 1.04-3.90), surgery as a treatment modality (AOR = 0.21; 95% CI: 0.06-0.78), combination therapy (AOR = 3.56; 95% CI: 1.68-7.54), treatment less than 3 cycle (AOR = 4.43; 95% CI: 1.53-12.80), and treatment 3-5 cycle (AOR = 3.55; 95% CI: 1.38-9.09) were significantly associated factors with cancer related fatigue.

CONCLUSION

Psychosocial assessment and intervention, nutritional support, early intervention of anemia, and promoting exercise are the key elements to minimizing fatigue among cancer patients.

Psychometric properties of the generalized anxiety disorder-7 (GAD-7) in a sample of workers

Objective

To evaluate the psychometric properties of the GAD-7 by obtaining evidence of internal structure (dimensionality, precision and differential functioning of items) and association with external variables.

Methods

A total of 2,219 protocols from three different studies conducted with Puerto Rican employees that administered the GAD-7 were selected for the current study. Item response theory modeling was used to assess internal structure, and linear association with external variables.

Results

The items were adapted to a graduated response model, with high similarity in the discrimination and location parameters, as well as in the precision at the level of the items and in the total score. No violation of local independence and differential item functioning was detected. The association with convergent (work-related rumination) and divergent (work engagement, sex, and age) variables were theoretically consistent.

Conclusion

The GAD-7 is a psychometrically robust tool for detecting individual variability in symptoms of anxiety in workers.

A propensity score matching study: The prevalence of mental health problems among pregnant women at first antenatal care increased in Chongqing during the first wave of the COVID-19 pandemic

Background

The 2019 coronavirus disease (COVID-19) pandemic increased the risks of mental health challenges, especially anxiety and depression. However, the impact of COVID-19 on mental health during pregnancy has not been fully established. Therefore, we investigated the impact of the COVID-19 pandemic on maternal mental health.

Methods

Two cohorts of pregnant women at their first antenatal care in the First Affiliated Hospital of Chongqing Medical University were enrolled in this study. One cohort was enrolled before the COVID-19 outbreak, from 1 June to 31 December 2019 (n = 5,728, pre-COVID-19 group), while the other was enrolled during the COVID-19 pandemic, from 24 January to 23 March 2020 (n = 739, COVID-19 pandemic group). Symptoms of depression, anxiety, and somatization disorders were assessed by the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-15 (PHQ-15), with a cutoff point of 10 for moderate-to-severe depression, anxiety, and somatoform symptoms. The propensity score matching method (1:1) was used to balance differences in demographic characteristics between groups. A chi-square analysis was performed to compare differences in demographic characteristics between the groups.

Results

Prevalence of moderate-to-severe depression, anxiety, and somatoform symptoms among pregnant women at their first antenatal care visit during the COVID-19 pandemic (9.5, 2.2, and 20.8%, respectively) was significantly lower than those before the pandemic (16.3, 4.4, and 25.7%, respectively) (p < 0.05). Compared with the same period before the pandemic, during the pandemic, the number of women newly registered for antenatal care decreased by nearly 50%. There were significant differences in the distributions of demographic characteristics between the groups (p < 0.05). After matching the demographic characteristics, differences in the prevalence of maternal mental health disorders between the groups reversed dramatically. Prevalence of moderate-to-severe depression, anxiety, and somatoform symptoms during the COVID-19 pandemic in this population (2.3, 9.6, and 20.8%, respectively) was significantly higher than those before the pandemic (0.3, 3.9, and 10%, respectively) (p < 0.05).

Conclusion

The COVID-19 pandemic increased mental health risks among pregnant women. As a large proportion of pregnant women with mental health challenges delay their prenatal care or change healthcare facilities after the outbreak of public health emergencies, there is a need to establish a balanced healthcare system in medical institutions at all levels.

Pain, mood, and suicidal behavior among injured working adults in Chile

BACKGROUND

Chronic pain is comorbid with psychiatric disorders, but information on the association of chronic pain with depressive symptoms, generalized anxiety, and suicidal behavior among occupational cohorts is inadequate. We investigated these associations among employed Chilean adults.

METHODS

A total of 1946 working adults were interviewed during their outpatient visit. Pain was assessed using the Short Form McGill Pain questionnaire (SF-MPG) while depression and generalized anxiety were examined using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. The Columbia-Suicide Severity Rating Scale was used to assess suicidal behavior and suicidal ideation. Multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95%CI) for the association of chronic pain with mood disorders, as well as suicidal behavior.

RESULTS

High chronic pain (SF-MPG > 11) was reported by 46% of participants. Approximately two-fifths of the study participants (38.2%) had depression, 23.8% generalized anxiety, 13.4% suicidal ideation, and 2.4% suicidal behavior. Compared to those with low pain (SF-MPG ≤11), participants with high chronic pain (SF-MPG > 11) had increased odds of experiencing depression only (aOR = 2.87; 95% CI: 2.21-3.73), generalized anxiety only (aOR = 2.38; 95% CI: 1.42-3.99), and comorbid depression and generalized anxiety (aOR = 6.91; 95% CI: 5.20-9.19). The corresponding aOR (95%CI) for suicidal ideation and suicidal behavior were (aOR = 2.20; 95% CI: 1.58-3.07) and (aOR = 2.18 = 95% CI: 0.99-4.79), respectively.

CONCLUSIONS

Chronic pain is associated with increased odds of depression, generalized anxiety, and suicidal behavior. Mental health support and appropriate management of patients experiencing chronic pain are critical.

A Case Report of Home-Based Cognitive-Behavioural Treatment for Late-Onset Post-Traumatic Stress Disorder, Triggered by Mask-Wearing in the Context of the COVID-19 Pandemic

A small but clinically significant number of people experience delayed-onset Post-traumatic stress disorder (PTSD); symptoms of trauma years after the events which are now being re-experienced. The following case report describes the use of the cognitive-behavioural treatment for PTSD with a woman experiencing flashbacks to domestic abuse endured more than 20 years ago. Mask-wearing mandated as a result of the COVID-19 pandemic triggered non-contextualised memories of life-threatening physical violence by an abuser who covered his face. She had been managing her flashbacks and intrusive thoughts with both behavioural and experiential forms of avoidance. An 18-session intervention was provided in her own home due to physical health difficulties. Treatment focused on managing hyper-arousal, reducing thought suppression, in-vivo exposure, stimulus-discrimination and re-contextualising traumatic memories. Regular outcome measurements were kept and results are presented as a single-case experimental design in 'AB' format (i.e. baseline period pre intervention). Symptoms of trauma fell to levels non-indicative of PTSD and speak to the evidence base for this modality, even when applied to delayed-onset difficulties in a non-traditional therapy setting. This conclusion is lent extra credence by an experimental design with good internal validity.

How Psychological Variables Maybe Correlated with Willingness to Get COVID-19 Vaccine: A Nationwide Cross-Sectional Study of Polish Novice Nurses

INTRODUCTION

Nurses became the largest medical group exposed to direct contact with the SARS-CoV-2 virus. In this study, we aimed to assess the readiness and motivation for vaccination, as well as the use of sources of information and attitudes toward vaccination depending on the psychological profile.

MATERIAL AND METHODS

A cross-sectional online survey study was conducted. The study included 145 novice nurses from 8 medical universities who completed 3-year undergraduate studies. Women constituted 97.2% of the respondents (N = 141). The Generalized Anxiety Disorder 7-Item Scale, General Self-Efficacy Scale, Brief Resilient Coping Scale, and an original questionnaire were used. Variables were analyzed with descriptive statistics methods. A p-value of <0.05 was considered statistically significant.

RESULTS

Among the participants, 73.1% had already been vaccinated against COVID-19 (N = 106). The participants were divided into two groups: G1 (N = 98), characterized by a lower level of anxiety with higher self-efficacy and resilient coping, and G2 (N = 47), with a higher level of anxiety with poorer self-efficacy and resilient coping. The analysis of the potential correlation of psychological pattern with the decision to vaccinate was not statistically significant (p = 0.166).

CONCLUSION

Psychological variables may be correlating with motivation, attitudes toward vaccination, and the choice of reliable sources of information about vaccination. Our study demonstrates the key role of two psychological variables, self-efficacy and resilient coping, in this context.

Validation of the generalized anxiety disorder screener (GAD-7) in Cypriot pregnant and postpartum women

Background

Anxiety is increasingly acknowledged as a common mental health issue during the perinatal period. Its prevalence as well as the associated adverse effects constitute screening imperative. This study evaluates the psychometric properties and underlying factor structures of a Greek version of GAD-7 among pregnant and postpartum women (up to 6 months) in Cyprus.

Methods

This study was conducted from June to December 2020. A total of 457 Cypriot women in the perinatal period (222 pregnant and 235 postpartum) were surveyed. The assessment included anxiety (GAD-7) and depression (EPDS), and psychosocial factors related with anxiety. The internal consistency and factor structure of GAD-7 were evaluated using reliability coefficients, Cronbach’s Alpha and McDonald's Omega, and factor analysis, both Exploratory as well as Confirmatory.

Results

GAD-7 demonstrated good internal consistency (α = 0.907; Ω = 0.909). Horn's parallel analysis indicated a single factor as the most appropriate. CFA using the standard ML method indicated a good model fit, χ2 = 21.207, p = 0.096; CFI = 0.999; SRMR = 0.027. More studies are needed to determinate the cut-off point and the maximisation of the scale’s sensitivity and specificity in pregnant and postpartum Greek Cypriot women.

Conclusions

GAD-7 is a valid and reliable measure and healthcare professionals should utilize GAD-7 as a standard instrument for the screening of anxiety symptoms in pregnant and postpartum Greek Cypriot women.

A Multidisciplinary Pelvic Pain Clinic: Integrated Health Psychology in a Specialty Care Setting

Purpose: Chronic pelvic pain (CPP) is a relatively common health problem, impacting around 25 million women globally. This study details the development of a multidisciplinary women's CPP clinic at a major U.S. academic medical center, and examines associations between mood, pain symptoms, and trauma history. Materials and Methods: Data were collected from 96 subjects, including self-report measures (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Brief Trauma Questionnaire), pain intensity ratings, psychiatric diagnoses, and relevant medical history. Results: Most subjects reported at least one traumatic experience. Nearly half of subjects met criteria for an anxiety disorder and/or a depressive disorder. Most subjects were diagnosed with pelvic floor dysfunction, and more than half were referred to physical therapy. Women with abdominal/pelvic surgery history reported more traumatic experiences than women without surgical history. Women with a history of sexual abuse reported trying more medications and seeking care from a greater number of providers. Many reported pain duration of >2 years. Conclusions: Study findings related to mental health and trauma support a multidisciplinary CPP approach that includes a clinical health psychology component. Future research may investigate the therapeutic processes that apply to this population to identify targeted efficacious interventions.

Rates of depressive and anxiety symptoms in the perinatal period during the COVID-19 pandemic: Comparisons between countries and with pre-pandemic data

BACKGROUND

The COVID-19 pandemic was a significant threat to perinatal mental health. This study examined differences in clinically significant depression, anxiety, and co-morbid symptoms among pregnant and postpartum women across several countries and compared prevalence of perinatal depression and anxiety before and during the pandemic in each participating country.

METHODS

Participants were 3326 pregnant and 3939 postpartum women (up to six months postpartum) living in Brazil, Chile, Cyprus, Greece, Israel, Portugal, Spain, Turkey, and the United Kingdom. An online survey was completed between June 7th and October 31st 2020, and included the Edinburgh Postnatal Depression Scale (EPDS) and the Generalized Anxiety Disorder Screener (GAD-7). The pre-pandemic studies were identified through literature review.

RESULTS

Prevalence of clinically significant depression (EPDS≥13), anxiety (GAD-7 ≥ 10), and co-morbid (EPDS≥13 and GAD-7 ≥ 10) symptoms was 26.7 %, 20 % and 15.2 %, in pregnant women, and 32.7 %, 26.6 % and 20.3 %, in postpartum women, respectively. Significant between-country differences were found in all mental health indicators in both perinatal periods. Higher levels of symptoms were observed during (versus before) the pandemic, especially among postpartum women.

LIMITATIONS

Participants were mostly highly educated and cohabiting with a partner. The online nature of the survey may have limited the participation of women from vulnerable socio-economically backgrounds.

CONCLUSIONS

Our findings expand previous literature on the negative impact of the COVID-19 pandemic on perinatal mental health, by highlighting that this may be influenced by country of residence. Mental health care policies and interventions should consider the unique needs of perinatal women in different parts of the world.

Prevalence and factors associated with food insecurity in eight high-altitude cities in Peru during the second wave of the COVID-19 pandemic: a retrospective, cross-sectional study

Background

Food insecurity has increased during the COVID-19 pandemic, affecting an estimated 260 million people. However, little evidence is available on how pandemic-related characteristics influence food security in a high-altitude population. The objective of this study was to assess factors associated with food insecurity in high-altitude Peruvian cities during the second epidemic wave of COVID-19.

Methods

A retrospective, cross-sectional study was conducted in eight Peruvian cities over 1,500 m above sea level. An online survey measuring food security, presence of anxiety & depressive symptoms, sleep quality, post-traumatic stress disorder (PTSD), resilience, and sociodemographic characteristics was disseminated through social networks between December 2020 and February 2021. Generalized linear models were used to identify an association between the study variables.

Results

Of 700 participants, the median age was 23 years, and more than half were female (56.7%). The prevalence of food insecurity was 37.1%. Anxiety symptoms, depressive symptoms, and PTSD were present in 72.7%, 64.1%, and 15% of respondents, respectively. The prevalence of food insecurity was higher in people with fair (PR: 1.60, 95% CI: 1.23–2.07) and very bad perception of their health (PR: 4.06, 95% CI: 2.63–6.26), individuals seeking mental health support (PR: 1.42, 95% CI: 1.25–1.62), and in those who lost their job due to the pandemic (PR: 1.82, 95% CI: 1.62–2.04). Having moderate (PR: 1.52, 95% CI: 1.26–1.83) and moderate to severe depressive symptoms (PR: 1.58, 95% CI: 1.11–2.27) also increased the prevalence of food insecurity.

Conclusion

During the pandemic, the prevalence of food insecurity has increased in the Peruvian high-altitude population, revealing the need for preventive strategies. Identification of pandemic-related characteristics that influence food insecurity can guide interventions in at-risk individuals and reduce the long-term impact of this problem on overall health and quality of life.

Dispositional Mindfulness and Self-Compassion Buffer the Effects of COVID-19 Stress on Depression and Anxiety Symptoms

Objectives

The COVID-19 pandemic has been associated with a dramatic rise in symptoms of depression and anxiety. Dispositional mindfulness (DM) and self-compassion (SC) have consistently been associated with psychological disorder symptoms and appear to buffer the effects of stress on depression and anxiety.

Methods

Across two studies (n = 888), we examined direct and indirect (moderation) relationships of DM, SC, COVID-19-related stress, and symptoms of depression and anxiety. We also examined the differential effects of several DM measures (FFMQ-15; FFMQ-39; MAAS) in the relationships of COVID-19 stress and psychological disorder symptoms. We recruited participants (Study 1 n = 350; 42.2% cis women; Study 2 n = 538; 44.3% cis women) online (MTurk) and examined associations of DM, SC, and COVID-19 stress, and emotional impact, and the moderating effect of DM and SC in the relationships of COVID-19-related fears, stress, emotional impacts, and psychological disorder symptoms.

Results

DM and SC were moderately and negatively correlated with COVID-19 fears and stress (correlations ranging r =  − .14 to r =  − .42) across studies. Study 1 moderation analyses demonstrated SC, but not DM (FFMQ-15), significantly moderated relationships of COVID-19 fears and emotional impacts with symptoms. Study 2 analyses demonstrated the FFMQ-39, but not the MAAS, significantly moderated relationships of COVID-19 stress and psychological disorder symptoms.

Conclusions

These results support the potential protective roles of DM and SC in disrupting pathological trajectories related to naturally elevated pandemic stress. Results also demonstrate the differential associations of several DM measures with COVID-19 stress. Future research should replicate such findings with more diverse samples and using various measures of self-compassion and risk metrics.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-022-02008-0.

A Machine Learning Approach for Continuous Mining of Nonidentifiable Smartphone Data to Create a Novel Digital Biomarker Detecting Generalized Anxiety Disorder: Prospective Cohort Study

BACKGROUND

Anxiety is one of the leading causes of mental health disability around the world. Currently, a majority of the population who experience anxiety go undiagnosed or untreated. New and innovative ways of diagnosing and monitoring anxiety have emerged using smartphone sensor-based monitoring as a metric for the management of anxiety. This is a novel study as it adds to the field of research through the use of nonidentifiable smartphone usage to help detect and monitor anxiety remotely and in a continuous and passive manner.

OBJECTIVE

This study aims to evaluate the accuracy of a novel mental behavioral profiling metric derived from smartphone usage for the identification and tracking of generalized anxiety disorder (GAD).

METHODS

Smartphone data and self-reported 7-item GAD anxiety assessments were collected from 229 participants using an Android operating system smartphone in an observational study over an average of 14 days (SD 29.8). A total of 34 features were mined to be constructed as a potential digital phenotyping marker from continuous smartphone usage data. We further analyzed the correlation of these digital behavioral markers against each item of the 7-item Generalized Anxiety Disorder Scale (GAD-7) and its influence on the predictions of machine learning algorithms.

RESULTS

A total of 229 participants were recruited in this study who had completed the GAD-7 assessment and had at least one set of passive digital data collected within a 24-hour period. The mean GAD-7 score was 11.8 (SD 5.7). Regression modeling was tested against classification modeling and the highest prediction accuracy was achieved from a binary XGBoost classification model (precision of 73%-81%; recall of 68%-87%; F₁-score of 71%-79%; accuracy of 76%; area under the curve of 80%). Nonparametric permutation testing with Pearson correlation results indicated that the proposed metric (Mental Health Similarity Score [MHSS]) had a colinear relationship between GAD-7 Items 1, 3 and 7.

CONCLUSIONS

The proposed MHSS metric demonstrates the feasibility of using passively collected nonintrusive smartphone data and machine learning-based data mining techniques to track an individuals' daily anxiety levels with a 76% accuracy that directly relates to the GAD-7 scale.

Anxiety among Adolescents and Young Adults during COVID-19 Pandemic: A Multi-Country Survey

(1) Background: Adolescents-and-young-adults (AYA) are prone to anxiety. This study assessed AYA's level of anxiety during the COVID-19 pandemic; and determined if anxiety levels were associated with country-income and region, socio-demographic profile and medical history of individuals. (2) Methods: A survey collected data from participants in 25 countries. Dependent-variables included general-anxiety level, and independent-variables included medical problems, COVID-19 infection, age, sex, education, and country-income-level and region. A multilevel-multinomial-logistic regression analysis was conducted to determine the association between dependent, and independent-variables. (3) Results: Of the 6989 respondents, 2964 (42.4%) had normal-anxiety, and 2621 (37.5%), 900 (12.9%) and 504 (7.2%) had mild, moderate and severe-anxiety, respectively. Participants from the African region (AFR) had lower odds of mild, moderate and severe than normal-anxiety compared to those from the Eastern-Mediterranean-region (EMR). Also, participants from lower-middle-income-countries (LMICs) had higher odds of mild and moderate than normal-anxiety compared to those from low-income-countries (LICs). Females, older-adolescents, with medical-problems, suspected-but-not-tested-for-COVID-19, and those with friends/family-infected with COVID-19 had significantly greater odds of different anxiety-levels. (4) Conclusions: One-in-five AYA had moderate to severe-anxiety during the COVID-19-pandemic. There were differences in anxiety-levels among AYAs by region and income-level, emphasizing the need for targeted public health interventions based on nationally-identified priorities.

Assessment of mental health in patients with chronic liver disease

Content available: Audio Recording.

Generalized Anxiety Disorder and Its Associated Factors Among Pregnant Women During COVID-19 at Public Health Facilities of East Gojjam Zone, 2020: A Multi-Center Cross-Sectional Study

Introduction

Pregnant women suffer from varying levels of generalized anxiety disorder that result in poor obstetrical outcomes. Therefore, this study aimed to assess the prevalence and factors associated with generalized anxiety disorder among pregnant women attending antenatal care during COVID-19 at the public health facilities in the east Gojjam zone.

Methods

A health facility-based cross-sectional study was conducted, from 1–30 December 2020. A total of 847 pregnant women were included in the study using a systematic random sampling technique. We used an interviewer-administered questionnaire to collect the data. Bivariate and multivariable logistic regression was used to identify factors associated with the outcome variable. Statistical significance was determined using a p-value < 0.05 and a 95% confidence level.

Results

The prevalence of generalized anxiety disorder was 43.7%, with a 95% CI (40.28–47.12). Having <3 the number of children (AOR: 1.53; 95% CI: 1.11–2.13, having a negative attitude about COVID (AOR: 1.47; 95% CI: 1.07–2.02 and having a high-risk perception about COVID (AOR: 1.86; 95% CI: 1.34–2.57 were factors significantly associated with generalized anxiety disorder.

Conclusions

The study found that the prevalence of generalized anxiety disorder was high. Having less than three children, having a negative attitude, and having a high-risk perception of COVID were independent risk factors of generalized anxiety disorder. Appropriate interventions should be considered to address generalized anxiety disorder during the pandemic.