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Gordon SH, Lee S, Steenland MW, Deen N, Feinberg E. Extended Postpartum Medicaid In Colorado Associated With Increased Treatment For Perinatal Mood And Anxiety Disorders. Health Aff (Millwood) 2024; 43:523-531. [PMID: 38560800 DOI: 10.1377/hlthaff.2023.01441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Perinatal mood and anxiety disorders (PMAD), a leading cause of perinatal morbidity and mortality, affect approximately one in seven births in the US. To understand whether extending pregnancy-related Medicaid eligibility from sixty days to twelve months may increase the use of mental health care among low-income postpartum people, we measured the effect of retaining Medicaid as a low-income adult on mental health treatment in the postpartum year, using a "fuzzy" regression discontinuity design and linked all-payer claims data, birth records, and income data from Colorado from the period 2014-19. Relative to enrolling in commercial insurance, retaining postpartum Medicaid enrollment was associated with a 20.5-percentage-point increase in any use of prescription medication or outpatient mental health treatment, a 16.0-percentage-point increase in any use of prescription medication only, and a 7.3-percentage-point increase in any use of outpatient mental health treatment only. Retaining postpartum Medicaid enrollment was also associated with $40.84 lower out-of-pocket spending per outpatient mental health care visit and $3.24 lower spending per prescription medication for anxiety or depression compared with switching to commercial insurance. Findings suggest that extending postpartum Medicaid eligibility may be associated with higher levels of PMAD treatment among the low-income postpartum population.
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Affiliation(s)
- Sarah H Gordon
- Sarah H. Gordon , Boston University, Boston, Massachusetts
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Schafer KM, Mulligan E, Shapiro MO, Flynn H, Joiner T, Hajcak G. Antenatal anxiety symptoms outperform antenatal depression symptoms and suicidal ideation as a risk factor for postpartum suicidal ideation. Anxiety Stress Coping 2024:1-11. [PMID: 38523456 DOI: 10.1080/10615806.2024.2333377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/16/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND AND OBJECTIVES Suicidal ideation (SI) during the postpartum phase is linked with suicide, a leading cause of death during this period. Antenatal depression and anxiety symptoms have both been linked with increased risk for postpartum SI. However, research aimed at examining the relative contributions of antenatal anxiety and depression symptoms towards postpartum SI remains nascent. In this study, we investigated the relative contribution of antenatal anxiety symptoms, depression symptoms, and SI towards postpartum SI. DESIGN These data are from a longitudinal study in which American mothers were assessed during pregnancy and again at six- to eight weeks postpartum. METHODS Data were analyzed using correlations and logistic regression models. RESULTS Antenatal anxiety symptoms and antenatal depression symptoms were significantly correlated with postpartum SI. Results from a logistic regression model indicated that antenatal anxiety symptoms (T1; OR = 1.185 [1.125, 1.245], p = .004), but not antenatal depression symptoms (T1; OR = 1.018 [0.943, 1.093], p = .812) or antenatal SI (T1; OR = 1.58 [0.11, 22.29], p = 0.73), were significantly associated with postpartum SI. CONCLUSIONS Antenatal anxiety symptoms, depression symptoms, and SI were positively associated with postpartum SI. When examined simultaneously, anxiety symptoms during the antenatal phase (but not depression symptoms or SI) predicted SI in the postpartum phase.
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Affiliation(s)
- Katherine Musacchio Schafer
- Tennessee Valley Healthcare System, Geriatric Research and Education Clinical Center, Nashville, TN, USA
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
| | | | - Mary O Shapiro
- Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
- South Central Mental Illness Research, Education and Clinical Center, New Orleans, LA, USA
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Heather Flynn
- School of Medicine, Florida State University, Tallahassee, FL, USA
| | - Thomas Joiner
- Psychology, Florida State University, Tallahassee, FL, USA
| | - Greg Hajcak
- Psychology, Florida State University, Tallahassee, FL, USA
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Reid HE, Edge D, Pratt D, Wittkowski A. Working with suicidal mothers during the perinatal period: a reflexive thematic analysis study with mental health professionals. BMC Psychiatry 2024; 24:106. [PMID: 38326817 PMCID: PMC10848420 DOI: 10.1186/s12888-024-05537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Suicide is the leading cause of death in mothers postpartum and one of the most common causes of death during pregnancy. Mental health professionals who work in perinatal services can offer insights into the factors they perceive as being linked to mothers' suicidal ideation and behaviour, support offered to mothers and improvements to current practices. We aimed to explore the experiences and perceptions of perinatal mental health professionals who have worked with suicidal mothers during the perinatal period. METHOD Semi-structured interviews were conducted face-to-face or via telephone with mental health professionals working in perinatal mental health inpatient or community services across England. Data were analysed using reflexive thematic analysis. RESULTS From the professionals' (n = 15) accounts three main themes were developed from their interview data. The first, factors linked to suicidal ideation and behaviour, overarched two sub-themes: (1.1) the mother's context and (1.2) what the baby represents and what this means for the mother. These sub-themes described factors that professionals assessed or deemed contributory in relation to suicidal ideation and behaviour when a mother was under their care. The second main theme, communicating about and identifying suicidal ideation and behaviour, which outlined how professionals enquired about, and perceived, different suicidal experiences, encapsulated two sub-themes: (2.1) how to talk about suicide and (2.2) types of suicidal ideation and attempts. The third main theme, reducing suicidal ideation through changing how a mother views her baby and herself, focused on how professionals supported mothers to reframe the ways in which they viewed their babies and in turn themselves to reduce suicidal ideation. CONCLUSION Professionals highlighted many factors that should be considered when responding to a mother's risk of suicide during the perinatal period, such as the support around her, whether the pregnancy was planned and what the baby represented for the mother. Professionals' narratives stressed the importance of adopting a tailored approach to discussing suicidal experiences with mothers to encourage disclosure. Our findings also identified psychological factors that professionals perceived as being linked to suicidal outcomes for mothers, such as self-efficacy; these factors should be investigated further.
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Affiliation(s)
- Holly E Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK
- Manchester Academic Health Sciences Centre, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK
- Manchester Academic Health Sciences Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK
- Manchester Academic Health Sciences Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Zochonis Building, Brunswick Street, M13 9PL, Manchester, UK.
- Manchester Academic Health Sciences Centre, Manchester, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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Chrzan-Dętkoś M, Murawska N, Łockiewicz M, de la Fe Rodriguez Muñoz M. Self-harm thoughts among postpartum women - associated factors. J Reprod Infant Psychol 2024:1-14. [PMID: 38319751 DOI: 10.1080/02646838.2024.2313487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Even though in many countries suicide is the leading cause of maternal deaths during the postpartum period, the prevalence of thoughts of self-harm (SHTs), an important risk factor for suicide attempts, is still not well documented. AIM We aimed to investigate the prevalence of SHTs in a Polish cohort of postpartum women and identify socio-demographic and maternal mental health factors associated with experiencing SHTs. METHOD 1545 women took part in a midwife-led postpartum depression (PPD) screening. 337 of them reported SHTs. The Edinburgh Postpartum Depression Scale (EPDS) was administered. Specifically, we used an abbreviated 5-item version to assess depression symptoms, item 10 to assess SHTs, a composite score of items 1 and 2 - anhedonia, and a composite score of items 3, 4, and 5 - anxiety. Logistic regression analyses were performed to examine associations between variables. RESULTS Approximately 2% (n = 337) of women self-reported experiencingSHTs. Within the group of postpartum mothers who self-reported SHTs, 65.60% (n = 221) manifested the symptoms of PPD, and 56.40% (n = 190) - of anxiety. The symptoms of PPD, a mood disorder diagnosed in the past, and younger age were predictors of SHTs. CONCLUSION The results of this study can contribute to the development of prevention strategies: analysing separately items from PPD screening questionnaires focusing on SHTs can be an important part of prevention. The lack of the symptoms of PPD and anxiety risk does notexclude experiencing SHTs.
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Affiliation(s)
| | - Natalia Murawska
- Institute of Psychology, the University of Gdansk, Gdansk, Poland
| | - Marta Łockiewicz
- Institute of Psychology, the University of Gdansk, Gdansk, Poland
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Jester JM, Riggs JL, Menke RA, Alfafara E, Issa M, Muzik M, Rosenblum KL. Randomized pilot trial of the "Mom Power" trauma- and attachment-informed multi-family group intervention in treating and preventing postpartum symptoms of depression among a health disparity sample. Front Psychiatry 2023; 14:1048511. [PMID: 37732075 PMCID: PMC10507705 DOI: 10.3389/fpsyt.2023.1048511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 08/15/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Perinatal depression, a common complication related to childbearing, impacts mothers, children, and families. Efficacious interventions reduce perinatal depression symptoms; effort is needed to prevent the onset of perinatal depression. To determine feasibility and preliminary efficacy in reducing perinatal depression, we conducted a community-based, randomized parallel open pilot trial of Mom Power, a group-based intervention to improve mental health and parenting in mothers with young children. Methods Mom Power consists of 10 group sessions, focused on parenting, child development and self-care and three individual sessions, to build rapport and provide personalized referrals. Control group participants received psychoeducational mailings. Computer-based urn randomization assigned mothers with experiences of interpersonal violence, depression, or other traumatic experiences to Mom Power (68) or control (54). Results At 3-months post-treatment, the 31 retained women assigned to Mom Power were half as likely to meet criteria for probable depression (26%) as the 22 women retained in the control group (55%), with treatment predicting lower incidence of probable depression (OR = 0.13, p = 0.015). Moreover, among the 23 women who did not meet criteria for depression diagnosis at baseline, no women in the treatment group developed depression (n = 0, 0%) compared to control group women (n = 3, 30%). Logistic regression controlling for selective attrition confirmed the treatment effect on preventing new onset of depression (OR = 0.029, p = 0.012). Conclusion These findings support the use of Mom Power for both treatment and prevention of perinatal depression. Clinical trial registration https://classic.clinicaltrials.gov/ct2/show/NCT01554215, NCT01554215.
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Kinser PA, Bodnar-Deren S, Amstadter AB, Lapato DM, Thacker LR, Johnson JA, Aubry C, Johnson A, Gault C, Hill-Thomas A, Russell S, Lanni S, Freeman A. Study protocol for the Mindful Moms Study: A randomized controlled trial evaluating a mindful movement intervention for marginalized pregnant people experiencing depression. Contemp Clin Trials 2023; 132:107302. [PMID: 37500008 PMCID: PMC10529983 DOI: 10.1016/j.cct.2023.107302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/22/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
More than 1 in 5 pregnant people in the United States experience depressive symptoms. Although treatments exist, many people remain under- or un-treated due to concerns about stigma, side effects, and costs of medications or psychotherapy, particularly those who are marginalized (defined as those who are minoritized, low-income, or with low-educational attainment). Further, the standard depression treatments do not address social connectedness, which is a potentially modifiable factor involved in depressive symptom etiology. This protocol presents the rationale, design, and status of the two-arm longitudinal parallel group randomized controlled trial - the Mindful Moms Study - which aims to evaluate the effects and mechanisms of a group-based mindful physical activity (yoga) intervention in marginalized pregnant people with depressive symptoms (n = 200) compared to a prenatal education control group. The primary aim is to evaluate effects of group assignment on depressive symptom severity, anxiety, and perceived stress over time from baseline to six weeks postpartum. Secondary aims include understanding the role of social connectedness as a moderator of the effects and to identify genome-wide DNA methylation patterns associated with depressive symptoms and perceived social connectedness at postpartum. A focus on adequate symptom management through non-pharmacologic, accessible therapies that address social connectedness during pregnancy in marginalized women is an urgent clinical and research priority. The successful completion of this study will provide important insights into social connectedness as a mechanism to decrease depressive symptoms in a largely understudied population. Trial registration: NCT04886856.
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Affiliation(s)
- Patricia A Kinser
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.
| | - Susan Bodnar-Deren
- Department of Sociology, Virginia Commonwealth University, Richmond, VA, USA
| | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA; Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Dana M Lapato
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA; Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Leroy R Thacker
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer A Johnson
- Department of Sociology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Christine Aubry
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Anisa Johnson
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Candice Gault
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Ariel Hill-Thomas
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Sally Russell
- School of Nursing, Virginia Commonwealth University, Richmond, VA, USA
| | - Susan Lanni
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Moazzam S, Noorjahan N, Jin Y, Nagy JI, Kardami E, Cattini PA. Effect of high fat diet on maternal behavior, brain-derived neurotrophic factor and neural stem cell proliferation in mice expressing human placental lactogen during pregnancy. J Neuroendocrinol 2023:e13258. [PMID: 36989439 DOI: 10.1111/jne.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 03/14/2023]
Abstract
Maternal obesity is a serious health concern because it increases risks of neurological disorders, including anxiety and peripartum depression. In mice, a high fat diet (HFD) in pregnancy can negatively affect placental structure and function as well as maternal behavior reflected by impaired nest building and pup-retrieval. In humans, maternal obesity in pregnancy is associated with reduced placental lactogen (PL) gene expression, which has been linked to a higher risk of depression. PL acting predominantly through the prolactin receptor maintains energy homeostasis and is a marker of placenta villous trophoblast differentiation during pregnancy. Impaired neurogenesis and low serum levels of brain-derived neurotrophic factor (BDNF) have also been implicated in depression. Augmented neurogenesis in brain during pregnancy was reported in the subventricular zone (SVZ) of mice at gestation day 7 and linked to increased prolactin receptor signaling. Here, we used transgenic CD-1 mice that express human (h) PL during pregnancy to investigate whether the negative effects of diet on maternal behavior are mitigated in these (CD-1[hGH/PL]) mice. Specifically, we examined the effect of a HFD on nest building prepartum and pup retrieval postpartum, as well as on brain BDNF levels and neurogenesis. In contrast to wild-type CD-1[WT]mice, CD-1[hGH/PL] mice displayed significantly less anxiety-like behavior, and showed no impairment in prepartum nest building or postpartum pup-retrieval when fed a HFD. Furthermore, the HFD decreased prepartum and increased postpartum BDNF levels in CD-1[WT] but not CD-1[hGH/PL] mice. Finally, neurogenesis in the SVZ as well as phosphorylated mitogen-activated protein kinase, indicative of lactogenic signaling, appeared unaffected by pregnancy and diet at gestation day 7 in CD-1[hGH/PL] mice. These observations indicate that CD-1[hGH/PL] mice are resistant to the negative effects of HFD reported for CD-1[WT] mice, including effects on maternal behaviors and BDNF levels, and potentially, neurogenesis. This difference probably reflects a direct or indirect effect of the products of the hGH/PL transgene.
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Affiliation(s)
- Showall Moazzam
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Canada
| | - Noshin Noorjahan
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Canada
| | - Yan Jin
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Canada
| | - James I Nagy
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Canada
| | - Elissavet Kardami
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Canada
- Institute of Cardiovascular Sciences, St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Peter A Cattini
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Canada
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Dudeney E, Coates R, Ayers S, McCabe R. Measures of suicidality in perinatal women: A systematic review. J Affect Disord 2023; 324:210-231. [PMID: 36584713 DOI: 10.1016/j.jad.2022.12.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Suicide is a leading cause of death for perinatal women. Identifying women at risk of suicide is critical. Research on the validity and/or reliability of measures assessing suicidality in perinatal women is limited. This review sought to: (1) identify; and (2) evaluate the psychometric properties of suicidality measures validated in perinatal populations. METHODS Nine electronic databases were systematically searched from inception to January 2022. Additional articles were identified through citation tracking. Study quality was assessed using an adapted tool, and the psychometric properties of measures were reviewed and presented using a narrative synthesis. RESULTS A total of 208 studies were included. Thirty-five studies reported psychometric data on ten suicidality measures. Fifteen studies reported both validity and reliability data, 12 reported more than one type of validity, seven validated more than one measure and four only reported reliability. Nearly all measures primarily screened for depression, with an item or subscale assessing suicidal ideation and/or behaviours. Three measures were specifically developed for perinatal women, but only two were validated in more than one study. The Postpartum Depression Screening Scale (PDSS), suicidal thoughts subscale, was validated most frequently. LIMITATIONS Methodological differences and variability between the measures (e.g., suicidality construct assessed, number of items and administration) precluded direct comparisons. CONCLUSION Further validation of suicidality measures is needed in perinatal women. Screening for perinatal suicidality often occurs in the context of depression. The development of a standalone measure specifically assessing suicidality in perinatal women may be warranted, particularly for use in maternity care settings.
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Affiliation(s)
- Elizabeth Dudeney
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK.
| | - Rose Coates
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Rose McCabe
- Centre for Mental Health Research, School of Health and Psychological Sciences, University of London, UK
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Salwan A, Maroney M, Tremayne L. Patient-reported perceptions of brexanolone in the treatment of postpartum depression: A qualitative analysis. Ment Health Clin 2023; 12:342-349. [PMID: 36644587 PMCID: PMC9819138 DOI: 10.9740/mhc.2022.12.342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 09/27/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Brexanolone demonstrates short-term efficacy for the treatment of postpartum depression (PPD). Postpartum depression is linked to infanticide and maternal suicide, and current treatment often fails to adequately control depressive symptoms. The purpose of this analysis is to further understand the experience(s) of women who have received brexanolone for the treatment of PPD. Methods Semistructured interviews modeled after the theory of planned behavior (TPB) were conducted to assess women's perceptions of treatment for PPD with brexanolone. Women who received treatment with brexanolone at this inpatient facility were eligible to participate in this study. The TPB is often used to predict intention to perform health-related behaviors. Semistructured interviews were recorded and transcribed, and thematic analysis was conducted to identify common ideas across all interviews. Follow-up assessment of depressive and anxious symptoms was also conducted using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), respectively. Results Five of the 10 women who received treatment with brexanolone at this facility were interviewed, and common themes related to the TPB were analyzed. Attitudes toward brexanolone were favorable, and having a strong support system was a motivating factor in receiving treatment for PPD. Insurance approval, need for childcare, and poor understanding of symptoms of PPD were barriers to receiving treatment with brexanolone. Symptoms of depression and anxiety were rated as low at the time of the follow-up interview as measured by the PHQ-9 (mean 1.6, range 1 to 3) and GAD-7 (mean 2.8, range 2 to 4), respectively. Discussion Brexanolone rapidly and sustainably reduced symptoms of PPD and was well-received by patients. Despite significant barriers to use, women who received treatment with brexanolone advocated for its availability as well as increased awareness of PPD.
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Affiliation(s)
- Aaron Salwan
- Behavioral Health Clinical Pharmacy Specialist, Montefiore Nyack Hospital, Nyack, New York,
| | - Megan Maroney
- Associate Professor, Rutgers the State University of New Jersey, Piscataway, New Jersey
| | - Lisa Tremayne
- Director, Perinatal Mood and Anxiety Disorders Clinic, Monmouth Medical Center, Long Branch, New Jersey
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Tiguh AE, Wondie KY, Gessesse DN, Tsega NT, Aklil MB, Temesgan WZ, Abegaz MY, Anteneh TA, Tibebu NS, Alemu HN, Haile TT, Seyoum AT, Mesele TT, Yismaw AE, Nenko G, Taye BT, Mihret MS, Kebede AA. Self-harm among post-natal mothers in Northwest Ethiopia: Implication for policy and practice. Front Public Health 2022; 10:916896. [PMID: 36424954 PMCID: PMC9679001 DOI: 10.3389/fpubh.2022.916896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Self-harm is a global public health concern affecting thousands of women. However, it is an under-reported and neglected aspect of maternal health, particularly in developing countries. In Ethiopia, there is a paucity of evidence regarding self-harm, and it is rarely given attention. Therefore, this study aimed to assess the proportion of self-harm and associated factors among postnatal mothers in Gondar city, Northwest Ethiopia. Method A community-based cross-sectional study was conducted from 1 July, 2021, to 30 August, 2021, in Gondar city. A cluster sampling technique was conducted to select 858 women who gave birth in the last 12 months. The data were collected using a structured questionnaire through face-to-face interviews. The data were entered into EpiData version 4.6 and exported to SPSS 25 for analysis. The multivariable logistic regression analysis was fitted to identify factors associated with the outcome variable. The level of significant association was determined at a p-value of ≤ 0.05. Result The proportion of postnatal self-harm was found to be 8.5% (95% CI: 6.7,10.5). Having lower family income (AOR: 2.41, 95% CI: 1.05,5.56), having unplanned pregnancy (AOR: 2.70, 95% CI: 1.53,4.79), experiencing adverse birth outcomes (AOR: 3.11, 95% CI: 1.10,8.83), birth not attended by health provider (AOR: 4.15, 95% CI: 1.76,9.79), experiencing intimate partner violence (AOR: 1.93, 95% CI: 1.12,3.32), and poor decision-making power (AOR: 1.70, 95% CI: 1.02, 2.84) were the variables significantly associated with self-harm. Conclusion This study revealed that the proportion of self-harm among postnatal mothers was prevalent. Factors like monthly income of a family, planned pregnancy, birth outcome, birth assistant, intimate partner violence, and decision-making power show an association with maternal self-harm. Antenatal and postnatal self-harm screening as part of the continuum of maternal healthcare is important. Self-harm is also a danger for women who have experienced intimate partner violence or have low socioeconomic economic status, all of which require exceptional mental health assessment.
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Affiliation(s)
- Agumas Eskezia Tiguh
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,*Correspondence: Agumas Eskezia Tiguh
| | - Kindu Yinges Wondie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dereje Nibret Gessesse
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nuhamin Tesfa Tsega
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mastewal Belayneh Aklil
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wubedle Zelalem Temesgan
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Marta Yimam Abegaz
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tazeb Alemu Anteneh
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Solomon Tibebu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haymanot Nigatu Alemu
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsion Tadesse Haile
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmra Tesfahun Seyoum
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tiruye Tilahun Mesele
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Engida Yismaw
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Goshu Nenko
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Birhan Tsegaw Taye
- School of Nursing and Midwifery, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Muhabaw Shumye Mihret
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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11
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Bright AM, Doody O, Tuohy T. Women with perinatal suicidal ideation–A scoping review of the biopsychosocial risk factors to inform health service provision and research. PLoS One 2022; 17:e0274862. [PMID: 36170289 PMCID: PMC9518889 DOI: 10.1371/journal.pone.0274862] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/07/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives This review aims to map the existing evidence on perinatal suicidal ideation, identify biopsychosocial risk factors associated with suicidal ideation and make recommendations for service provision and future research. Methods Scoping review guided by Arskey’s and O’Malley’s (2005) framework. Five academic databases (PsycINFO, MEDLINE, CINAHL, ASSIA and Academic Search Complete) were searched from 1st January 2009 to 1st April 2022. Studies were screened by title, abstract and full text against inclusion and exclusion criteria. Primary qualitative, quantitative and mixed-methods studies, written in English pertaining to perinatal suicidal ideation were included. Forty-one studies met the eligibility criteria, data were extracted and narratively synthesised. Findings are reported in accordance with the PRISMA-SR extension. Key conclusions Findings were mapped onto the biopsychosocial framework and include sleep deprivation, maternal age, pregnancy complications, mood disorders, intimate partner violence, childhood maltreatment/abuse, low socioeconomic status, alcohol and tobacco misuse, miscarriage/perinatal loss, birth trauma and sleep deprivation. The findings demonstrate that the biopsychosocial risk factors for perinatal suicidal ideation are varied and complex. Implications for practice The minimisation of women’s experiences may lead to detrimental consequences and there is a need for increased knowledge of mental health problems by those working with women in the perinatal period to ensure safety planning conversations occur with every woman meeting ‘at risk’ criteria.
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Affiliation(s)
- Ann-Marie Bright
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
- * E-mail:
| | - Owen Doody
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Teresa Tuohy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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12
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Kiewa J, Meltzer-Brody S, Milgrom J, Bennett E, Mackle T, Guintivano J, Hickie IB, Colodro-Conde L, Medland SE, Martin N, Wray N, Byrne E. Lifetime prevalence and correlates of perinatal depression in a case-cohort study of depression. BMJ Open 2022; 12:e059300. [PMID: 35973706 PMCID: PMC9621163 DOI: 10.1136/bmjopen-2021-059300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study sought to evaluate the prevalence, timing of onset and duration of symptoms of depression in the perinatal period (PND) in women with depression, according to whether they had a history of depression prior to their first perinatal period. We further sought to identify biopsychosocial correlates of perinatal symptoms in women with depression. DESIGN AND SETTING The Australian Genetics of Depression Study is an online case cohort study of the aetiology of depression. For a range of variables, women with depression who report significant perinatal depressive symptoms were compared with women with lifetime depression who did not experience perinatal symptoms. PARTICIPANTS In a large sample of parous women with major depressive disorder (n=7182), we identified two subgroups of PND cases with and without prior depression history (n=2261; n=878, respectively). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was a positive screen for PND on the lifetime version of the Edinburgh Postnatal Depression Scale. Descriptive measures reported lifetime prevalence, timing of onset and duration of PND symptoms. There were no secondary outcome measures. RESULTS The prevalence of PND among parous women was 70%. The majority of women reported at least one perinatal episode with symptoms both antenatally and postnatally. Of women who experienced depression prior to first pregnancy, PND cases were significantly more likely to report more episodes of depression (OR=1.15 per additional depression episode, 95% CI 1.13 to 1.17, p<0.001), non-European ancestry (OR 1.5, 95% CI 1.0 to 2.1, p=0.03), severe nausea during pregnancy (OR 1.3, 95% CI 1.1 to 1.6, p=0.006) and emotional abuse (OR 1.4, 95% CI 1.1 to 1.7, p=0.005). CONCLUSIONS The majority of parous women with lifetime depression in this study experienced PND, associated with more complex, severe depression. Results highlight the importance of perinatal assessments of depressive symptoms, particularly for women with a history of depression or childhood adverse experiences.
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Affiliation(s)
- Jacqueline Kiewa
- Child Health Research Centre, The University of Queensland Faculty of Medicine and Biomedical Sciences, Brisbane, Queensland, Australia
| | | | - Jeannette Milgrom
- Parent-Infant Research Institute, Heidelberg Heights, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Jerry Guintivano
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Nick Martin
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Naomi Wray
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Enda Byrne
- Child Health Research Centre, The University of Queensland Faculty of Medicine and Biomedical Sciences, Brisbane, Queensland, Australia
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13
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Liu ZF, Sylivris A, Gordon M, Sundram S. The association between tryptophan levels and postpartum mood disorders: a systematic review and meta-analysis. BMC Psychiatry 2022; 22:539. [PMID: 35941560 PMCID: PMC9361669 DOI: 10.1186/s12888-022-04178-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
Over 50% of women experience mood disturbance in the postpartum period, with significant implications for maternal and infant health but identifying those at risk is not easily possible. The essential amino acid, tryptophan (TRP) through its neuroactive metabolites, has been implicated in the pathology of mood disorders. Thus, TRP levels tested in the peripartum period have been proposed as a potential biomarker for subsequent development of postpartum mood disturbances, in particular postpartum depression (PPD). A systematic review and meta-analysis following PROSPERO guidelines [CRD42021252462] was conducted on peer-reviewed, English language studies that measured blood levels of TRP during the postpartum period in women who were also evaluated for postpartum "blues" or PPD. Thirteen studies met the inclusion criteria, of which five studies contained sufficient data to conduct a meta-analysis. Low total TRP levels in postpartum days 1 to 5 were significantly associated with PPD (SMD: -5.39, 95%CI [-7.72, -3.05]). No significant association was found between free TRP levels in the postpartum period and PPD (SMD: -3.43, 95%CI [-7.76, 0.89]). Our findings confirm the necessity for more replicable designed studies regarding TRP and its relationship to postpartum depression. If there were greater clarity regarding TRP metabolism during pregnancy, then the next step would be to consider measuring total plasma TRP levels on postpartum days 1 to 5 to identify women at greater risk of developing PPD.
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Affiliation(s)
- Zhao Feng Liu
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Amy Sylivris
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Michael Gordon
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.,Mental Health Program, Monash Health, Melbourne, VIC, Australia
| | - Suresh Sundram
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia. .,Mental Health Program, Monash Health, Melbourne, VIC, Australia. .,Monash Medical Centre, Block P, Level 3, 246 Clayton Rd, Melbourne, 3168, VIC, Australia.
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14
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Reid HE, Pratt D, Edge D, Wittkowski A. Maternal Suicide Ideation and Behaviour During Pregnancy and the First Postpartum Year: A Systematic Review of Psychological and Psychosocial Risk Factors. Front Psychiatry 2022; 13:765118. [PMID: 35401283 PMCID: PMC8987004 DOI: 10.3389/fpsyt.2022.765118] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Suicide is a leading cause of maternal death during pregnancy and up to a year after birth (perinatal period). Many psychological and psychosocial risk factors for maternal suicidal ideation and behaviour have been investigated. Despite this, there have been no attempts to systematically search the literature on these risk factors. Additionally, few studies have described how the risk factors for suicidal ideation, attempted suicides and suicide deaths differ, which is essential for the development of tools to detect and target suicidal ideation and behaviour. Seven databases were searched up to June 2021 for studies that investigated the association between suicidal ideation and/or suicidal behaviour and psychological/psychosocial risk factors in pregnant and postpartum women. The search identified 17,338 records, of which 59 were included. These 59 studies sampled a total of 49,929 participants and investigated 32 different risk factors. Associations between abuse, experienced recently or during childhood, and maternal suicide ideation, attempted suicide and death were consistently reported. Social support was found to be less associated with suicide ideation but more so with suicide attempts. Identifying women who have experienced domestic violence or childhood abuse and ensuring all women have adequate emotional and practical support during the perinatal period may help to reduce the likelihood of suicidal behaviour.
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Affiliation(s)
- Holly E. Reid
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Anja Wittkowski
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Academic Health Science Centre, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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15
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Morres ID, Tzouma NA, Hatzigeorgiadis A, Krommidas C, Kotronis KV, Dafopoulos K, Theodorakis Y, Comoutos N. Exercise for perinatal depressive symptoms: A systematic review and meta-analysis of randomized controlled trials in perinatal health services. J Affect Disord 2022; 298:26-42. [PMID: 34728280 DOI: 10.1016/j.jad.2021.10.124] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 09/14/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Exercise improves perinatal depressive (PD) symptoms, but reports call for more robust evidence. This systematic review and meta-analysis aimed at synthesizing evidence exclusively from randomized controlled trials (RCTs) examining the effects of exercise on PD symptoms in women recruited through perinatal health services. METHODS Nine e-databases and fifteen systematic reviews were searched for relevant RCTs. Exercise-specific tools extracted/coded data. A meta-analysis using a random effects model (Standardized Mean Difference [SMD]) investigated the effects of exercise on PD scores post-intervention. RESULTS From 285 records, 14 RCTs (2.025 participants) were considered eligible including two RCTs with clinically diagnosed PD women. Exercise showed a statistically significant, small, overall antidepressant effect (SMD = -0.21, 95% CI = -0.31, -0.11, p = 0.0001) with low/non-significant heterogeneity (Q = 17.82, I 2 = 16%, p = 0.27). Only the fail-safe criterion recorded marginally significant publication bias, but trim-fill analysis added no study. Sensitivity analyses increased the overall effect in RCTs showing lower risk of bias or delivering ≥150 min/week moderate intensity aerobic exercise. Subgroup analyses revealed significant antidepressant effects for exercise across various settings, delivery formats, depressive symptoms severities and outcome measures used. Heterogeneity was low/non-significant in all analyses (I 2 ≤ 50%). Hedges' g corrections did not influence the results. LIMITATIONS Study limitations include the small number of available trials and clinically diagnosed PD samples and the variety of exercise modalities. CONCLUSIONS Exercise improved PD symptoms, especially in RCTs with lower risk of bias or with ≥150 min/day moderate intensity aerobic exercise interventions. Findings are clinically useful but more RCTs for clinically diagnosed PD women are needed for firmer conclusions.
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Affiliation(s)
- Ioannis D Morres
- Department of Physical Education and Sport Science, School of Physical Education, Sport & Dietetics, University of Thessaly, Trikala, Greece.
| | - Natalia-Antigoni Tzouma
- Department of Physical Education and Sport Science, School of Physical Education, Sport & Dietetics, University of Thessaly, Trikala, Greece
| | - Antonis Hatzigeorgiadis
- Department of Physical Education and Sport Science, School of Physical Education, Sport & Dietetics, University of Thessaly, Trikala, Greece
| | - Charalampos Krommidas
- Department of Physical Education and Sport Science, School of Physical Education, Sport & Dietetics, University of Thessaly, Trikala, Greece
| | | | - Konstantinos Dafopoulos
- Department of Obstetrics and Gynecology, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Yannis Theodorakis
- Department of Physical Education and Sport Science, School of Physical Education, Sport & Dietetics, University of Thessaly, Trikala, Greece
| | - Nikolaos Comoutos
- Department of Physical Education and Sport Science, School of Physical Education, Sport & Dietetics, University of Thessaly, Trikala, Greece
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16
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Arditi-Arbel B, Hamdan S, Winterman M, Gvion Y. Suicidal ideation and behavior among perinatal women and their association with sleep disturbances, medical conditions, and known risk factors. Front Psychiatry 2022; 13:987673. [PMID: 36741562 PMCID: PMC9893018 DOI: 10.3389/fpsyt.2022.987673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Suicide is considered one of the leading causes of maternal mortality, especially among women with postpartum depression. In the current systematic review, we conducted a qualitative data synthesis of recent studies exploring novel risk factors including sleep disturbances and medical conditions, alongside known and significant risk factors for perinatal suicidality. EVIDENCE ACQUISITION We conducted a systematic search of the literature according to PRISMA guidelines on PubMed, PsycNET, and Scopus databases. Search terms were "pregnancy" "OR" "postpartum" "OR" "peripartum" "OR" "perinatal" "OR" "postnatal" combined with the Boolean "AND" operator with "suicide" "OR" "suicidality" "OR" "suicidal ideation" "OR" "suicidal behavior." EVIDENCE SYNTHESIS The initial search yielded 1,458 records, of which 51 research reports that met inclusion criteria were analyzed. These 51 studies sampled a total of 45,942 participants. Clinically, sleep disturbance, psychopathology, and social support have been identified as dominant risk factors for suicidal behavior among pregnant and postpartum women, as well as medical conditions and aversive life events. CONCLUSION Monitoring sleep disturbance, depression, and perceived social support is critical given that they are significant risk factors for suicide among perinatal women. Early identification of perinatal women who may be at risk of suicide, although not depressed, is crucial. LIMITATIONS The use of tools designed to identify depression to identify suicidal risk, fail to identify women who are at risk but who do not suffer from depression. Other methodological limitations are the lack of longitudinal studies and the complexity of examining suicidal behavior in sample studies.
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Affiliation(s)
- Bar Arditi-Arbel
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Sami Hamdan
- Department of Psychology, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yafo, Israel
| | - May Winterman
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Yari Gvion
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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17
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Blum S, Mack JT, Weise V, Kopp M, Asselmann E, Martini J, Garthus-Niegel S. The impact of postpartum obsessive-compulsive symptoms on child development and the mediating role of the parent-child relationship: A prospective longitudinal study. Front Psychiatry 2022; 13:886347. [PMID: 36203839 PMCID: PMC9532008 DOI: 10.3389/fpsyt.2022.886347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The first 2 years of life are a particularly sensitive period for the parent-child relationship as well as a healthy, age-appropriate child development. Both have been shown to be linked to postpartum depressive and anxiety symptoms, while the role of obsessive-compulsive symptoms, which are also common, is still largely understudied. In addition, fathers have been neglected in this area of research. This study, which includes both mothers and fathers, aims to investigate the longitudinal associations between postpartum obsessive-compulsive symptoms and different domains of child development, as well as the mediating role of the parent-child relationship. METHODS Data were drawn from the prospective longitudinal study DREAM, with 674 mothers and 442 fathers from the general population completing self-report questionnaires at four measurement points. Longitudinal associations between parental postpartum obsessive-compulsive symptoms 8 weeks postpartum, the parent-child relationship 14 months postpartum, and child development 24 months postpartum were investigated using regression and mediation analyses. A number of potential confounding variables were considered, i.e., age, academic degree, postpartum depressive and anxiety symptoms of the parents, preterm birth and temperament of the child, as well as COVID-19 pandemic-driven adversities. RESULTS When adjusting for confounders, neither maternal nor paternal postpartum obsessive-compulsive symptoms had adverse effects on the respective parent-child relationship and child development. Further, no mediating role of the parent-child relationship between parental postpartum obsessive-compulsive symptoms and child development could be confirmed. Instead, we found that the mother- and father-child relationship were differentially related to specific child developmental domains. For mothers, a poorer mother-child relationship was prospectively related to poorer fine motor development. For fathers, a poorer father-child relationship prospectively predicted a poorer overall development as well as poorer gross motor, fine motor, problem-solving, and personal-social development. CONCLUSION Our results suggest that negative effects on the parent-child relationship and child development may only become apparent in full-blown postpartum obsessive-compulsive disorder. Given the differential impact on specific developmental domains, our findings also suggest that it is crucial to consider both parents in clinical practice as well as in future research, rather than focusing only on the mother-child dyad.
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Affiliation(s)
- Sophie Blum
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Judith T Mack
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Victoria Weise
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Marie Kopp
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Eva Asselmann
- Department of Psychology, HMU Health and Medical University, Potsdam, Germany
| | - Julia Martini
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Institute for Systems Medicine and Faculty of Medicine, Medical School Hamburg, Hamburg, Germany.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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18
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Xiao M, Hu Y, Huang S, Wang G, Zhao J, Lei J. Prevalence of suicidal ideation in pregnancy and the postpartum: A systematic review and meta-analysis. J Affect Disord 2022; 296:322-36. [PMID: 34600967 DOI: 10.1016/j.jad.2021.09.083] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 09/13/2021] [Accepted: 09/26/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Suicidal ideation, a significant risk factor of suicide, is considered a potential trigger for intervention prior to self-harm or suicide; however, the prevalence of maternal suicidal ideation varied widely between studies. This review aims to synthesis the available evidence to estimate the prevalence of maternal suicidal ideation before and after pregnancy. METHODS We searched six English databases (PubMed, Web of Science, Embase, the Cochrane Library, PsycINFO, CINAHL) and three Chinese databases (China National Knowledge Infrastructure, Wang Fang, Chinese Biomedical Literature Databases) from database inceptions before August 31, 2020; and checked the reference list for relevant studies. Data in the included studies were used to calculate the prevalence of maternal suicidal ideation. Subgroup analysis and meta-regression were performed to detect the potential sources of heterogeneity. RESULTS 6094 potentially studies were identified. 71 studies, including 23 cohort studies, 47 cross-sectional studies, and 1 RCT study, were included for final analysis. The total participants were 92146, with sample size ranged from 23 to 22118. The included studies were from 23 different countries distributing on six continents, most of the studies were conducted in Asia (n = 18), North America (n = 16), and South America (n = 15). The pooled prevalence of maternal suicidal ideation reported by eligible studies was 8% (95% CI 7-10%), with 10% in antenatal and 7% in postpartum. Prevalence significantly varied based on measuring tools, study design, study countries, and publication year, while prevalence was not conditional on the time-point assessment, sample size, and maternal age. LIMITATION Obvious heterogeneity and no standardization tools for measuring suicidal ideation may limit the results' interpretation. CONCLUSION Our systematic review reported the prevalence of suicidal ideation in pregnancy and postpartum was 8%. Future studies should establish standardization tools for measuring suicidal ideation and identify strategies of prevention and treatment.
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19
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Weingarten S, Diop S, Specht C, Turmes L, Juckel G, Mavrogiorgou P. Differences in interactional behaviour in postpartum depression with and without pre-existing mental disorder. Compr Psychiatry 2021; 108:152248. [PMID: 34044326 DOI: 10.1016/j.comppsych.2021.152248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Mothers with postpartum depression (PPD) show impaired affects and behaviour patterns in the mother-child interaction, which affects an infant's emotional and cognitive development and the maternal course of disease. However, impairment of the mother-child relationship does not occur in every case of PPD. AIM The aim of this exploratory-descriptive video-based study was to investigate the possible associations between mother-child interactions and aspects of maternal biography and clinical history, with a focus on pre-existing mental disorder. METHODS Sixty-two mother-child dyads (31 mothers with PPD and pre-existing mental disorders and 31 mothers with PPD but no further mental disorder) hospitalized at the mother and baby unit (MBU) of the LWL-Hospital Herten were included in this study. The Marcé Clinical Checklist and the "Mannheimer Beurteilungsskala zur Erfassung der Mutter-Kind-Interaktion im Säuglingsalter" (MBS-MKI-S) were used to explore sociodemographic and clinical parameters, and video-based interaction behaviour was examined. RESULTS Mother-infant interaction behaviour showed a significant group difference on the MBS-MKI-S-Vm subscale (variability in maternal behaviour) before psychiatric treatment (exact Mann-Whitney U test: U = 555, p = 0.023), with higher scores in mothers with a pre-existing mental disorder. Furthermore, significant differences were shown on the MBS-MKI-S-RSm (maternal reactivity/sensitivity) (U = 259, p = 0.019) and MBS-MKI-S-Rc (child's reactivity) subscales at discharge (U = 251, p = 0.021). Among mothers with a pre-existing diagnosis, the MBS-MKI-S-Tm (maternal tenderness) and MBS-MKI-S-Rc (child's reactivity) subscales were significantly correlated after treatment. CONCLUSIONS Mothers with PPD and a pre-existing mental disorder displayed significantly more behavioural variability than mothers with only PPD. Maternal behaviour seems to influence the child's responsive behaviour; thus, mothers and their children can benefit from inpatient treatment at an MBU. Further investigations with larger samples should be conducted.
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Affiliation(s)
- Sina Weingarten
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany
| | - Shirin Diop
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany
| | - Christina Specht
- Department of Psychiatry, Psychotherapy, Psychosomatic Medicine and Preventive Medicine, LWL-Hospital Herten, Im Schloßpark 20, 45699 Herten, Germany
| | - Luc Turmes
- Department of Psychiatry, Psychotherapy, Psychosomatic Medicine and Preventive Medicine, LWL-Hospital Herten, Im Schloßpark 20, 45699 Herten, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany.
| | - Paraskevi Mavrogiorgou
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany
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20
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Sleed M, Isosävi S, Fonagy P. The assessment of representational risk (ARR): Development and psychometric properties of a new coding system for assessing risk in the parent-infant relationship. Infant Ment Health J 2021; 42:529-545. [PMID: 34105777 DOI: 10.1002/imhj.21932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are few clinically valid tools that can be used to assess potential parent-infant relational risk. This study describes the development and initial validation of the assessment of representational risk (ARR) coding system to be applied to the parent development interview (Slade, A., Aber, J. L., Bresgi, I., Berger, B., & Kaplan, M. (2004). The Parent Development Interview - Revised. Unpublished protocol. New York, NY: The City University of New York.) for assessing potential risk in caregivers' representations of their infant, themselves as parents, and their relationship. The ARR was developed and validated in three samples in England. A review of the literature informed the selection of 10 items. It had a three-factor structure that was used to inform subscales: hostile, helpless, and narcissistic caregiving representations. The subscales and total risk scores showed good criterion validity for discriminating between high and low risk samples and good concurrent validity with measures of parental psychopathology and parent-infant interaction. The ARR is a potentially valuable coding system for identifying risk in early attachment relationships.
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Affiliation(s)
- Michelle Sleed
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), The Anna Freud Centre, 4-8 Rodney Street, London, N1 9JH, UK.,Division of Psychology and Language Sciences, University College London, London, UK
| | | | - Peter Fonagy
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), The Anna Freud Centre, 4-8 Rodney Street, London, N1 9JH, UK.,Division of Psychology and Language Sciences, University College London, London, UK
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21
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Yang Q, Sjölander A, Li Y, Viktorin A, Bertone-Johnson ER, Ye W, Fang F, Valdimarsdóttir UA, Lu D. Clinical indications of premenstrual disorders and subsequent risk of injury: a population-based cohort study in Sweden. BMC Med 2021; 19:119. [PMID: 34034729 PMCID: PMC8152351 DOI: 10.1186/s12916-021-01989-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/21/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Premenstrual disorders, including premenstrual syndrome and premenstrual dysphoric disorder, are suggested to be correlated with suicidal behavior and accidents in cross-sectional and retrospective studies. However, prospective data are still lacking. METHODS We performed a population-based cohort study including 1,472,379 Swedish women of reproductive age who were followed from 2001 to 2012. Within the cohort, we also performed a sibling analysis where we compared the rates of injury between full sisters. By linking to the Patient and the Prescribed Drug Registers, we identified 18,628 women with any clinical indications for premenstrual disorders in the cohort (population analysis) and 7674 women in the sibling analysis. Any injury, primarily suicidal behavior (completed suicide and suicide attempt) or accidents (e.g., fall and transportation accidents), was identified through the Patient and Causes of Death Registers as the primary outcome. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of these outcomes among women with premenstrual disorders in both population and sibling analyses using multivariable Cox proportional hazards regression. RESULTS During a maximal follow-up of 12 years (mean 9.55 years), we identified 2390 women with premenstrual disorders with any injury; 216 through suicidal behavior and 2191 through accidents. Compared to women without premenstrual disorders, women with premenstrual disorders were at increased risk of any injury (HR 1.37, 95% CI 1.31-1.42), particularly suicidal behavior (HR 2.26, 95% CI 1.97-2.59) and accidents (HR 1.32, 95% CI 1.27-1.38). Such associations somewhat attenuated yet remained significant in the sibling analysis (HRs: 1.31 for any injury, 1.86 for suicidal behavior, and 1.29 for accidents). Additional adjustment for psychiatric comorbidities minimally altered the associations with any injury and accidents in both population and sibling analyses, whereas the association with suicidal behavior was considerably attenuated to non-significance in the sibling analysis. Such risks were particularly strong within 2 years after receiving the diagnosis of premenstrual disorders and were evident among women with premenstrual disorders with and without psychiatric comorbidities. CONCLUSIONS Our findings suggest that women with a clinical indication of premenstrual disorders are at increased subsequent risk of injury, particularly accidents within the first 2 years after diagnosis.
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Affiliation(s)
- Qian Yang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 17177, Stockholm, Sweden.
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 17177, Stockholm, Sweden
| | - Yuchen Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 17177, Stockholm, Sweden
| | - Alexander Viktorin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 17177, Stockholm, Sweden
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA-01003, USA.,Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA-01003, USA
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 17177, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Unnur A Valdimarsdóttir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 17177, Stockholm, Sweden.,Center of Public Health Sciences, Faculty of Medicine, University of Iceland, IS-101, Reykjavík, Iceland.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA-02115, USA
| | - Donghao Lu
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA-02115, USA
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22
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Dejean D, Chan-Chee C, Legendre G, Picard A, Krembel A, Gillard P, Gohier B, Duverger P, Riquin E. [Suicidality in the perinatal period: Descriptive study on factors associated with suicidal ideation among women hospitalized in the perinatal period at the specialized hospital center]. Encephale 2021; 48:139-147. [PMID: 33994157 DOI: 10.1016/j.encep.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Suicide is the leading cause of maternal mortality in high-resource countries. The onset of suicidal ideation is a major risk factor for suicide attempts. Suicidality has a major impact on the mother-baby relationship and on child development. The main objective of the study was to identify factors associated with the occurrence of perinatal suicidal ideation in women requiring hospitalization. The secondary objectives of the study were to describe the socio-demographic and clinical characteristics of this specific population, to specify the follow-up procedures at hospital discharge and to develop a semi-directed interview framework for psychiatric evaluation of perinatal patients admitted to a psychiatric hospital in order to better identify those at risk of suicide and improve overall management, particularly in terms of referral to existing perinatal care services. METHODS Descriptive and retrospective study carried out at the Specialized Hospital Center of women hospitalized in the perinatal period between 2014 and 2019. The inclusion criteria were: inpatient pregnant or postpartum within one year of delivery, 16 to 43 years. A keyword search was performed to retrieve the computerized records. All records matching the inclusion criteria were included. We studied the occurrence of suicidal ideation according to the main known clinical and socio-demographic risk factors. RESULTS The sample included 25 pregnant patients and 57 post-partum patients. The presence of a psychiatric history increased the risk of suicidal ideation by 4.38 (P<0.03). The association between the occurrence of a stressful life event and the risk of suicidal ideation onset was close to significant (P<0.10). One third of the patients had been admitted for a reason related to suicidality. Less than one-third of the patients had been referred to existing perinatal services. CONCLUSIONS Suicidality in the perinatal period has a major impact on the dyad as well as on the whole family. The search for suicidal ideas must be systematic during psychiatric interviews, a fortiori when a psychiatric history has been authenticated. Every patient hospitalized in adult psychiatry should be referred to specialized outpatient perinatal psychiatry services. Prevention involves raising awareness and training of all health professionals, networking, but also informing the general public.
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Affiliation(s)
- D Dejean
- Service de Psychiatrie et d'Addictologie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - C Chan-Chee
- Direction Santé Environnement Travail, Agence nationale de santé publique, 12, rue du Val d'Osne, 94415 Saint-Maurice cedex
| | - G Legendre
- Service de gynécologie obstétrique, CHU Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - A Picard
- Service de psychiatrie périnatale, CHRU de Lille, 2, rue André Verhaeghe, 59037 Lille
| | - A Krembel
- Centre Roger Misès - Secteur Psychiatrie Infanto-Juvénile Ouest, 33, rue de la Charnasserie, 49100 Angers
| | - P Gillard
- Service de gynécologie obstétrique, CHU Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - B Gohier
- Service de Psychiatrie et d'Addictologie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France; Laboratoire de Psychologie, LPPL EA4638, Université d'Angers, Maison des sciences humaines, 5, bis boulevard Lavoisier, 49045 Angers cedex 01, France
| | - P Duverger
- Laboratoire de Psychologie, LPPL EA4638, Université d'Angers, Maison des sciences humaines, 5, bis boulevard Lavoisier, 49045 Angers cedex 01, France; Service de Psychiatrie de L'Enfant et de l'Adolescent, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - E Riquin
- Laboratoire de Psychologie, LPPL EA4638, Université d'Angers, Maison des sciences humaines, 5, bis boulevard Lavoisier, 49045 Angers cedex 01, France; Service de Psychiatrie de L'Enfant et de l'Adolescent, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France; Unité Mitovasc, UMR CNRS 6015-Inserm 1083, 3, rue Roger Amsler, 49100 Angers, France; Fondation Santé des Etudiants de France, Centre Pierre Daguet, route du Mans, 72302 Sablé-sur-Sarthe.
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23
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Rao WW, Yang Y, Ma TJ, Zhang Q, Ungvari GS, Hall BJ, Xiang YT. Worldwide prevalence of suicide attempt in pregnant and postpartum women: a meta-analysis of observational studies. Soc Psychiatry Psychiatr Epidemiol 2021; 56:711-20. [PMID: 33191455 DOI: 10.1007/s00127-020-01975-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 10/24/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Past suicide attempts (SA) are a major contributor to suicide. The prevalence of SA in pregnant and postpartum women varied significantly across studies. Therefore, this meta-analysis was conducted to examine the prevalence of SA and its mediating factors in this population. METHODS Relevant articles published in PubMed, EMBASE, Web of Science, PsycINFO, Medline complete, Chinese National Knowledge Infrastructure database (CNKI), Chinese Wanfang and Chongqing VIP database were systematically searched from inception to March 28, 2019. Titles, abstracts and full texts were reviewed independently by three researchers. Studies were included if they reported data on SA prevalence or provided relevant data that enabled the calculation of SA prevalence. Data were extracted by two researchers and checked by one senior researcher. The random-effects model was used to analyze data by the CMA 2.0 and Stata 12.0, with the high degree of statistical heterogeneity present. The primary outcomes were prevalence of SA with 95% CI during pregnancy and during the first-year postpartum. RESULTS Fourteen studies covering 6,406,245 pregnant and postpartum women were included. The pooled prevalence of SA was 680 per 100,000 (95% confidence interval 0.10-4.69%) during pregnancy and 210 per 100,000 (95% confidence interval 0.01-3.21%) during the first-year postpartum. Data source was significantly associated with prevalence of SA in the subgroup analysis (pregnancy, p < 0.001; the first-year postpartum, p = 0.013). CONCLUSION The prevalence of SA is not high in pregnant and postpartum women. Due to the potential loss of life and negative impact of SA on health outcomes, however, careful screening and effective preventive measures should be implemented for this population.
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24
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Ntow KO, Krzeczkowski JE, Amani B, Savoy CD, Schmidt LA, Van Lieshout RJ. Maternal and Infant Performance on the Face-to-Face Still-Face Task following Maternal Cognitive Behavioral Therapy for Postpartum Depression. J Affect Disord 2021; 278:583-591. [PMID: 33032029 DOI: 10.1016/j.jad.2020.09.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study examined the impact of treating postpartum depression (PPD) with cognitive-behavioral therapy (CBT) on mother and infant behavior on the face-to-face still-face (FFSF) paradigm. METHODS Data from 68 mothers and their infants, 35 women with PPD within 12 months of delivery, and 33 healthy control dyads matched on infant age, sex and familial socioeconomic status were examined. Women with PPD received nine weeks of group CBT and were compared with healthy control dyads with at three timepoints on changes in mother-infant performance on the FFSF. RESULTS A significant group x FFSF phase x visit interaction was observed for infant withdrawn behavior at the three months post-treatment (p=0.006). Infants of mothers with PPD displayed significantly less withdrawn behavior after treatment, normalizing to levels of control infants. LIMITATIONS A relatively small sample consisting predominantly of Caucasian mother-infant dyads and the presence of comorbid anxiety in the PPD group. CONCLUSION Three months after group CBT for PPD, infants' withdrawn behavior appears to normalize to levels seen in the infants of healthy controls. Future studies should investigate whether treatments focused on the mother-infant dyad have distinctive effects on mothers and their infants' behaviors.
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Affiliation(s)
- Kwadjo O Ntow
- Global Health Graduate Program, McMaster University, Ontario, Canada.
| | | | - Bahar Amani
- Neuroscience Graduate Program, McMaster University, Ontario, Canada
| | - Calan D Savoy
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Ontario Canada
| | - Louis A Schmidt
- Department of Psychology, Neuroscience & Behavior, McMaster University, Ontario Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Ontario Canada
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25
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Faisal-Cury A, Levy RB, Matijasevich A. The Relationship Between Mother-Child Bonding Impairment and Suicidal Ideation in São Paulo, Brazil. Matern Child Health J 2021; 25:706-14. [PMID: 33206304 DOI: 10.1007/s10995-020-03024-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate the association between mother-child bonding at 6-9 months after birth and suicidal ideation METHODS: A cross-sectional study embedded in a clinical trial with 358 low-income postpartum women who had antenatal depression in São Paulo, Brazil. The Postpartum Bonding Questionnaire and the Patient Health Questionnaire-9 were used RESULTS: The percentage of the main outcome, suicidal ideation (SI) was 10.3%. Using logistic regression models, bonding impairment (BI) was associated with SI even after controlling for postpartum depression and other covariates. CONCLUSIONS FOR PRACTICE SI affects 10% of vulnerable postpartum women. BI is independently associated with SI. Treating BI may prevent SI.
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26
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Mazúchová L, Kelčíková S, Porubská A, Malinovská N, Grendár M. Mother-infant bonding in the postpartum period and its predictors. Cent Eur J Nurs Midw 2020. [DOI: 10.15452/cejnm.2020.11.0022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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27
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du Toit E, Niehaus D, Jordaan E, Koen L, Jones R, Leppanen J. Perinatal suicidality: Risk factors in South African women with mental illness. S Afr J Psychiatr 2020. [DOI: 10.4102/sajpsychiatry.v26i0.1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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28
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Mebrahtu H, Sherr L, Simms V, Weiss HA, Rehman AM, Ndlovu P, Cowan FM. Effects of Maternal Suicidal Ideation on Child Cognitive Development: A Longitudinal Analysis. AIDS Behav 2020; 24:2421-9. [PMID: 31997056 DOI: 10.1007/s10461-020-02802-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study aimed to assess the association between suicidal ideation among mothers living with HIV in Zimbabwe and the cognitive development of their children. Participants were mother–child dyads recruited from two rural districts in Zimbabwe. Data were collected at baseline and 12 months follow-up. Suicidal ideation was assessed using item-10 from the Edinburgh postnatal depression scale. Mixed-effects linear regression was used to assess the association of child cognitive outcomes at follow-up (using the Mullen scales of early learning) with maternal suicidal ideation. Mothers with suicidal ideation at baseline (n = 171) tended to be younger, unmarried, experienced moderate to severe hunger, had elevated parental stress and depression symptoms compared with non-suicidal mothers (n = 391). At follow-up, emerging maternal suicidal ideation was associated with poorer child cognitive outcomes (adjusted mean difference − 6.1; 95% CI − 10.3 to − 1.8; p = 0.03). Suicidal ideation affects child cognitive development and should be addressed, particularly in HIV positive mothers.
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29
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Gelabert E, Gutierrez-Zotes A, Navines R, Labad J, Puyané M, Donadon MF, Guillamat R, Mayoral F, Jover M, Canellas F, Gratacós M, Guitart M, Gornemann I, Roca M, Costas J, Ivorra JL, Subirà S, de Diego Y, Osorio FL, Garcia-Esteve L, Sanjuan J, Vilella E, Martin-Santos R. The role of personality dimensions, depressive symptoms and other psychosocial variables in predicting postpartum suicidal ideation: a cohort study. Arch Womens Ment Health 2020; 23:585-593. [PMID: 31802248 DOI: 10.1007/s00737-019-01007-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/07/2019] [Indexed: 12/14/2022]
Abstract
Suicidability has been associated with neuroticism and psychoticism, but its role during perinatal period has not been analyzed. We explore the association between personality dimensions, depressive symptoms, and other psychosocial variables in postpartum suicidal ideation. A cohort of 1795 healthy Spanish women from the general population was assessed for suicidal ideation (EPDS-Item10) in early postpartum, 8 and 32 weeks postpartum. Sociodemographic, obstetric, and reproductive variables, psychiatric history, social support, stressful life-events during pregnancy, depressive symptoms (EPDS), and the Eysenck's personality dimensions (EPQ-RS) were also assessed at baseline. A major depressive episode (DSM-IV) was confirmed in women with EPDS>10 at follow-up assessments. Descriptive, bivariate, and multivariate analyses were conducted. Adjusted logistic regression analysis was reported as odds ratio (ORs) with 95% confidence intervals (CIs). Seven percent of mothers reported suicidal ideation during the first 8 months postpartum. Sixty-two percent of women with suicidal ideation had a major depressive episode at 8 weeks, and 70% at 32 weeks postpartum. Neuroticism and psychoticism predicted suicidal ideation throughout the first 2 weeks after delivery (OR, 1.03; 95%CI 1.01-1.06; and OR, 1.03; 95%CI 1.01-1.05 respectively). Early postpartum depressive symptoms (OR 1.2; 95%CI 1.11-1.26), personal psychiatric history (OR 2.1; 95%CI 1.33-3.27), and stressful life events during pregnancy (OR 1.88; 95%CI 1.12-3.16) also emerged as predictors of postpartum suicidal ideation. Analysis of women for postpartum suicidal ideation should include not only psychiatric symptoms but also psychosocial assessment (i.e., covering psychiatric history, stressful events, or long-standing personality vulnerabilities) in order to identify those in need of early psychosocial or psychiatric care.
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Affiliation(s)
- E Gelabert
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - A Gutierrez-Zotes
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - R Navines
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - J Labad
- Parc Taulí Hospital Universitario, Instituto de Investigación Sanitaria Parc Taulí (I3PT), UAB, CIBERSAM, Sabadell, Spain
| | - M Puyané
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - M F Donadon
- Department of Neuroscience and Behavior, Ribeirão Preto, University of São Paulo, National Institute for Science and Technology (INCT-TM, CNPq, Brazil), São Paulo, Brazil
| | - R Guillamat
- Departamento de Psiquiatria, Departamento de Salud Mental, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - F Mayoral
- Instituto de Investigación Biomédica de Málaga (IBIMA) and Hospital Universitario Regional de Málaga, UGC Salud Mental, España, Málaga, Spain
| | - M Jover
- Hospital Clinic, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - F Canellas
- Institut Universitari d'Investigació en Ciències de la Salut, Red en Asistencia Primaria (RediAPP), Hospital de Son Dureta, Palma de Mallorca, Spain
| | - M Gratacós
- Centro de Regulación Genómica (CRG) y UPF, Barcelona, Spain
| | - M Guitart
- Parc Taulí Hospital Universitario, Instituto de Investigación Sanitaria Parc Taulí (I3PT), UAB, CIBERSAM, Sabadell, Spain
| | - I Gornemann
- Instituto de Investigación Biomédica de Málaga (IBIMA) and Hospital Universitario Regional de Málaga, UGC Salud Mental, España, Málaga, Spain
| | - M Roca
- Institut Universitari d'Investigació en Ciències de la Salut, Red en Asistencia Primaria (RediAPP), Hospital de Son Dureta, Palma de Mallorca, Spain
| | - J Costas
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Servizo Galego de Saúde (SERGAS), Complexo Hospitalario Universitario de Santiago (CHUS), Galicia, Spain
| | - J L Ivorra
- Hospital Clinic, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - S Subirà
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Y de Diego
- Instituto de Investigación Biomédica de Málaga (IBIMA) and Hospital Universitario Regional de Málaga, UGC Salud Mental, España, Málaga, Spain
| | - F L Osorio
- Department of Neuroscience and Behavior, Ribeirão Preto, University of São Paulo, National Institute for Science and Technology (INCT-TM, CNPq, Brazil), São Paulo, Brazil
| | - L Garcia-Esteve
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - J Sanjuan
- Hospital Clinic, Universidad de Valencia, CIBERSAM, Valencia, Spain
| | - E Vilella
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - R Martin-Santos
- Department of Psychiatry and Psychology, Hospital Clinic, Institut of Neuroscience, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM); Neuroscience Programe, IMIM-Parc de Salut Mar, Barcelona, Spain.
- Department of Neuroscience and Behavior, Ribeirão Preto, University of São Paulo, National Institute for Science and Technology (INCT-TM, CNPq, Brazil), São Paulo, Brazil.
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30
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Gül H, Gül A, Kara K. Maternal depression, anxiety, psychoticism and paranoid ideation have effects on developmental delay types of infants: A study with clinical infant-mother dyads. Arch Psychiatr Nurs 2020; 34:184-190. [PMID: 32513470 DOI: 10.1016/j.apnu.2020.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Developmental delay in infancy includes cognitive-language delay, fine motor delay, gross motor delay, and social-self help delay. Delay in one intellectual domain frequently effects the other areas of development; therefore, determining risk factors are essential. In this study, we evaluated the relationship between maternal psychiatric symptoms and developmental delay types of infants who have not a known risk factor and are expected to show healthy development but have some behavioral and developmental problems. METHODS The sample consisted of 79 infant-mother (26 girls, 53 boys) dyads who had been admitted to the Department of Child and Adolescent Psychiatry at Gulhane Research and Training Hospital over a one year period. Brief Infant-Toddler Social and Emotional Assessment Scale, Brief Symptom Inventory and Ankara Developmental Screening Inventory were used. RESULTS The most frequent developmental delay types were fine motor and social -self-help delay in this sample. For all developmentally delayed infants, maternal interpersonal sensitivity, and depression scores were higher than healthy developed ones. Logistic regression analyses revealed the risk factors: Higher maternal paranoid ideation increases the language-cognitive delay; maternal hostility and anxiety increase the gross motor delay; maternal psychoticism increases the social and self-help delay, and maternal depression increases the total development delay of infants. CONCLUSION Maternal depression, anxiety, psychoticism, and paranoid ideation are important risk factors for infants' developmental delay types and should be addressed while evaluating infant-mother dyads in clinical practice.
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Affiliation(s)
- Hesna Gül
- Department of Child and Adolescent Psychiatry, Gulhane Research and Training Hospital, Ankara, Turkey.
| | - Ahmet Gül
- Department of Psychiatry, Ufuk University School of Medicine, Ankara, Turkey
| | - Koray Kara
- Department of Child and Adolescent Psychiatry, Gulhane Research and Training Hospital, Ankara, Turkey
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31
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Doi S, Fujiwara T, Isumi A, Mitsuda N. Preventing postpartum depressive symptoms using an educational video on infant crying: A cluster randomized controlled trial. Depress Anxiety 2020; 37:449-457. [PMID: 32058628 DOI: 10.1002/da.23002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/27/2019] [Accepted: 01/27/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the impact of watching an educational video on infant crying within 1 week of age after delivery at maternity wards to reduce the prevalence of postpartum depressive symptoms at 1 month after giving birth. METHODS The study design was a cluster randomized controlled trial. The intervention hospitals were randomly assigned, stratified by area and function of the hospital. Participants included 47 obstetrics hospitals or clinics out of 150 hospitals or clinics in Osaka Prefecture, Japan. In total, 44 hospitals or clinics completed the trial and 2,601 (intervention group = 1,040, control group = 1,561) caregivers responded to the questionnaire on postpartum depression (response rate: 55.1%). Mothers in the intervention group watched an educational video, within 1 week of age, during hospitalization at maternity wards. Primary outcome in this study was postpartum depression assessed by the Edinburgh Postnatal Depression Scale as 9+ and assessed via questionnaire at a 1-month health checkup. RESULTS In the intervention group, 142 (13.7%) mothers reported postpartum depression compared to 250 (16.0%) in the control group. Intention-to-treat analysis showed no significant difference in the prevalence of postpartum depression between the groups. However, among young mothers (<25 years), the analysis showed a 67.0% reduction in postpartum depression (odds ratio: 0.33, 95% CI: 0.15-0.72). CONCLUSIONS Watching an educational video on infant crying within 1 week after delivery at maternity wards did not reduce postpartum depression at 1 month after giving birth, but it was effective for young mothers aged <25 years.
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Affiliation(s)
- Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Aya Isumi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Nobuaki Mitsuda
- Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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Labrague LJ, McEnroe-Petitte D, Tsaras K, Yboa BC, Rosales RA, Tizon MM, D'souza MS. Predictors of postpartum depression and the utilization of postpartum depression services in rural areas in the Philippines. Perspect Psychiatr Care 2020; 56:308-315. [PMID: 31355473 DOI: 10.1111/ppc.12428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 06/07/2019] [Accepted: 07/14/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study explored the prevalence and predictors of postpartum depression (PPD) as well as the utilization and evaluation of PPD services among postpartum women in rural areas of the Philippines. DESIGN AND METHODS A cross-sectional study was conducted. One hundred sixty-five women who visited maternal facilities in the rural areas of the Central Philippines completed the Edinburgh Postnatal Depression Scale (EPDS). FINDINGS The prevalence of PPD was 16.4% at the sixth postpartum week. Occupation and marital status had significant direct influences on PPD. PPD services were not routinely provided by doctors and nurses. PRACTICE IMPLICATIONS Our results highlight a greater need to intensify government programs relative to PPD services, specifically related to the early detection and screening of PPD among high-risk pregnancies.
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Affiliation(s)
- Leodoro J Labrague
- Department of Fundamentals and Administration, College of Nursing, Sultan Qaboos University, Muscat, Sultanate of Oman
| | | | - Konstantinos Tsaras
- Department of Nursing, Technological Educational Institute of Thessaly, Larissa, Greece
| | - Begonia C Yboa
- College of Nursing and Health Sciences, Catbalogan, Philippines
| | | | - Maricel M Tizon
- College of Nursing and Health Sciences, Catbalogan, Philippines
| | - Melba S D'souza
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, Canada
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Wang I, Breadon C. A retrospective audit of joint mother-baby admissions to the Werribee Mercy mother and baby unit (MBU) and of the severity of maternal depression over the course of admission. Australas Psychiatry 2020; 28:220-225. [PMID: 31564115 DOI: 10.1177/1039856219878649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study examined (i) the demographic and illness profiles of mothers admitted to Werribee Mercy MBU in Victoria, Australia and (ii) the severity of maternal depressive symptoms over the course of admission. METHOD A retrospective audit was conducted on consecutively admitted mother-baby dyads between January 2011 and June 2015. Routinely collected maternal Beck Depression Inventory, second edition (BDI-II) scores were analysed for severity and change. RESULTS A total of 307 mother-baby dyads were admitted during the study period. The majority of mothers was partnered and educated young adults. The average length of stay was 4.4 weeks. The mean age of babies was 3.3 months. One-third of mothers met International Classification of Diseases, 10th edition criteria for two or more psychiatric diagnoses. Unipolar major depression was the commonest diagnosis. Of the 307 mothers, 125 mothers completed BDI-II on admission and on discharge, which showed a mean reduction of 16 points (p < 0.001) on discharge. CONCLUSIONS This study notes the similarities between the clinical profiles of the study population with mother-baby admissions to MBUs worldwide. Maternal depressive symptoms improved by 16 points on the BDI-II over the course of MBU admission, which shows the utility of MBU admission on maternal depressive symptoms.
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Affiliation(s)
- Imogen Wang
- North Western Mental Health, Parkville, VIC, Australia
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Abstract
Mixed states in patients with a perinatal mood episode is seldom encountered. Lack of appropriate assessment tools could be partly responsible for this observation. The authors conducted a selective review of studies dealing with the reporting of mixed symptoms in women during the perinatal period with the intention to quantify the phenomenon. In many instances of reported postpartum depression, either a first onset or an onset in the context of bipolar disorder, mixed states were identifiable. However, the strict application of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, mixed features specifier to these episodes risks misdiagnosis.
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Affiliation(s)
- Alexia Emilia Koukopoulos
- SPDC, Azienda Ospedaliera Universitaria Policlinico Umberto I, Sapienza School of Medicine and Dentistry, Rome, Italy; Centro Lucio Bini, Rome, Italy; Azienda Ospedaliera Sant'Andrea, UOC di Psichiatria, Via di Grottarossa 1035, CAP 00189, Rome 00185, Italy.
| | - Gloria Angeletti
- Centro Lucio Bini, Rome, Italy; Azienda Ospedaliera Sant'Andrea, UOC di Psichiatria, Via di Grottarossa 1035, CAP 00189, Rome 00185, Italy; NESMOS Department, Sapienza School of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Gabriele Sani
- Institute of Psychiatry, Università Cattolica del Sacro Cuore, Roma, Italy; Department of Psychiatry, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
| | - Delfina Janiri
- Centro Lucio Bini, Rome, Italy; Azienda Ospedaliera Sant'Andrea, UOC di Psichiatria, Via di Grottarossa 1035, CAP 00189, Rome 00185, Italy; NESMOS Department, Sapienza School of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Giovanni Manfredi
- Centro Lucio Bini, Rome, Italy; Azienda Ospedaliera Sant'Andrea, UOC di Psichiatria, Via di Grottarossa 1035, CAP 00189, Rome 00185, Italy; NESMOS Department, Sapienza School of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- Centro Lucio Bini, Rome, Italy; Azienda Ospedaliera Sant'Andrea, UOC di Psichiatria, Via di Grottarossa 1035, CAP 00189, Rome 00185, Italy; NESMOS Department, Sapienza School of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Lavinia De Chiara
- Centro Lucio Bini, Rome, Italy; Azienda Ospedaliera Sant'Andrea, UOC di Psichiatria, Via di Grottarossa 1035, CAP 00189, Rome 00185, Italy; NESMOS Department, Sapienza School of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
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Slomian J, Honvo G, Emonts P, Reginster JY, Bruyère O. Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. ACTA ACUST UNITED AC 2020; 15:1745506519844044. [PMID: 31035856 PMCID: PMC6492376 DOI: 10.1177/1745506519844044] [Citation(s) in RCA: 381] [Impact Index Per Article: 95.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: The postpartum period represents the time of risk for the emergence of
maternal postpartum depression. There are no systematic reviews of the
overall maternal outcomes of maternal postpartum depression. The aim of this
study was to evaluate both the infant and the maternal consequences of
untreated maternal postpartum depression. Methods: We searched for studies published between 1 January 2005 and 17 August 2016,
using the following databases: MEDLINE via Ovid, PsycINFO, and the Cochrane
Pregnancy and Childbirth Group trials registry. Results: A total of 122 studies (out of 3712 references retrieved from bibliographic
databases) were included in this systematic review. The results of the
studies were synthetized into three categories: (a) the maternal
consequences of postpartum depression, including physical health,
psychological health, relationship, and risky behaviors; (b) the infant
consequences of postpartum depression, including anthropometry, physical
health, sleep, and motor, cognitive, language, emotional, social, and
behavioral development; and (c) mother–child interactions, including
bonding, breastfeeding, and the maternal role. Discussion: The results suggest that postpartum depression creates an environment that is
not conducive to the personal development of mothers or the optimal
development of a child. It therefore seems important to detect and treat
depression during the postnatal period as early as possible to avoid harmful
consequences.
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Affiliation(s)
- Justine Slomian
- 1 Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Germain Honvo
- 1 Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Patrick Emonts
- 2 Department of Obstetrics and Gynaecology, CHU Liège, Liège, Belgium
| | - Jean-Yves Reginster
- 1 Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Olivier Bruyère
- 1 Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.,3 Department of Sport Science, University of Liège, Liège, Belgium
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Kubota C, Inada T, Shiino T, Ando M, Sato M, Nakamura Y, Yamauchi A, Morikawa M, Okada T, Ohara M, Aleksic B, Murase S, Goto S, Kanai A, Ozaki N. The Risk Factors Predicting Suicidal Ideation Among Perinatal Women in Japan. Front Psychiatry 2020; 11:441. [PMID: 32499731 PMCID: PMC7242750 DOI: 10.3389/fpsyt.2020.00441] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 04/29/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The aim of the present study was to elucidate the foreseeable risk factors for suicidal ideation among Japanese perinatal women. METHODS This cohort study was conducted in Nagoya, Japan, from July 2012 to March 2018. The Edinburgh Postnatal Depression Scale (EPDS) questionnaire was conducted at four time points: early pregnancy, late pregnancy, 5 days postpartum, and 1 month postpartum. A total of 430 women completed the questionnaires. A logistic regression analysis was performed using the presence of suicidal ideation on the EPDS as an objective variable. The explanatory variables were age, presence of physical or mental disease, smoking and drinking habits, education, hospital types, EPDS total score in early pregnancy, bonding, and quality and amount of social support, as well as the history of major depressive disorder (MDD). RESULTS The rate of participants who were suspected of having suicidal ideation at any of the four time points was 11.6% (n=52), with the highest (n=25, 5.8%) at late pregnancy. For suicidal ideation, education level (OR: 1.19; 95% CI: 1.00-1.41; p=0.047), EPDS total points in the pregnancy period (OR: 1.25; 95% CI: 1.16-1.34; p < 0.000), a history of MDD (OR: 2.16; 95% CI: 1.00-4.79; p=0.049), and presence of mental disease (OR: 2.39; 95% CI: 1.00-5.70; p=0.049) were found to be risk factors for suicidal ideation. Age [odds ratio (OR): 0.88; 95% confidence interval (CI): 0.80-0.95; p=.002] and quality of social support (OR: 0.77; 95% CI: 0.60-0.99; p=.041) were found to be protective factors. CONCLUSION Based on these results, effective preventive interventions, such as increasing the quality of social support and confirming the history of depression, should be carried out in pregnant depressive women at the early stage of the perinatal period.
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Affiliation(s)
- Chika Kubota
- Department of Psychiatry, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiya Inada
- Department of Psychiatry and Psychobiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoko Shiino
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Division of Developmental Emotional Intelligence Research Center for Child Mental Development, University of Fukui, Fukui, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Maya Sato
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukako Nakamura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Aya Yamauchi
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mako Morikawa
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Okada
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masako Ohara
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Branko Aleksic
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satomi Murase
- Department of Psychiatry, Liaison Medical Marunouchi, Nagoya, Japan
| | - Setsuko Goto
- Department of Obstetrics and Gynecology, Goto Setsuko Ladies Clinic, Nagoya, Japan
| | - Atsuko Kanai
- Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Abstract
AIM To assess the prevalence and associated factors of suicidal behaviour (suicidal ideation, plan or suicide attempt) in postpartum mothers. METHOD An institutional cross-sectional study was employed from March to April 2017. SETTING Two primary health centres and one referral hospital in northwestern Ethiopia. PARTICIPANTS A total of 1065 mothers aged ≥18 years during routine postnatal care were included and 988 of them completed the study. Those who were unable to communicate due to illness were not included. OUTCOME MEASURE Mothers who visit for routine postnatal care were assessed for suicidal behaviour using a suicidal screening tool. Logistic analysis was employed with adjusted OR (AOR) and 95% CI, and with p value less than 0.05 as the level of significance. RESULTS The prevalence of suicidal behaviour (suicidal ideation, plan or suicide attempt) was found at 14.0% (138/988) (95% CI 12.00 to 16.00) in postpartum mothers. Poor wealth of the mother (AOR=2.80, 95% CI 1.18 to 6.84), unplanned pregnancy of the current child (AOR=2.28, 95% CI 1.48 to 3.54), history of rape (AOR=2.26, 95% CI 1.42 to 3.61) and sickness of the new child (AOR=1.68, 95% CI 1.12 to 2.52) were significantly associated with suicidal behaviours. CONCLUSION Suicidal behaviour was found pretty high among postpartum mothers and was associated with poor wealth, unplanned pregnancy, history of rape and sickness of the new infant. It is recommended to screen mothers for possible suicidal behaviour during routine postnatal care.
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Affiliation(s)
- Habte Belete
- Psychiatry, College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eyaya Misgan
- Gynecology and Obstetrics, College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Mokhele I, Nattey C, Jinga N, Mongwenyana C, Fox MP, Onoya D. Prevalence and predictors of postpartum depression by HIV status and timing of HIV diagnosis in Gauteng, South Africa. PLoS One 2019; 14:e0214849. [PMID: 30947293 PMCID: PMC6448929 DOI: 10.1371/journal.pone.0214849] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/17/2019] [Indexed: 12/03/2022] Open
Abstract
Background Postpartum depression (PPD) is a common mental health condition that can compromise the quality of life and functional capacity of mothers and cause health and developmental problems in children born to affected mothers. Objectives We set out to measure the prevalence of PPD comparing postpartum HIV-1 infected women with pre-pregnancy HIV care experience, newly diagnosed (in latest pregnancy) HIV-1 infected women and HIV negative women, and to identify predictors of major PPD among these women in a peri-urban clinic in South Africa. Methods We conducted a cross-sectional survey of 1151 adult (≥18 years) postpartum HIV-1 infected (690) and HIV negative (461) women who delivered up to 30 days before study enrolment, interviewed after their first post-natal visit (3–6 days post- delivery) at Midwife Obstetric Units in Gauteng, South Africa. PPD was categorised into no depression (CES-D 10 total score <5), low to medium depression (CES-D 10 total score ≥5 and <10) and major depressive symptoms (CES-D 10 total score≥10). We used ordered logistic regression to identify predictors of postpartum depression and report adjusted odds ratio (aOR) and 95% confidence intervals (CIs). Results Overall 288 (25.0%) women screened positive for postpartum depression, a total of 168 (14.6%) women had low to medium PPD and 120 (10.4%) had major PPD. A higher proportion of HIV negative women experienced PPD, 129/461 (28.0%) among HIV negative vs. 159/690 (23.0%) among HIV-1 infected. Among HIV positive women, there was no meaningful difference in PPD between newly HIV diagnosed and those diagnosed before the most recent pregnancy (aOR 1.3, 95% confidence interval (CI): 0.9–1.8). Predictors of PPD among HIV positive women were living with friends/in a house-share (aOR 0.5 for house-share vs. own home, 95% CI: 0.3–0.9), and attending antenatal care (ANC) for the most recent pregnancy (aOR 0.2 for ANC attendance vs. no ANC attendance, 95% CI: 0.0–0.5). Living with friends/in a house-share was also a predictor of PPD among HIV negative women (aOR 0.4 for house-share vs. own home, 95% CI: 0.2–0.8). Conclusions and recommendations Targeted symptom screening based on identified risk factors should be considered for postpartum women to increase PPD case-finding and referral to specialised social support services.
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Affiliation(s)
- Idah Mokhele
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cornelius Nattey
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nelly Jinga
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Constance Mongwenyana
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew P. Fox
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Dorina Onoya
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
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Rodriguez VJ, Mandell LN, Babayigit S, Manohar RR, Weiss SM, Jones DL. Correlates of Suicidal Ideation During Pregnancy and Postpartum Among Women Living with HIV in Rural South Africa. AIDS Behav 2018; 22:3188-3197. [PMID: 29752621 DOI: 10.1007/s10461-018-2153-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In developing countries, up to 20% of maternal deaths during pregnancy are due to suicide, and being HIV-infected confers additional risk. This manuscript sought to identify perinatal correlates of suicidal ideation among women living with HIV (WLHIV) in rural South Africa. Pregnant WLHIV (N = 681) were recruited and re-assessed at 12-months postpartum. Mean age was 28.3 (SD = 5.7) years and 68% were below the poverty line. Prenatal suicidal ideation was 39%; suicidal ideation continued for 7% at 12 months, 13% experienced incident suicidal ideation, and for 19% suicidal ideation had stopped postnatally. Intimate partner violence (AOR = 1.17) and depression (AOR = 1.14) predicted sustained suicidal ideation. Increased income (AOR = 2.25) and greater stigma (AOR = 1.33) predicted incident suicidal ideation. Younger age (AOR = 0.94), disclosure of HIV status to partner (AOR = 0.60), and greater stigma (AOR = 1.24) predicted postnatal cessation of suicidal ideation. Perinatal care may provide windows of opportunity for identification and treatment of suicidal ideation.
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Ahmad NA, Silim UA, Rosman A, Mohamed M, Chan YY, Mohd Kasim N, Yusof M, Abd Razak MA, Omar M, Abdul Aziz FA, Jamaluddin R, Ismail F, Ibrahim N, Aris T. Postnatal depression and intimate partner violence: a nationwide clinic-based cross-sectional study in Malaysia. BMJ Open 2018; 8:e020649. [PMID: 29764882 PMCID: PMC5961592 DOI: 10.1136/bmjopen-2017-020649] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/25/2018] [Accepted: 04/13/2018] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION An estimated 13% of women in the postnatal period suffer from postnatal depression (PND) worldwide. In addition to underprivileged women, women who are exposed to violence are at higher risk of PND. This study aimed to investigate the relationship between intimate partner violence (IPV) and PND in Malaysia. METHODS This survey was conducted as a nationwide cross-sectional study using a cluster sampling design. Probable PND was assessed using a self-administered Edinburgh Postnatal Depression Scale (EPDS). Demographic profiles and IPV were assessed using a locally validated WHO Multicountry Study on Women's Health and Life Events Questionnaire that was administered in a face-to-face interview. An EPDS total score of 12 or more and/or a positive tendency to self-harm were used to define PND. RESULTS Out of 6669 women, 5727 respondents were successfully interviewed with a response rate of 85.9%. The prevalence of probable PND was 4.4% (95% CI 2.9 to 6.7). The overall prevalence of IPV was 4.9% (95% CI 3.8 to 6.4). Among the women in this group, 3.7% (95% CI 2.7 to 5.0), 2.6% (95% CI 1.9 to 3.5) and 1.2% (95% CI 0.9 to 1.7) experienced emotional, physical and sexual violence, respectively. Logistic regression analysis revealed that women who were exposed to IPV were at 2.3 times the risk for probable PND, with an adjusted OR (aOR) of 2.34 (95% CI 1.12 to 4.87). Other factors for PND were reported emotional violence (aOR 3.79, 95% CI 1.93 to 7.45), unplanned pregnancy (aOR 3.32, 95% CI 2.35 to 4.69), lack of family support during confinement (aOR 1.79, 95% CI 1.12 to 2.87), partner's use of alcohol (aOR 1.59, 95% CI 1.07 to 2.35) or being from a household with a low income (aOR 2.99; 95% CI 1.63 to 5.49). CONCLUSIONS Exposure to IPV was significantly associated with probable PND. Healthcare personnel should be trained to detect and manage both problems. An appropriate referral system and support should be made available.
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Affiliation(s)
- Noor Ani Ahmad
- Institute for Public Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Umi Adzlin Silim
- Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Azriman Rosman
- Public Health Department, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Majdah Mohamed
- Public Health Department, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Ying Ying Chan
- Institute for Public Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Noraida Mohd Kasim
- Institute for Public Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Muslimah Yusof
- Institute for Public Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | | | - Maisarah Omar
- Institute for Public Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | | | - Rasidah Jamaluddin
- Institute for Public Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Fatanah Ismail
- Public Health Department, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Nurashikin Ibrahim
- Public Health Department, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Tahir Aris
- Institute for Public Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
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Giallo R, Pilkington P, Borschmann R, Seymour M, Dunning M, Brown S. The prevalence and correlates of self-harm ideation trajectories in Australian women from pregnancy to 4-years postpartum. J Affect Disord 2018; 229:152-158. [PMID: 29310064 DOI: 10.1016/j.jad.2017.12.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/02/2017] [Accepted: 12/31/2017] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Women in the perinatal period are at increased risk of experiencing self-harm ideation. The current study longitudinally examines the prevalence, trajectories, and correlates of self-harm ideation in a population-based sample of Australian women from pregnancy through to the early years of parenting. METHODS Drawing on data from 1507 women participating in a prospective pregnancy cohort study, data were collected during pregnancy, at 3-, 6-, 12-, and 18-months postpartum, and 4-years postpartum. Longitudinal Latent Class Analysis was conducted to identify groups of women based on their responses to thoughts of self-harm at each time-point. Logistic regression analysis was used to identify factors associated with group membership. RESULTS Approximately 4-5% of women reported experiencing self-harm ideation at each time-point from pregnancy to 4-years postpartum. Cross-sectional analyses revealed that self-harm ideation was most frequently endorsed in the first 12-months postpartum (4.6%), and approximately 15% of women reported self-harm ideation at least once during the study period. Longitudinally, approximately 7% of women had an enduring pattern of self-harm ideation from pregnancy to 4-years postpartum. Women who had experienced a range of preconception and current social health issues and disadvantage were at increased risk of self-harm ideation over time. LIMITATIONS Limitations included use of brief measures, along with an underrepresentation of participants with particular socio-demographic characteristics. CONCLUSIONS A proportion of women are at increased risk of experiencing self-harm ideation during the perinatal period and in the early years of parenting, underscoring the need for early identification during pregnancy and early postpartum to facilitate timely early intervention.
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Affiliation(s)
- Rebecca Giallo
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
| | - Pamela Pilkington
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia; Health Service and Population Research Department; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Department of Psychiatry, The University of Melbourne, Australia
| | - Monique Seymour
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Melissa Dunning
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia; Department of General Practice and Primary Health Care Academic Centre, The University of Melbourne, Parkville, VIC, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Shi P, Ren H, Li H, Dai Q. Maternal depression and suicide at immediate prenatal and early postpartum periods and psychosocial risk factors. Psychiatry Res 2018; 261:298-306. [PMID: 29331710 DOI: 10.1016/j.psychres.2017.12.085] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 07/01/2017] [Accepted: 12/31/2017] [Indexed: 01/27/2023]
Abstract
Maternal depression has been intensively explored; however, less attention has been paid to maternal suicide. No studies to date have observed maternal depression and suicide at immediate prenatal and early postpartum stages. In total, 213 Chinese women were recruited in hospitals after they were admitted for childbirth. All completed a short-term longitudinal survey at perinatal stages. Women reported lower depression scores (6.65) and higher suicidal ideation incidence (11.74%) after childbirth. Prenatal depression raised the possibility of prenatal suicidal ideation, while prenatal depression and suicidal ideation increased postpartum depression and suicidal ideation. At immediate prenatal stage, marital satisfaction protected women from depression, while miscarriage experiences and self-esteem increased the risk. At early postpartum stage, in contrast, being first-time mother, marital satisfaction, and harmony with mother-in-law prevented them from depression. Our study is among the first to confirm that women have decreased depression but increased suicidal ideation at early postpartum, and a causal relationship between them, which are worthy of public attention. Potential protective (marital satisfaction, being first-time mother, and harmony with mother-in-law) or risk factors (miscarriage experiences and self-esteem) of maternal depression and suicidal ideation are identified at perinatal stages. This offers reliable guidance for clinical practice of health care.
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Affiliation(s)
- Peixia Shi
- Department of nursing psychology, the Third Military Medical University, Chong qing 400038, China
| | - Hui Ren
- Department of nursing, the Third Military Medical University, Chong qing 400038, China
| | - Hong Li
- Psychology & Social College, Shenzhen University, Shenzhen 518060, China
| | - Qin Dai
- Department of nursing psychology, the Third Military Medical University, Chong qing 400038, China; Psychology & Social College, Shenzhen University, Shenzhen 518060, China.
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Dagvadorj A, Ganbaatar D, O Balogun O, Yonemoto N, Bavuusuren B, Takehara K, Mori R, Akahira-Azuma M. Maternal socio-demographic and psychological predictors for risk of developmental delays among young children in Mongolia. BMC Pediatr 2018; 18:68. [PMID: 29458342 PMCID: PMC5817794 DOI: 10.1186/s12887-018-1017-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/29/2018] [Indexed: 11/26/2022] Open
Abstract
Background Factors influencing child development are not well studied in developing settings, and especially in Mongolia. This cohort study examined the relationship between maternal socio-demographic and psychological conditions on risk of young child developmental delay. Methods A total of 150 children aged between 13 ~ 24 months old participated in this study. The participants were randomly selected from a pre-existing cohort of 1297 children who were involved in a study on infant bilirubin nomogram development conducted at a tertiary health facility in Mongolia between 2012 and 2013. Child development was evaluated using the Mongolian Rapid Baby Scale (MORBAS), a validated scale for child development. The potential factors for child developmental delay were assessed using a pre-tested questionnaire comprising of 52 questions. Fisher’s exact test and multivariable logistic regression analysis were conducted. Results Seventeen (11%) out of the 150 children that participated in the study were at risk of developmental delay. There was a negative association between the risk of child developmental delay and higher maternal education (AOR 0.15, 95% CI: 0.03–0.66). Increasing maternal age (AOR 1.12, 95%CI: 0.98–1.27), maternal depression symptoms (AOR 4.93, 95%CI: 0.93–26.10), child gender being female (AOR 0.25, 95%CI: 0.06–1.00) and being from single mother household (AOR 0.14, 95%CI: 0.01–1.11) were also predictors for risk of developmental delay – although the association was marginal. Conclusions Our findings suggest that being of underprivileged social status, and poor psychological condition of mothers in Mongolia possibly increases the risk of child developmental delays. Interventions targeting these modifiable predictors are needed to develop prevention strategies for child developmental delay.
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Affiliation(s)
- Amarjargal Dagvadorj
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Duurenbayar Ganbaatar
- Department of Pediatrics, Mongolian National University of Medical Science, Ulaanbaatar, Mongolia
| | - Olukunmi O Balogun
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Naohiro Yonemoto
- Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan
| | - Bayasgalantai Bavuusuren
- Department of Pediatrics, Mongolian National University of Medical Science, Ulaanbaatar, Mongolia
| | - Kenji Takehara
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Moe Akahira-Azuma
- Department of Pediatrics, National Center for Global Health and Medicine, Tokyo, Japan
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Ramachandran Pillai R, Wilson AB, Premkumar NR, Kattimani S, Sagili H, Rajendiran S. Low serum levels of High-Density Lipoprotein cholesterol (HDL-c) as an indicator for the development of severe postpartum depressive symptoms. PLoS One 2018; 13:e0192811. [PMID: 29444162 PMCID: PMC5812627 DOI: 10.1371/journal.pone.0192811] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 01/30/2018] [Indexed: 12/05/2022] Open
Abstract
Postpartum depression (PPD) is a psychiatric complication of childbirth affecting 10-20% of new mothers and has negative impact on both mother and infant. Serum lipid levels have been related to depressive disorders, but very limited literatures are available regarding the lipid levels in women with postpartum depression. The present study is aimed to examine the association of serum lipids with the development of postpartum depressive symptoms. This is a cross sectional study conducted at a tertiary care hospital in South India. Women who came for postpartum check-up at 6th week post-delivery were screened for PPD (September 2014-October 2015). Women with depressive symptoms were assessed using EPDS (Edinburgh Postnatal Depression Scale). The study involved 186 cases and 250 controls matched for age and BMI. Serum levels of lipid parameters were estimated through spectrophotometry and the atherogenic indices were calculated in all the subjects. Low serum levels of Total Cholesterol (TC) and High Density Lipoprotein cholesterol (HDL-c) were significantly low in PPD women with severe depressive symptoms. The study recorded a significant negative correlation between HDL-c and the EPDS score in PPD women (r = -0.140, p = 0.05). Interestingly, the study also observed a significant negative correlation between Body Mass Index (BMI) and EPDS scores in case group (r = -0.146, p = 0.047), whereas a positive correlation between the same in controls (r = 0.187, p = 0.004). Our study demonstrated that low levels of serum HDL-c is correlated with the development of severe depressive symptoms in postpartum women. Study highlights the role of lipids in the development of postpartum depressive symptoms.
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Affiliation(s)
- Raji Ramachandran Pillai
- Ph.D Scholar, Department of Biochemistry, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anand Babu Wilson
- Junior Research Fellow, Department of Biochemistry, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nancy R. Premkumar
- Medical Social Worker, Medico Socio Services, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Shivanand Kattimani
- Additional Professor, Department of Psychiatry, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Haritha Sagili
- Associate Professor, Department of Obstetrics & Gynecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
| | - Soundravally Rajendiran
- Additional Professor, Department of Biochemistry, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India
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Tabb KM, Huang H, Valdovinos M, Toor R, Ostler T, Vanderwater E, Wang Y, Menezes PR, Faisal-Cury A. Intimate Partner Violence Is Associated with Suicidality Among Low-Income Postpartum Women. J Womens Health (Larchmt) 2018; 27:171-178. [DOI: 10.1089/jwh.2016.6077] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Karen M. Tabb
- University of Illinois at Urbana-Champaign, School of Social Work, Urbana, Illinois
- Identifying Depression through Early Assessment (IDEA) Research Team, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Hsiang Huang
- Identifying Depression through Early Assessment (IDEA) Research Team, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts
- Faculty of Medicine, Institute of Psychiatry and LIM-23, University of São Paulo, São Paulo, Brazil
| | - Miriam Valdovinos
- University of Connecticut, School of Social Work, West Hartford, Connecticut
| | - Raman Toor
- University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, Washington
| | - Teresa Ostler
- University of Illinois at Urbana-Champaign, School of Social Work, Urbana, Illinois
| | - Erin Vanderwater
- University of Illinois at Urbana-Champaign, School of Social Work, Urbana, Illinois
- Identifying Depression through Early Assessment (IDEA) Research Team, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Yang Wang
- University of Illinois at Urbana-Champaign, School of Social Work, Urbana, Illinois
- Identifying Depression through Early Assessment (IDEA) Research Team, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Paulo Rossi Menezes
- Faculty of Medicine, Department of Epidemiology LIM-39, University of São Paulo, São Paulo, Brazil
| | - Alexandre Faisal-Cury
- Identifying Depression through Early Assessment (IDEA) Research Team, University of Illinois at Urbana-Champaign, Urbana, Illinois
- Faculty of Medicine, Department of Epidemiology LIM-39, University of São Paulo, São Paulo, Brazil
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Angelotta C, Wisner KL. Treating Depression during Pregnancy: Are We Asking the Right Questions? Birth Defects Res 2017; 109:879-887. [DOI: 10.1002/bdr2.1074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/13/2017] [Accepted: 06/02/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Cara Angelotta
- Northwestern University; Feinberg School of Medicine, Department of Psychiatry
| | - Katherine L. Wisner
- Northwestern University; Feinberg School of Medicine, Department of Psychiatry
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Abstract
OBJECTIVES To assess the scope of the published literature on the consequences of maternal morbidity on health-related functioning at the global level and identify key substantive findings as well as research and methodological gaps. METHODS We searched for articles published between 2005 and 2014 using Medline, Embase, Popline, CINAHL Plus and three regional bibliographic databases in January 2015. DESIGN Systematic scoping review PRIMARY OUTCOME: Health-related functioning RESULTS: After screening 17 706 studies, 136 articles were identified for inclusion. While a substantial number of papers have documented mostly negative effects of morbidity on health-related functioning and well-being, the body of evidence is not spread evenly across conditions, domains or geographical regions. Over 60% of the studies focus on indirect conditions such as depression, diabetes and incontinence. Health-related functioning is often assessed by instruments designed for the general population including the 36-item Short Form or disease-specific tools. The functioning domains most frequently documented are physical and mental; studies that examined physical, mental, social, economic and specifically focused on marital, maternal and sexual functioning are rare. Only 16 studies were conducted in Africa. CONCLUSIONS Many assessments have not been comprehensive and have paid little attention to important functioning domains for pregnant and postpartum women. The development of a comprehensive instrument specific to maternal health would greatly advance our understanding of burden of ill health associated with maternal morbidity and help set priorities. The lack of attention to consequences on functioning associated with the main direct obstetric complications is of particular concern. REVIEW REGISTRATION CRD42015017774.
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Affiliation(s)
- Kazuyo Machiyama
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Atsumi Hirose
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Jenny A Cresswell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Maria Barreix
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Doris Chou
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Nenad Kostanjsek
- Department of Health Statistics and Informatics, World Health Organization, Classification, Terminology and Standards, Geneva, Switzerland
| | - Lale Say
- Department of Reproductive Health and Research, World Health Organization, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Geneva, Switzerland
| | - Véronique Filippi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Cavalcante MCV, Lamy Filho F, França AKTDC, Lamy ZC. Relação mãe-filho e fatores associados: análise hierarquizada de base populacional em uma capital do Brasil-Estudo BRISA. Ciênc saúde coletiva 2017; 22:1683-1693. [DOI: 10.1590/1413-81232017225.21722015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 11/24/2015] [Indexed: 11/22/2022] Open
Abstract
Resumo Diversos fatores podem interferir na relação mãe-filho. Estudos sobre as diferentes características maternas e esta relação são escassos, avaliam principalmente mulheres com psicopatologias e utilizam modelos de regressão simultânea com ajuste para múltiplos confundidores. Este estudo objetivou avaliar fatores associados a prejuízos na relação mãe-filho por meio de uma coorte com 3.215 mães de crianças entre 15 e 36 meses de idade. Prejuízos na relação mãe-filho, avaliado pelo Postpartum Bonding Questionnaire, constituiu a variável desfecho e as variáveis explanatórias foram características demográficas, socioeconômicas, da saúde reprodutiva e da saúde mental das mães bem como das condições do nascimento das crianças. Foi utilizada análise de regressão multivariada com abordagem hierarquizada em que os blocos hierárquicos foram estruturados segundo influência na relação mãe-filho. A prevalência de prejuízos na relação mãe-filho foi elevada (12,6%) e associada com fatores de risco à menor escolaridade da mãe (RR = 1,64), não ter planejado a gravidez (RR = 1,42), consumo de bebida alcoólica durante a gravidez (RR = 1,42) e sintomas maternos de estresse (RR = 1,88) e depressão (RR = 2,00). Escolaridade e elementos relacionados à saúde mental materna constituíram risco para prejuízos na relação mãe-filho.
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Muzik M, Brier Z, Menke RA, Davis MT, Sexton MB. Longitudinal suicidal ideation across 18-months postpartum in mothers with childhood maltreatment histories. J Affect Disord 2016; 204:138-45. [PMID: 27344623 DOI: 10.1016/j.jad.2016.06.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/20/2016] [Accepted: 06/11/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The current study extends our understanding of postpartum suicidal ideation (SI) in the context of childhood maltreatment (CM). The study longitudinally examines the prevalence and severity of maternal SI. We further examined risk and protective factors' associations with postpartum SI. METHODS SI was assessed at 4, 6, 12, 15, and 18-months postpartum in a non-clinical sample of mothers with CM histories (N=116). For the first aim, frequency, longitudinal percentage counts, and ANOVAs were conducted. For the second aim, logistic and linear regressions were completed to examine associations between risk and protective factors and the presence and severity of SI, respectively. RESULTS Endorsement of SI was highest at 4-months (37%) and remained at approximately 25% for the duration of the study. While the severity of CM was not significant, our sample of women with CM histories evidenced markedly higher rates of SI than other postpartum investigations. Resilience, marital status, maltreatment-related shame, and family support were associated with suicidal ideation or severity at some assessments; however, these relationships were highly variable over time. LIMITATIONS of this study include the use of self-report measures and generalizability to mothers without CM histories. CONCLUSION Mothers with histories of CM are at risk for postpartum SI. Our findings elucidate the importance of understanding the interplay and variability of risk and protective factors during postpartum. These results aid clinicians in identifying women at risk for suicidal ideation during postpartum.
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